A top medical graduate struggling to find a job in a hospital says Health NZ needs to do more to ensure locally-trained doctors are not being "lost" to the system.
Marley Joseph was awarded the top GP prize at graduation from Auckland University in 2022 - but still needs at least two years on-the job training to qualify as a doctor.
He did get an internship at Waitematā straight out of medical school, but resigned after a couple of months amid a series of personal crises.
Since then, he has applied to every region in the country without success.
"Because I don't have a clean slate (because I started an internship and quit), I don't fit into the formal criteria or policies that DHBs [Health NZ] have for re-entry."
Joseph is not the only graduate looking for a job.
About 25-30 medical graduates each year are not guaranteed internships by Health NZ - the fee-paying international students.
The Medical Students Association called their situation "deeply distressing and completely unnecessary" and has lobbied the government to offer every graduate a position.
"We need these young doctors, yet our system continues to treat them with disregard."
One in three medical graduates leave NZ within 10 years
Auckland University dean of medical and health sciences Professor Warwick Bagg agreed New Zealand should be trying to hold on to all the doctors it has trained.
"These students have spent at least five or six years training with us and sometimes they've been in the country for longer. They have been trained in our bicultural ways, they understand the context.
"So you have someone who is ready-made for our system, as opposed to someone who is having to come in and adapt to our system."
Both Auckland and Otago medical schools have welcomed the government's decision to fund another 50 medical school places from next year, increasing the cap to 639 first-year students.
But Bagg said it was only part of the answer.
Medical Council data showed 30 percent of medical graduates left the country within 10 years.
"So one of the things I keep talking about is not only turning on the tap in terms of increasing the number of medical graduates, but also putting the bath plug in so we don't lose medical graduates, because that is a big number."
Otago pro vice chancellor of health sciences Associate Professor Megan Gibbons (Ngāpuhi) said the university had between five and 25 international students starting in its medical programme each year.
"We have no formal cap on the number of international students in medicine, but always give priority to admitting the maximum number of domestic students the government will allow.
"Many of the international students are sponsored by their own governments and there is an expectation that they will return to their own countries on graduating to gain registration," Gibbons said.
"Currently, the key constraint on increasing intakes is the government-imposed caps."
Last year, 565 people graduated from medical school, and 563 graduates applied for first year internships with Health NZ. Almost all of them were offered jobs - but 26 turned them down.
Health NZ Te Whatu Ora said it was not able to say why those people opted to reject their job offers.
Health NZ using staff shortages as lever to get funding' - union
But Resident Doctors Association head Deborah Powell said some were going straight overseas, where they could earn more and pay off their student loans faster.
The number of internships went up each year to match the number of New Zealanders coming out of medical school - but hospitals were still woefully understaffed at every level, she said.
"This is a funding issue. They want more funding and they are are using it as a lever to get funding," she said.
"They [Health NZ] don't want to increase those numbers unless they get more money for it. It's bonkers, because we're short of SMOs [senior medical officers], and to get SMOs you need RMOs [resident medical officers]. And quite frankly, to get RMOs, you need medical school graduates."
Dream of working as GP in Northland in doubt
Joseph said it made "no sense" that Health NZ was paying millions of dollars in overtime and for locums to cover roster gaps, but it refused to employ more permanent staff.
"Across four separate weeks in 2023, Auckland's major hospitals spent nearly $2m on 2900 of these additional shifts, adding up to 17,500 hours of extra work," he said.
"If that trend continued across the year, it suggests Auckland alone is short by around 110 full-time junior doctors (RMOs), costing taxpayers an estimated $26m annually in temporary staffing fees.
"To put this into perspective, $26 million could fund the salaries of more than 300 full-time junior doctors each year, providing continuity of care and reducing burnout."
Joseph, who grew up in Whangārei, would like to return to serve as a GP in Northland, which is desperately short of primary care services.
"It's a bit insulting, that I'm not seen as worth a couple of years' internship to be able to train as a GP in Northland," he said.
"I think it's a policy failure, and a massive waste of human resources and a waste of taxpayers' money."
Meanwhile, the Medical Council has tripled the number of spots for overseas-trained doctors to sit its registration exam, from 60 to 180.
If they pass, they will also need to do two years of supervised training.
"Health NZ hasn't expanded the number of internship placements they need to become fully registered. The result? We have built a system that is failing from both ends-turning away new Kiwi doctors while simultaneously inviting foreign-trained doctors to New Zealand with no clear path to employment."
Health NZ working to find 'suitable' placements
Health New Zealand Te Whatu Ora director for workforce planning and development John Snook said the agency was "committed to growing a strong, sustainable and stable clinical workforce to support better health outcomes for all New Zealanders".
"The announcement of 25 more doctor training places will require an increase in PGY1 and PGY2 [post graduate year 1 and 2] positions both within hospitals and in primary care settings.
"We are working to identify suitable positions, or establish additional positions where needed, to accommodate the forecasted increase in medical graduates. This includes ensuring required supervision and training is available."
Health Minister Simeon Brown earlier this month announced plans to allow up to 100 international medical graduates and 50 local graduates to do their internships mainly in primary care instead of hospitals.
This article was first published by RNZ
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