For Kawhia GP Dr John Burton, being always on call means he’s been involved in most of the medical emergencies that people have had in this small Waikato coastal town over the last 25 years.
“It means I’ve got a special relationship with my patients and it’s one of the most rewarding parts of being a rural GP,” he explained.
But not all doctors share his love of a lifestyle which can feel quite isolated.
The vacancy rate in rural general practice in NZ is around 25 per cent, and 40 per cent of the current GPs plan to retire in the next ten years. This workforce shortage means there are waiting list for patients wanting to enrol, and NZ ends up importing many of its doctors from overseas to try and meet demand.
Many of Dr Burton’s GP colleagues in other rural towns have really struggled to find doctors to replace them when they retire, or even to find cover for them to go on leave.
He said: “Being a doctor in a small community is not as appealing to new medical school graduates. They worry about how they will cope with emergencies without the support that they are used to, or how they will keep up with the latest medical education or that they won’t be able to take time off. They also worry about what their partner will do, and about their children’s education.
“I tried to get a locum to relieve me to take a sabbatical last year but could not find anyone and it is likely to be very hard to find a doctor to replace me if I get sick or leave.”
When John graduated he did a number of locum jobs in rural areas of NZ and in Tonga before working in a mission hospital in Benin, West Africa where there were three doctors for around one million people and over half of the children were dying before the age of five.
“This helped me get over the learned helplessness of having been trained in a mainly urban setting where being a good doctor included using technology and working with hospital consultants – none of which were available in Benin,” he said.
When John returned to New Zealand and wanted to work in a small rural community he was overwhelmed with offers as there were so few other NZ doctors considering rural practice.
“Our Kawhia home is our favourite place in the world. All our children have been born here and gone to the local school, but there is an inherent fragility in small general practices such as mine. If a key person leaves, it can be very hard to get a replacement.”
John says that while the current medical schools have gradually increased the exposure of students to rural areas, there is still more to be done to train doctors in NZ who would be motivated to work in rural communities. They also need to stay long enough to really get to know these communities and see how they can work with local people and make a positive contribution to their health.
The Kawhia community, like many rural Waikato communities faces massive health problems now and into the future.
“50 percent of my patients aged 45 or older have now been diagnosed with either diabetes or pre-diabetes. It’s symptomatic of poor lifestyle choices in terms of exercise and nutrition, which in turn is influenced by educational and socio-economic factors. Add to this the amount of alcohol and cigarettes that people consume as well as drug problems, and we can’t boast the best health statistics in the country.”
John recognises there are challenges to engaging with his community about their health issues – his training equipped him to deal with diseases rather than helping address lifestyle choices that lead to poor health.
But John is keen to learn from others. A former student has offered to cover for him so he can head off on a secondment to the Northern Ontario Medical School in Canada where they’ve had a lot of success engaging with remote rural communities with a high indigenous population.
The Northern Ontario Medical School is one model being studied by the University of Waikato and Waikato District Health Board as part of their proposal for a third medical school in New Zealand, based in the Waikato.
The Waikato Medical School would help address the region’s workforce shortages and community health needs by producing doctors who will be more representative of the communities they serve, will focus on the healthcare of high needs communities and be able to use the latest advances in technology.
An alternative to Auckland and Otago’s medical schools, it will complement what they offer. Being a graduate entry programme, and offering four years of training rather than five, it opens the doors wider for more people to train as doctors.
It would enable student to undertake a higher proportion of their clinical placements in community settings outside the main centres – helping them get a real understanding of the community and a desire to work there.
John said: ““Currently the main selection criteria at medical school is how good your grades are. We know that there a lot of students who don’t get the top grades, but who are more than competent to complete a medical training programme. Many of the students we are currently rejecting are actually better suited for working in rural communities than some of the students that are being accepted.”
In Ontario John will be working for about a month with each medical school class, starting with the first years and finishing with the fourth years and is excited to learn about what Ontario have been achieving and bring the learnings back.
“Around 60 per cent of their graduates are choosing to work in rural general practices in Northern Ontario. Compare this with the 10 graduates a year that Auckland Medical School has been producing who have gone on to get vocational registration in general practice, let alone rural general practice.
“Their selection criteria gives students credit for coming from a rural area as it’s been shown that they are more likely to return to a rural area. It also gives credit to candidates who have already demonstrated a commitment to a rural community, and listens to recommendations of rural organisations, including indigenous peoples.
“And 40 per cent of their training is done in rural communities which means their graduates are much better suited for working in such communities than if their skills have all been developed working in urban hospitals.”
John hopes that New Zealand can learn from what’s happening in Canada and other rural areas round the world and that future doctors would choose to work in places like Kawhia.
“My son is studying to be a doctor now and he’s thrilled to be part of the rural immersion programme offered by his medical school. We need more of this type of training if we want to meet the needs of our population in the future.”
Read more information about a third medical school proposed for New Zealand.