The Advanced Trainee Fellowship Scheme enables health professionals with demonstrated leadership potential to undertake advanced training or further study in New Zealand or overseas in a shortage specialty area. This is intended over time to help to address New Zealand’s reliance on overseas-trained health professionals.
Since its launch in 2010, 34 applicants have received financial assistance to expand their expertise in fields such as forensic pathology, colorectal surgery and health leadership.
To date, only one nurse has taken part. HWNZ aims to attract more nurses on to the Scheme, and also encourages allied health professionals to apply.
The Rural Health Interprofessional Immersion Programme, supported by HWNZ, involves rural training placements for undergraduate nursing, medical, physiotherapy, pharmacy, dental and other students from The University of Auckland and the University of Otago.
Through the Programme, the students gain clinical experience and the chance to work in rural communities and with Māori health providers in Māori communities. The Programme will test whether some experience of rural settings at an undergraduate level influences postgraduate career decisions.
Managing the medical and nursing pipelines
New Zealand’s health workforce supply has changed in the past five years. To increase workforce self- sufficiency, more government funding has been provided for additional nursing and medical school student places.
The number of medical school places is being increased incrementally by 200 places over a five-year period. It is expected to rise from 285 in 2004 to 505 in 2014, and is on track to reach a total of 565 places in 2016.
A proportion of the new medical school places have been set aside for students from rural backgrounds. Preferential rural entry schemes are based on research findings that medical students raised in the country are more likely to return to work in rural areas once they have graduated. Preferential entry places are also provided to encourage Māori and Pacific participation in the workforce.
The introduction of additional medical places is reflected in increased numbers of New Zealand-trained graduates. Alongside other factors (such as the fact that fewer graduates are choosing to travel overseas), this has meant that for the first time in 2013, the number of applicants for postgraduate year one (PGY1) positions exceeded the number of places available across the DHBs. HWNZ and the DHBs continue to ensure that sufficient entry-level placements are found for all New Zealand Government- funded medical graduates who apply for PGY1 positions.
As the supply of medical students increases, specialties previously considered vulnerable, or critical to achieving health targets, may find they are able to attract more graduates into their training programmes. An increasing supply of graduates is likely to impact on the geographic maldistribution of the medical workforce.
A Medical Workforce Taskforce and a Working Group have been set up to identify key issues affecting medical students’ career choices and factors that constrain their ability to achieve career objectives. The Taskforce is chaired by the Chair of the HWNZ Board, and includes the four regional DHB Chief Executives, the two Medical School Deans, the Chair of the MCNZ, the Chair of the Council of Medical Colleges, the General Secretary of the New Zealand Resident Doctors Association, the Executive Director of the Association of Salaried Medical Specialists, the Director of the National Health Board and the Director of HWNZ.
In support of the work being undertaken by the Taskforce, HWNZ is undertaking modelling work on the medical training pipeline. In addition, HWNZ conducted meetings with groups of resident medical officers (RMOs) to identify the challenges they face in following their chosen career pathways. Meetings with DHB chief executives and senior executives at regional level and in provincial areas have also contributed to the development of strategies to address issues faced by RMOs as they move from internship through to vocational registration.
While the Taskforce initially focused on the immediate postgraduate period, it has now adopted a whole-of-career perspective. The most important issue currently is the impact of a prolonged period of medical labour market shortages on the workloads, wellbeing and productivity of DHB-employed senior doctors. Other areas under consideration, some of which are directly related, include the distribution and long-term retention, including retirement intentions, of doctors trained in New Zealand and overseas. Leadership opportunities in systems improvement and innovation, consistent with the In Good Hands report on clinical leadership, are another focus for the Taskforce.8
Setting up the nursing workforce programme
The number of graduate nurses passing the Nursing Council of New Zealand’s state registration examination increased from 1321 in 2010 to 1817 in 2013. Although not all nursing graduates gain employment immediately on completing their studies, the number who find work increases over time. The medium- and long-term employment prospects for nurses are good. There is enough information about our growing and ageing population, the nature of disease and the ageing nursing workforce to show that New Zealand is not educating too many nurses.
To increase the employment opportunities of graduate nurses and enhance the sustainability of the nursing workforce, the government announced funding for up to 200 additional places for the Nurse Entry to Practice (NETP) programme in July 2014, bringing the total number of places up to 1300 from 2015. The NETP programme provides professional and educational support for newly registered nurses in their first year of practice.
Of the new places, 160 will be located in DHBs (in public hospitals and DHB-funded community health services) and 40 in aged residential care facilities.
Additional funding has been allocated for an extra 25 graduate nursing scholarships in 2015 (in addition to 48 scholarship places in the past year) in GP practices in high-needs communities through the Very Low Cost Access Scheme (VLCA). Many nursing graduates want to work in the regions they trained in. The VLCA places assist them to live and work in regions with high health need populations.
HWNZ is establishing a nursing workforce programme to plan and implement the nursing workforce of the future, through:
improving the integrity of nursing data
improving graduate nursing recruitment
improving nurse retention
The programme will be delivered by a governance group and a working group made up of Ministry and nursing sector representatives.