LEAVING IT TOO LATE

MATT SHAND, JOURNALIST

The inability to take sufficient leave is taking its toll on the stretched health care system and is now costing jobs as people pack it in due to trying conditions. New data released to ASMS reveals the extent of the problem.

More than a millennium of outstanding leave is currently owed to senior medical officers across the country, showing the gap in our health care workforce and increasing the risk of burnout.

Data released to The Specialist under the Official Information Act shows senior medical specialists across the country have 1.72 million hours (or 1,024 years) of leave ticked up, with the number creeping higher every day.

More than 50 per cent of SMOs have leave balances higher than their annual accrual, and 22 per cent have more than 11 weeks owed to them. Five per cent of SMOs have leave balances higher than 24 weeks, meaning they are carrying more than six months of annual leave.

The data is just one more measure to show how stretched the health care workforce is. In order to cover the growing leave balances, at least another 1,000 doctors would be needed. Already, ASMS industrial officers are being told stories of doctors resigning from the public system as a direct result of being unable to take adequate time off.

The worst-hit areas include general medicine (which accounts for 13 per cent of all unclaimed leave), mental health and emergency medicine (which each make up 7.5 per cent of the total leave balance).

Capital, Coast and Hutt Valley district recently reported that three staff members resigned, specifically naming the ‘inability to take leave’ as a major factor during their exit interviews.

One doctor – whom we have not named – has walked away from a decadelong career in New Zealand due to difficulties taking leave.

“The situation is, if you wanted to take any leave, you had to find someone to cover you, and you had to tick a box on your application stating who you had found and what shifts they were covering,” they said.

“If you are lucky, someone will cover it, but in general it means you never get to take enough leave or CME leave. If a colleague is going to a conference, then I won’t be able to go.

“The workload is unsustainable as it is [in New Zealand], and there is no reprieve. I never had the intention to leave but the workload is ridiculous, and nothing is being done about it.”

The doctor is joining other health care workers now leaving New Zealand for Australia and other countries, where salary and conditions are better.

“The main reason I am leaving is due to the workload,” they said.

“The workload in Australia is much better, and it doubles your salary in many instances. And the CME allowance is paid to you directly and you are treated as an adult to spend it correctly.

“If you look at the turnover rates, people are already quiet-quitting and looking to leave. It’s already happening. Te Whatu Ora needs to create more jobs to fill. Even if they were fully staffed they would still be short, and they seem unwilling to do that.”

Another doctor says they have six to seven months’ worth of leave owed to them due to being unable to take it in recent years.

“Earlier this year I applied for leave for the end of the year and received a message back stating there was no cover. I was also told that I was asking for too many weeks of leave in the year,” they said.

Even with the doctor’s leave being high, they were unable to use it during the school holidays to care for their grandchildren.

“I had to cancel that leave and make alternative arrangements, which was a shame,” they said.

The doctor says the frustrations have increased over the last year.

“There’s no cover and no advertising to find locums or cover,” they said.

“Senior doctors are often asked for a plan to reduce their leave, but on the other hand, when they apply for leave, often with quiet advance notice, it is not signed off.

“The whole system is messy and frustrating, and further reduces the morale at work.”

This is reflected in the staffing reports presented by Te Whatu Ora within Joint Consultative Committee (JCC) meetings. Capital and Coast showed 72 departures, with only 66 hires in the last 12 months and a deficit of about 14 per cent on expected staffing numbers.

Some departments – like mental health, which carries a large burden of leave balances – have been hit hard, with 16 departures.

Te Whatu Ora CEO Margie Apa told The Specialist the health care workforce is 5,000 clinical roles short of where it needs to be.

ASMS would suggest the figure is much higher.

ASMS’ 2022 survey of clinical directors found all specialties recorded shortfalls of specialists of between 10 and 63 per cent, with a mean 24 per cent. At the national level that means Aotearoa is short approximately at least 1,850 SMOs. This is on top of shortages of 4,000 to 5,000 nurses.

Aotearoa continues to fall behind Australia’s ratio of doctors per head of population, which is 485.8 per 100,000, compared to 366.7 per 100,000 here.

Auckland University of Technology Professor Jarrod Haar conducts studies into burnout. He found that 35 per cent of all employees in New Zealand are suffering from severe burnout.

“In December 2022, burnout rates were much higher than in years previous,” he said. “One in three was showing signs of burnout, where a normal level would be 1 in 13.”

Haar says being unable to take leave, or feeling like you cannot take leave, can contribute to burnout. This echoes ASMS’ own findings on burnout and fatigue.

“The World Health Organization and my data show if you are working 55 hours a week, this is a red line for the workforce,” Haar said.

ASMS’ 2021 report My Employer is Exhausting found almost 50 per cent of SMOs and SDOs reported experiencing burnout. This mirrored similar findings in 2015. It found an association between respondents reporting working more than 14 consecutive hours as well as failing to have a 24-hour break free of any scheduled work and the proportion scoring as burnt out for workrelated and personal burnout.

“I had been speaking to dermatologists who are on 55 hours a week as a normal work week. That’s not good for burnout levels, particularly if they cannot take leave to recharge. If we have medical professionals unable to take leave, it will contribute to the reasons people are saying, ‘Stuff it. I’ll move to Australia to get more pay and better conditions.’

“We need to see some of this Covid money used to upgrade the workforce to allow better working conditions.”

ASMS Industrial Director Steve Hurring says the large, and growing, leave balances for SMOs represent a workplace shortage and a shortchanging of staff working in vital health roles.

“It means Te Whatu Ora is operating on an FTE budget that is less than what they need,” he said.

“There are not enough staff to cover the time off, and this is adversely affecting the desirability for people to work within the public system.”

ASMS has also heard of instances where weeks of leave were declined for piecemeal amounts of one or two days at a time due to a lack of cover.

“People are entitled to take their leave to rest and structure their holidays as they see fit,” Hurring said.

“Under the law, staff are entitled to two consecutive weeks off a year, and the expectation is you’re allowed to take the remainder of leave in weeklong periods.

“Not doing so makes the job less attractive, and it just breaks people.”

Hurring says he has seen times when people have requested leave without pay to get some time off. In some cases, even that is declined.

“It is a significant health and safety issue and one that the employer needs to address,” Hurring said.

“It’s a contributor to burnout and ultimately it means people work longer hours than they should, and, in a way, the employer gets that time for free.

“There are solutions, and it all revolves around the current workforce shortage. There are not enough doctors to cover leave. There is not enough pay to attract and retain doctors. There are not enough people, as a result, willing to stay in New Zealand to work.

“Whenever we lose another doctor, that is one less doctor to cover leave, and the problem cycles around.”

Data obtained by The Specialist was shared with Te Whatu Ora’s Chief People Officer Andrew Slater.

“The challenges with staff attaining leave are as you [ASMS] present them,” he said.

“Off the back of these conversations I think I need to work with our leaders to make sure that when people are applying for leave we’re taking a more holistic approach to that and making sure we look to the medium and long term advantages of providing leave rather than the short term disadvantages, or challenges associated with approving it.

“I think that is a good outcome. This data has prompted me to talk to a number of leaders across the organisation and understand a little bit more about the daily reality of working through handling leave.”

He says management cannot force people to have leave paid out and if this has occurred staff should contact their HR department. “Leave can only be paid out at the request of the individual,” he said.

Slater says, with New Zealand competing on the global stage for healthcare workers, any problem (such as with taking leave), which leads to preventable loss of staff, has to be avoided.

“My priority is workforce,” he said. “Any doctor leaving New Zealand at the moment for reasons that were avoidable is one too many.”