NZ’s medical licensing system is still a major hurdle for desperately needed foreign-trained doctors

Immigration New Zealand’s recent announcement^[1] that all medical doctors would be included on the straight-to-residence pathway doesn’t quite give the full picture. In fact, “all” only includes those doctors who can have their medical registration approved^[2] before coming to New Zealand.

For many foreign-trained doctors already living here, the obstacle preventing them from working isn’t immigration – it’s medical licensing. If more is not done to streamline and speed up the licensing process, New Zealand risks losing prospective doctors to countries that make the process easier.

Doctors trained in Australia^[3], the United Kingdom and Ireland^[4], or other “comparable health systems^[5]”, can usually register and receive a job offer before immigrating.

But as of mid-November^[6], more than 50 foreign-trained doctors who have met the Medical Council’s standards are still caught in a bottleneck, waiting for supervised hospital positions that will allow them to be provisionally registered before their exam pass expires.

Furthermore, some of them have already been offered jobs in those same countries with “comparable health systems”. So why can’t they get registered in New Zealand?

Competent and comparable

Potentially hundreds of other doctors already in New Zealand are also waiting to take the required local clinical skills exam (NZREX^[7]), which is only open to 30 people at a time. The exam has only been offered four times – instead of the usual nine – in the past three years, with only one currently scheduled for 2023.

A few hundred doctors may not sound like much, but patients are being turned away from GPs^[8] all over New Zealand. Up to half of practices are not accepting any new patients.

Read more: Critically understaffed and with Omicron looming, why isn't NZ employing more of its foreign-trained doctors?^[9]

Just one GP can safely have around 1,400 patients^[10] on their books, although this number is currently up to 2,500 for many overworked GPs.

Dr Orna McGinn, Chair of the New Zealand Women in Medicine (NZWIM) Charitable Trust, recently surveyed almost a thousand doctors^[11] working in New Zealand. McGinn noted that doctors’ concerns around a medical workforce crisis have been dismissed and diminished.

Doctors who trained overseas are especially struggling to be heard. As part of my research, I’ve spoken to more than 20 foreign-trained doctors living in New Zealand, most of whom aren’t yet able to work here.

As one doctor said to me of those who have been offered jobs in “competent” and “comparable” countries like Australia, the UK and Ireland:

If a doctor can work in the UK, why can’t they work here? The same doctor is not welcome here.

Starting from scratch

Another doctor I spoke to asked:

Why are they giving permanent residency to skilled migrants and then asking them to start from scratch?

Yet another respondent described how they had moved to New Zealand with their spouse as skilled migrants, with their medical degree contributing points towards the shared visa application. More than five years later – and after passing the NZREX – they were still waiting for their provisional registration.

A New Zealand doctor, who trained in a “non-comparable” health system, has also passed NZREX and was considering a job offer in the UK:

I grew up in New Zealand, I am a New Zealand citizen […] but if I can’t work as a doctor here then I’ll go to the UK, Australia or the US and work for 33 months – then I’ll consider if I want to come back here or not.

Read more: Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients^[12]

Returning with 33 months’ recent experience in a “comparable health system^[13]” like the UK would allow them to skip the bottleneck faced by other foreign-trained doctors. But that’s only if they decide to return.

A common sentiment shared by many of the foreign-trained doctors I spoke to was summarised by one doctor’s advice to other NZREX candidates thinking of coming to New Zealand: “Don’t waste your time”.

Simple solutions?

This situation is a “lose-lose” not only for our over-burdened medical workforce and these individual doctors, but also for the New Zealand public who experience delays^[14] in accessing medical care.

That said, there are some relatively simple solutions to this thorny issue. In August, the Minister of Health announced two new pilot programmes^[15] for NZREX doctors.

The first is a bridging programme that doesn’t guarantee a job offer at the end of it for participants. The other will allow eight to ten doctors who want to be GPs to complete some of their supervised work placements in GP clinics where there is more capacity to support them, rather than in hospitals.

This will be life-changing for the lucky individuals who get the positions, but still leaves many behind. As a pilot programme, there is also no guarantee that this will be expanded any time soon.

Read more: Despite what political leaders say, New Zealand's health workforce is in crisis – but it's the same everywhere else^[16]

The Medical Council of New Zealand has also just proposed two options^[17] for doctors who are eligible for general registration in the UK. But even if the proposed changes are approved, NZREX doctors living in New Zealand would need to spend at least one year in the UK, or end up in the same bottleneck for supervised work they are in now.

Right now, the NZREX pathway to licensing that exists on paper is virtually impossible without a stroke of luck.

New Zealanders should be pushing for further change. At a minimum, there should be viable supervised pathways for all doctors who demonstrate the required knowledge through international and local exams, as well as more exam offerings.

Perhaps the most striking thing about my conversations with NZREX doctors was their frequent use of the phrase “second class citizens” to describe their experience here.

But NZREX doctors in New Zealand don’t need our pity. They need respect, recognition and the ability to utilise their skills. These are considered highly sought after in other “comparable health systems” and would surely be invaluable to those New Zealanders waiting in line for healthcare.

References

1. ^{^} recent announcement (www.immigration.govt.nz)
2. ^{^} medical registration approved (www.immigration.govt.nz)
3. ^{^} Australia (www.mcnz.org.nz)
4. ^{^} United Kingdom and Ireland (www.mcnz.org.nz)
5. ^{^} comparable health systems (www.mcnz.org.nz)
6. ^{^} mid-November (www.mcnz.org.nz)
7. ^{^} NZREX (www.mcnz.org.nz)
8. ^{^} turned away from GPs (www.1news.co.nz)
9. ^{^} Critically understaffed and with Omicron looming, why isn't NZ employing more of its foreign-trained doctors? (theconversation.com)
10. ^{^} around 1,400 patients (www.nzherald.co.nz)
11. ^{^} recently surveyed almost a thousand doctors (www.nzdoctor.co.nz)
12. ^{^} Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients (theconversation.com)
13. ^{^} comparable health system (www.mcnz.org.nz)
14. ^{^} experience delays (www.nzherald.co.nz)
15. ^{^} two new pilot programmes (www.mcnz.org.nz)
16. ^{^} Despite what political leaders say, New Zealand's health workforce is in crisis – but it's the same everywhere else (theconversation.com)
17. ^{^} proposed two options (www.mcnz.org.nz)