23 Nov 2022

Paediatric surgery in Wellington will not be fully-staffed until 2024

8:30 pm on 23 November 2022
All but one of the country's DHBs operated at a loss this financial year.

Wellington Hospital's paediatric surgical centre covers the entire lower North Island (file picture). Photo: 123rf

Children who need operations in Wellington and the lower North Island will continue to rely on out-of-town surgeons flying in for another two years.

Specialists say the collapse of paediatric surgery services in Wellington is symptomatic of wider problems in the health system - with some arguing the barriers for overseas-trained doctors are too high.

When Wellington's new $110 million Children's Hospital Te Wao Nui opened in September, it was already down to one full-time paediatric surgeon on staff, instead of four.

Since April, Professor Spencer Beasley and his team from Christchurch Hospital - together with backup from Waikato paediatric surgeons on the weekends - have flown the equivalent of two-and-half times around the globe to ensure children in Wellington get this critical service.

"It has consequences for our families as well," he said.

"Most of the surgeons here have school-aged children. We're often away from home for two or three days a time. It's not always Wellington. Yesterday, for example, I was in Masterton."

One of only four paediatric surgical centres in the country, Wellington covers the entire lower North Island, including Wairarapa, Palmerston North, Whanganui, Taranaki and Hawke's Bay.

Three new surgeons recruited from overseas are set to start in July 2023, November 2023 and in 2024, although one arrives in February for four months before finishing training overseas.

Professor Beasley said that would fix Wellington's workforce problem - but the situation had shown clearly there were too many barriers for overseas trained specialists to get registered in New Zealand.

"We've had a number of potential opportunities of getting overseas people to fill these gaps but under the current regulations that's been difficult to achieve. I suspect this is something that's going to have to be looked at in some detail because it probably affects other specialities in addition to ours."

Paediatric surgery is the smallest speciality in New Zealand, with fewer than 20 full-time equivalent surgeons.

Starship Hospital surgeon Neil Price, who leads the paediatric surgical training committee for the Royal Australasian College of Surgeons, said it was a critical national service, which had been completely delegated to four district health boards to provide as they saw fit.

"So there's been this whole series of ad hoc historical arrangements of what's provided to what district health board by whom, so the delivery of care has been hampered by that fragmented system.

"And also the planning around the surgical workforce has devolved down to four organisations."

The collapse of the Wellington team has also put pressure on New Zealand's ability to train paediatric surgeons locally.

Dr Price said it took eight years to train a paediatric surgeon and "one or two years" to recruit from overseas, but health boards had previously tended to wait until there was a crisis before thinking about succession planning.

However, in his view the registration process for overseas trained doctors was "fair" and he was not convinced that a fast-track process would solve problems in the long-run.

"It may only create bigger problems if you hurry someone into a position without reasonable level of scrutiny of their suitability for that position."

Any change to the Medical Council's requirements would require a law change.

Wellington example of 'failure to succession plan'

Association of Salaried Medical Specialists executive director Sarah Dalton said the biggest frustration for most overseas trained doctors was not getting their qualifications recognised but dealing with Immigration.

Wellington's woes should be a warning to others, she said.

"It's an example of failure to succession plan and a culture across our system that's made a virtue of slightly understaffing rather than looking ahead, looking around the corner, recognising that for specialists in particular (even when someone says yes), it can take 12 or even 24 months to get people in a post and working."

No-one from Te Whatu Ora was available for interview.

However, in a written statement Capital, Coast and Hutt Valley director of provider services Joy Farley said vacancies could be "the result of a range of factors including staff leaving to retire, family reasons, other career opportunities, difficulties finding suitably qualified surgeons nationally and internationally, and more".

"During this time we will continue with our existing arrangement with Canterbury and Waikato paediatric surgeons to provide cover. We are immensely grateful and appreciative for the support these specialists are giving. They are enabling us to mitigate the impact of our vacancies, and ensure that the children of our District and the lower North Island can continue to receive safe emergency care and planned care."

Surgeon fees, travel, meals and accommodation for the period April to September had cost $503,642 but these costs had been "offset by the vacancies".

Medical Council chief executive Joan Simeon was not available for interview either but provided a written statement saying the organisation was "aware of the pressure on health services", which emphasised "the importance of ensuring doctors have the necessary training and experience to safely practise in Aotearoa".

"The Medical Council has some of the most flexible and permissive pathways for international medical graduates (IMGs) to gain registration in the western world, and there are a number of pathways to registration.

"Council is continually reviewing its pathways to registration to ensure they are fit for purpose and do not pose any unnecessary barriers for IMGs to gain registration."

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