The Health of the Health Workforce 2015, is the second of Health Workforce New Zealand’s yearly reports on the state of the New Zealand health and disability workforce, hereafter referred to as the workforce.
Role of Health Workforce New Zealand
Health Workforce New Zealand (HWNZ) was established in 2009 to lead and coordinate the planning and development of New Zealand’s health and disability workforce. HWNZ is a business unit within the Ministry of Health. It has an independent board chaired by Professor Des Gorman and is made up of representatives from the health and disability workforce sector.
The sector is made up of responsible authorities (regulatory bodies), professional colleges, representative bodies, tertiary education providers, unions and health workforce employers, including the district health boards (DHBs). HWNZ liaises with the sector about their common interest in the planning, recruitment and retention of a workforce that is fit for purpose, equitably distributed and capable of meeting government health care priorities for New Zealanders, now and into the future.
You can find out more about HWNZ in The Role of Health Workforce New Zealand, published in 2014 and available at www.health.govt.nz/publication/role-health-workforce-new-zealand
HWNZ is the primary provider of funding for post-entry clinical training in New Zealand, with an allocation of $174.3 million from Vote Health in the 2015/16 financial year for postgraduate training, workforce development and innovation.
Evidence from a variety of sources contributes to HWNZ’s ability to synthesise information about the workforce and the environment it operates in, and from there to identify trends.
The data and workforce intelligence cited in these reports are drawn from multiple sources, including regulatory bodies such as: the Medical Council of New Zealand (MCNZ) and the Nursing Council of New Zealand (NCNZ); the wider Ministry of Health; DHBs and other employers; OECD1 reports; and New Zealand Census data.
We have aimed to publish the most recent data in this report, but because the relevant organisations publish their reports at different times of the year and use a range of methodologies, there is some variation in the dates and content of the workforce data.
General workforce facts and figures
The workforce is made up of a wide variety of occupational groups and is generally grouped under the following occupational headings:
Doctors, dentists, nurses, midwives and a number of allied health (including allied health science and technical) professions are covered by the Health Practitioners Competence Assurance (HPCA) Act 2003, and are together referred to as the regulated workforce (see Appendix 1). Practitioners must be registered with the relevant regulatory body that issues annual practising certificates, determines appropriate qualifications, considers complaints and takes disciplinary action when needed.
The regulated workforce numbered 97,786 in 2015, based on annual practising certificate data for all regulated professions. This included:
3068 midwives (based on 2014 data).
DHBs are a key employer of the regulated workforce, with estimated employed full-time equivalent (FTE) workforces in March 2015 (compared to 2008 data) that included:2
21,200 (17,523) nurses
7648 (5930) doctors
892 (801) midwives.
Allied health science and technical statistics are included in table 4 on page 18.
Voluntary Bonding Scheme
The Voluntary Bonding Scheme, administered by HWNZ, incentivises medical, nursing and midwifery graduates to work in hard-to-staff specialties or communities for three to five postgraduate years. Medical physicists, sonographers and radiation therapists working in New Zealand are also eligible in 2015. This may be subject to change. More information is available at www.health.govt.nz.
The medical workforce includes many specialties (included in Appendix 2), which deal with different, even competing, issues. However, there are some key common features.
The demographics of the medical workforce are changing due to the increasing number of doctors retiring as the workforce ages, the recent changes to the number of medical graduates and the associated flow-on effects, DHB employment of international medical graduates, and the proportion of doctors working part time (which, in turn, is influenced by the changing gender balance).
Geographical maldistribution of the workforce is a major challenge, particularly for primary care and rural and provincial hospitals, which can struggle to recruit and retain the specialists they need (see Figures 1 and 2). The distribution of the workforce between specialties is also challenging, with general practice, cardiothoracic surgery, clinical genetics, dermatology, palliative care, orthopaedic surgery and psychiatry facing shortages.
Figure 1: Hard-to-staff communities (shaded) for doctors on the 2015 Voluntary Bonding Scheme
Figure 2: Hard-to-staff communities (shaded) for GP trainees on the 2015 Voluntary Bonding Scheme
Nearly all medical specialties are dealing with adjustments to the scope of their work with the introduction of new roles, new technologies and changing models of care. Meanwhile, disease patterns are moving towards more chronic disease, obesity and diabetes, mental health disorders, and age-related diseases. The Government’s approach to these patterns, including targets and initiatives such as screening programmes, affects the need for particular types of specialists.
The medical workforce has grown by 17.5% in the past six years. There were 14,678 doctors in 2015 with annual practising certificates registered with MCNZ, up from 12,493 in 2009.3