A Critical Analysis of the Gastroenterology Specialist Workforce in New Zealand

By T Caspritz, M Arnold, C White, M Schultz | Posted: Friday November 16, 2018

Challenges & Solutions - EXECUTIVE SUMMARY – Dr Thomas Caspritz

To date there have been no comprehensive data available regarding the gastroenterology specialist workforce in New Zealand, unlike in Australia. The NZSG is concerned about adequate gastroenterology service delivery to meet the growing needs of our country. A survey was undertaken and a booklet published in 2018 to recommend solutions and actions. This is a short summary; please refer to the full text in the booklet for further information and details.

Figures from November 2017 showed that there were 93 gastroenterology (GE) specialists (consultants) providing clinical service in New Zealand, nine of whom work exclusively in private practice. This does not equal 93 FTEs.  Measured by headcount (for international comparisons),the NZ GE specialist per capita ratio is 1.93/100,000 population (or 1.74/100,000 excluding fully private specialists), which is substantially lower than in similar countries such as Australia (3/100,000) and Scotland (2.34/100,000).
There are substantial regional, socio-economic and ethnic inequalities in access to GE treatment. Some smaller DHBs have very limited service, and there are 4 DHBs with no local residentGE specialist. These areas coincidentally show evidence of significant deprivation.
The NZ GE specialist workforce is relatively old, with 42 percent likely to retire within the next 10 years and an insufficient number of qualified local specialists to replace them. We rely on overseas-trained doctors to fill open positions and about 40 percent of the current GE workforce gained their specialist qualification overseas. The training output in New Zealand is 8 GE specialists/year, and around half of them leave NZ to take up positions overseas.
Gastroenterology specialists provide more colonoscopies per specialist than other endoscopists. The mean number of colonoscopies performed per year per GE is 466 (264 public and 202 private), and per general surgeon is 269 (151 public and 118 private).

The NZSG recommends:

  •  Match the gastroenterologist/population ratio with the Australian model, as previously proposed in the 2011 Workforce Review. Implement the recommendations of the 2011 Workforce Review which have not yet been actioned.
  •  Address regional, rural and socio-economic inequities in access to high-quality GE care and treatment.
  • Direct DHBs who are currently critically under-resourced in GE capacity to establish new GE specialist positions and to fill vacant positions to match their population’s needs, based on the ratio proposed above and in line with the Ministry of Health’s objectives and statement of intent.
  • Establish provincial gastroenterology fellowships with funding from Health Workforce NZ.
  • Establish scholarships for Māori doctors to undertake GE training.
  •  Survey current gastroenterology trainees and recent graduate to explore reasons for leaving and feasibility of incentives to stay, and determine whether the number of training positions needs to be increased.
  • Establish yearly workforce data acquisition and the publication of a ‘gastroenterology workforce fact sheet’ (as currently produced in Australia).
  • Establish a joint Ministry of Health – New Zealand Society of Gastroenterology steering group to drive and support the implementation and monitoring of these actions.

See full report here