Until the early 20th century most doctors were general practitioners (GPs), whether they worked in hospitals or private practice. Some doctors started to specialise in surgery from around 1900, and specialisation became more widespread and varied from the 1930s.
Until the first local medical school opened in 1875 doctors trained overseas, mainly in London or Edinburgh. Initially, the University of Otago Medical School’s programme in Dunedin was limited, and students had to qualify overseas. The first student qualified at Otago in 1887. The country’s second medical school, the University of Auckland School of Medicine and Health Sciences, was established in Auckland in 1968.
Trainee doctors spend six years at medical school. They work under supervision for a year before they can become registered by the Medical Council of New Zealand. Once qualified, doctors choose which branch of medicine to practise.
Recruitment into specialties is through vocational training controlled by professional organisations called colleges. The Royal New Zealand College of General Practitioners is a New Zealand college. Many of the other colleges are Australasian (New Zealand and Australian).
Blazing a rocky trail
The first women to graduate from medical school in New Zealand were Emily Siedeberg in 1896 and Margaret Cruickshank in 1897. Women faced difficulties establishing themselves as medical professionals. There were few barriers to entering medical school, but once they graduated women were much less likely to earn the high salaries enjoyed by their male counterparts, or win honorary hospital appointments, which represented the peak of medical practice in the 19th and early 20th centuries. Even in the 21st century women were under-represented in surgical specialities.
In 2015 there were 14,678 registered doctors in New Zealand. They comprised 15% of the total health workforce. A third were GPs.
Women have increasingly participated in the medical workforce. They were 7% of registered doctors in the 1930s and only 8% in the early 1970s, but 42% in 2015. That year, 45% of female doctors were under the age of 40. compared to 28% of male doctors. This reflects the trend towards more female than male medical students that has been evident since the 1990s.
In 2014 women outnumbered men in vocational training for general practice (60%), obstetrics and gynaecology (84%), paediatrics (73%), pathology (61%) and public health medicine (82%). Areas where women were under-represented were general surgery (25%), accident and emergency practice (36%), and orthopaedic surgery (13%).
Doctors from overseas made up around 40% of the medical workforce in the early 21st century.
Coming and going
Doctors from North Africa and the Middle East have the highest retention rate – they are most likely to stay in New Zealand – followed by those from sub-Saharan Africa and Asia. Doctors from the Americas, the United Kingdom and Oceania have the lowest retention rates.
Hours and places of work
Doctors often have heavy workloads. Their average working week in 2014 was 44 hours. Workloads have declined in the 21st century, however – the average in 1999 was 49 hours.
The feminisation of medicine has implications for workforce planning as women doctors work fewer hours than men – six hours fewer per week in 2014. Women typically do fewer hours because they spend more time in unpaid work – having and caring for children, often while maintaining careers.
Some parts of New Zealand are better supplied with doctors than others. In 2014 the Auckland District Health Board (DHB) area had 105 GPs per 100,000 population and the Lakes District had 90 per 100,000, compared to 65 in Counties Manukau and 61 on the West Coast.
Rural practices and hospitals often struggle to attract doctors because of high workloads and difficulty accessing ongoing vocational training. Both the Otago and Auckland medical schools allocate places for rural students because they are more likely to practise in rural districts than their urban counterparts.