Border policy slows the brain gain

The Government plans to make immigrating to New Zealand easier for health care professionals, but does our immigration and registration process mean we lose good doctors in the bureaucracy? The Specialist speaks to radiologists about what changes could help.

All patients needing radiology in Hawke’s Bay are reliant on overseas-trained doctors who have had to brave a lengthy battle to be in the country and authorised to provide that treatment. There is not a single New Zealand trained radiologist working in the region.

Reflecting that pattern around the country, the Medical Council of New Zealand (MCNZ) says it issued 996 registrations to immigrating doctors last year, with just 550 registrations to New Zealand graduates.

In August, Minister of Health Andrew Little announced a plan to address a shortfall in radiologists by funding 15 more training spots. Hawke’s Bay radiologist Dr Kai Haidekker says training more doctors in New Zealand is important, but it will take 13 years for a first year medical student to become a consultant. for patient needs. But there can be problems getting those IMGs to New Zealand.

“New Zealand needs to change the way it supports immigrating doctors because we are missing out on filling vacancies,” says Haidekker.

“We are advertising, but I hardly get any applicants at all. The few applicants we get are often from countries which are not considered to be comparable health systems, and therefore eligibility for vocational registration with MCNZ is unlikely.

“There are other specialities, like psychiatry, which have a similar problem. We have doctors already working in New Zealand sitting in limbo, waiting 18 to 24 months to get residency. They cannot even buy a house and settle. It’s just not good enough.”

Little announced changes to the way immigration will be conducted at the start of August, including:

• covering international doctors’ salaries during their six-week clinical induction course and three-month training internship

• dedicated immigration support services to make it easier for health workers to move to New Zealand.

Stalled immigration processing

Radiologists from Haidekker’s department will likely form part of that training process but only because their international doctors have persevered through the minefield of the immigration process themselves.

Radiologist Dr Richard Cooper had been living in New Zealand one year, to the day, when contacted by The Specialist.

“Of the four-stage process I am still at stage two,” he said. “Immigration NZ has no idea when I will progress to stage three. I have a work to residency visa but, like a lot of doctors, I am stuck in the process.”

Delays in residency cause several issues for people wanting to call New Zealand home. The main issue is the inability to buy property.

“This makes it difficult for me to feel settled,” he said. “I have an offer on a house, but its purchase is conditional on getting residency. I know of other doctors who have given up and left. They can’t live like this or expect their children to live like this, so they leave. As a whole, New Zealand misses out.”

Cooper says the frustration of ongoing delays is compounded by poor communication about the residency process. He decided to write to Minister of Immigration Michael Wood but to no avail.

Immigration NZ has recently changed its process so arriving health professionals, including doctors, are fast tracked. However, those arriving before these changes, like Cooper, are sitting waiting and hoping their application will eventually be processed.

“Other people who have just arrived are receiving their residency visas within a few weeks. I am very happy for them, but it makes me wonder where mine is. It puts my life on hold. New Zealand needs people like us to run training programmes and deliver vital services to our patients.”

Dr Alexandra Kahn-Ziech also found it hard to settle in New Zealand.

“When we first thought about moving, Covid didn’t exist,” she says. “We were here June 2020 and wanted to apply for residency in November 2020 but everything shut down. For 18 months we sat there with nothing.

“There are a lot of things you cannot get access to in New Zealand if you do not have residency.

“Simple things you take for granted like getting credit cards or bank loans. You cannot buy a house, and that has affected me a lot.”

This limbo doctors get stuck in can have flow-on effects for staffing numbers, says Kahn-Ziech.

“New Zealand is reliant on foreign doctors, and we need more. We’re understaffed and need more people to come here to work. If foreign doctors are not looked after, they don’t have their families here, they can’t even buy houses here, they will just leave.”

While navigating the immigration process, most are also handling MCNZ registration simultaneously, as well as adjusting to a new country.

Chief Executive of MCNZ Joan Simeon says the time to gain registration for the majority of IMGs in New Zealand is 20 working days, with 95% of all applications for provisional, general and special purpose registration processed within that time frame.

“The Medical Council has some of the most flexible and permissive pathways for IMGs to gain registration in the Western world.”

“Our primary role is to protect the health and safety of the public, by ensuring that doctors are competent and safe to practise.

“There are a number of pathways to registration for IMGs which take into account the qualifications, training and experience of applicants. They allow the vast majority of IMGs to gain registration without the need to sit and pass an examination. This allows flexibility while ensuring the protection of the public.”

Recognition for registration

There are 23 countries MCNZ recognises as being comparable to New Zealand, allowing doctors who practised in those areas to apply for registration.

“We are continually reviewing the countries recognised,” says Simeon.

“The process is longer for those coming from countries that are not considered comparable and who wish to gain vocational registration to work at a consultant level in New Zealand.

“The time frame for provisional vocational registration IMG applications is six months, as this is a comprehensive process which involves the relevant medical college in New Zealand providing advice to Council.”

If a doctor does not fit into the standard pathways, they need to sit a New Zealand Registration Examination (NZREX) pitched at the level of a final-year student at a New Zealand medical school. Only a few are required to do this, which does add weight to the notion some employers are preferring to go without rather than go through the process.

Of the 996 registrations last year, only 3.8% had to sit NZREX to get registration.

But one radiologist from a Western European country says the issues with immigration and registration still made them feel like leaving New Zealand.

The radiologist says they were part of a Facebook group for German doctors wanting to move to New Zealand.

“This is how I found my job,” they said.

“But I don’t think there will be any more overseas doctors from this group as it is too much to get them into the country.”

Richard Cooper says it is important that the country has a robust registration process and that MCNZ maintains high standards for good reason. “However, sometimes the MCNZ process feels disproportionately onerous when the IMG is from a Western European country with implicit high training standards,” he said.

“Those going through the registration process while their immigration status remains uncertain may be less inclined to start altogether.

“I think New Zealand needs to do more to support those immigrating, which means providing them with a certain, secure future.

“Fast track to permanent residency, citizenship and support through the MCNZ process will go a long way. People do not like uncertainty and will take steps to reduce uncertainty for themselves and their families.

Matt Shand | Journalist