Colorado Medical Society
http://dev.cms.org/articles/living-the-adventure/Living the adventure
Monday, May 01, 2017 12:26 PMIn late 2015 I told my husband it was time for our next adventure. Six months later, and after lots of paperwork, I started working in a community hospital in Timaru, South Canterbury, New Zealand, on the Pacific coast of the South Island. Three months after that my husband joined me (after selling our home and packing our possessions in storage).
Here we are, living the adventure. When we are not climbing mountains, tramping (hiking), kayaking or walking to the ocean five minutes from our home, I spend my days working as a senior geriatric consultant at Timaru Hospital. My husband works as a business consultant telecommuting with clients and partners in the U.S. And yes, friends and family make the trek down under to visit.
It is a different system to work in, and frankly one that is less stressful and by far more functional than the current model in the United States. Coming here for a “life chapter” has been a great move. That view is shared not only by numerous other Americans who work here, but by Brits, Europeans and Asians as well.
Here’s a glimpse into life as a physician in a small city in New Zealand.
My day in the 20-bed Assessment, Treatment and Rehabilitation Unit (AT&R) starts at 8:15 with a team-based “morning report” consisting of two geriatricians, two house officers, the head nurse, social worker, physical therapist, occupational therapist, and three clinical nurse specialists (CNS). I supervise house officers (who do initial workups, orders and charting), attend family meetings, and conduct residential and nursing home visits. These visits are for at-risk frail elderly, challenging geriatric cases such as complex dementia, worsening Parkinson’s, repeat falls, unusual neurologic cases, etc. I average six visits a week. I conduct geriatric and palliative care consults on the medical and surgical wards as requested, an average of one to two a day. I assist general practitioners with the task of de-prescribing for patients with polypharmacy. I conduct teaching rounds twice a week and attend hospital-based “grand rounds” and other educational forums. I have time to read articles and write thorough, well-researched consults and presentations.
Morning tea is schedule for around 10:30, lunch is mid-day, afternoon tea is 3:30. I head home around 4-4:30. No call. No weekends.
The system is sane, civilized, uncomplicated. New Zealand has a global, government-based health care model that provides for all citizens and permanent residents. A doctor’s decision to hospitalize is not questioned. No insurance or financial questions are asked when patients are admitted. Patients do not see a hospital bill upon discharge. Pharmaceuticals are reasonably priced. For accidents, citizens and visitors receive free medical care under an additional tax-funded scheme.
Health care quality leaves little to complain about. For example, our hospital has state-of-the-art MRI and CT scanners. A stroke victim can arrive in the emergency department and within 10 minutes imaging studies can be done and decisions made regarding thrombolysis. If appropriate, alteplase will be delivered within 20 minutes of arrival. A telemedicine arrangement with radiologists provides consultation at any hour.
A patient with NSTEMI (Non-ST-elevation myocardial infarction) will be treated in Timaru. A patient with MI (myocardial infarction) requiring catheterization will be transported via 30-minute helicopter ride to Christchurch, a large city with a major medical center and world-class services. General surgery and most orthopedic surgery is done in Timaru. Neurosurgery or urologic surgery requires a two-hour ambulance drive or 30-minute helicopter ride.
Normally, care is delivered where you live. If you live in Timaru, you receive care in Timaru, unless the medically-indicated care is not available, in which case you are transported to the closest medical center where the next level treatment can be provided. Residents can choose to purchase insurance policies and receive medical care wherever they want. For the remote areas of the country, helicopter transportation is used to move people to the most appropriate medical setting. People have no fear of not receiving health care. Few people misuse the system.
In large cities such as Auckland and Christchurch, private hospitals serve patients who choose to pay for elective procedures at the time of their choosing. Wait times for non-urgent services vary. Timaru has one ophthalmologist and the routine cataract surgery waitlist is about six months.
What is physician pay compared to the U.S.? The Medical Council of New Zealand (MCNZ) sets a recommended pay scale for physicians based on factors such as educational level and years of practice. Most hospitals employ physicians using the MCNZ pay scale. Extra pay is provided for physicians who work after hours (on call) and for “colleague leave cover.” For my position as a senior consultant, the base pay is $216,000 New Zealand dollars ($152,000 U.S.) with an additional $15,600 New Zealand dollars ($11,000 U.S.) for colleague leave cover, six weeks of paid vacation and 10 additional paid national holidays. I also receive an additional $16,000 New Zealand dollars ($11,200 U.S.) of annual CME funds to use wherever I choose. I am going to the European Geriatric Conference in Nice, France, in September.
Where’s the rub? How can this system seem so ideal?
- There is no burdensome fear of liability lurking in the hearts and minds of physicians. Virtually no malpractice lawsuits occur.
- Paperwork (with no billing!) is minimal, including reasonable documentation requirements.
- Medical specialties are almost never oversupplied. Medical schools graduate the numbers of physicians needed to cover the population appropriately. That number increases yearly as the population is growing.
- Physicians working in the public system are paid a decent wage, not an extravagant wage. If doctors want to work longer hours they can make more money in the private system in larger cities. Some consultants work part time in the public system to enjoy the medical educational/teaching hospital system, the patient diversity, and service to the population, and also work part time in the private system to earn additional money.
- Wait times exist, although not to the detriment of those who need urgent care. For most Americans, the idea of waiting six months for an elective hip replacement is unacceptable. Here it is considered acceptable by most patients.
- General practitioners provide the bulk of care in the community and are the primary medical providers for New Zealanders. They are well trained and able to manage a broad array of pathology in the community. Consultants and specialists are hospital-based and manage high-acuity, challenging diagnoses and treatments. Consultants do have outpatient clinics where they diagnose and treat, and then turn patients over to the general practitioners to manage ongoing care.
There are open positions for an internist and a palliative care specialist in Timaru. Many more New Zealand communities need physicians. Think about it! Join a group of international physicians, have a great lifestyle, a delightful professional experience and explore some of the most magical places on earth.
I hope some Coloradans come to work! For the rest of you, I hope to see you here when you come to see the splendor of New Zealand.