We had a fantastic year in New Zealand. It was a wonderful opportunity to remove ourselves from our usual lives and experience a whole new country, workplace, school and set of friends. It was valuable for the whole family and it was hard for all of us to leave New Zealand. We are excited about being able to reconnect with friends and family in the States though!
The pace of medicine is more relaxed than what I'm used to in the States. Patients call the doctor by their first name. I was given 15 minute tea breaks morning and afternoon, an hour for lunch, and then an hour for paperwork time at the end of the day. Everyone in the whole clinic was out the door by 5pm every day! The work life balance definitely emphasizes life over work in New Zealand. Everyone takes 3 weeks off over the Christmas (Summer) Holidays and goes to the beach with their family. All the doctors in my clinic took holiday and they hired 1-2 locums to cover the clinic.
The public system gives medical coverage to everyone. In addition there is a private system that operates in tandem with the public system and the same specialists practice in both systems. People mainly purchase private insurance so they don't have to wait so long to see a specialist. That is the main downside I saw in the New Zealand system, the wait to see a specialist in the public system. They have 3 categories, urgent (get in within a month), semi-urgent (get in within 3 months), and routine (get in within 6 months). If something is truly urgent a telephone call gets the patient seen in the ED or at the specialist's office the same day though. For the most part patients are used to the wait and don't seem to mind.
Despite providing universal coverage, NZ spends half what the US spends per capita on health care. They get their cost savings by managing their formulary (there are only certain drugs available, and some drugs can only be prescribed by a specialist or only by filling out a questionnaire and getting approval). In addition, GP's aren't able to order many CT or any MRI's. These must be ordered by the specialists. All visits to the specialist must be referred by the GP which likely cuts down on the number of specialty visits. Of course, in a single payer system the administrative costs are lower and insurance companies are not getting a slice of the pie either.
The whole medical malpractice system is different in New Zealand. In the1970's they passed a system called ACC or Accident Compensation Corporation. This provides compensation for any injury you suffer while on NZ soil whether or not you're a NZ citizen. This is provided in exchange for not being able to sue for damages. It also applies to medical malpractice or "medical misadventure." If you're injured through any cause you're entitled to a set reimbursement plus a monthly payment if you're unable to work due to your injury. There's still an avenue to make a complaint against a doctor through the Medical Council of New Zealand, but you're not able to sue your doctor for damages. Thus my medical malpractice insurance costs went from ~$15,000 in the States to ~$1,400 in NZ.
They have very few Nurse Practitioners or Physician Assistants in NZ. However, the nurses are called Practice Nurses and typically do more than nurses in the states. They run their own clinics, do pap smears, have their own panel of patients that they see on a regular basis. These tend to be the diabetic patients and sicker older patients with multiple medical problems. They see these patients frequently to help motivate them on lifestyle measures and to catch problems early before they become bigger problems.
Both boys really enjoyed going to Onslow College. Most colleges (high schools) are single sex and the students wear uniforms, even in the public schools. They went to a more alternative public school that was co-ed with no uniforms. They found it to be much more relaxed. Students are expected to be self motivated and there's very little homework. You're expected to keep up on your own, and most of the assessment is done by end of the year exams called NCEA exams. Your scores on these determine which university you get into and which courses you're able to study. They also have a vocational training program that is quite well organized. If you wish, you can enroll in this instead of your last year of high school. The boys found the students to be quite laid back, friendly and fun loving. They didn't seem stressed or worried about getting into University. There are 4 major universities there, and pretty much if you want to go to university you'll be able to go. If you want to get into law or medicine you'll need higher scores, but otherwise there's not a lot of pressure to get good grades.
Kiwis tend to be thrifty and self sufficient. Since most things need to be shipped in and the market is small (there are only 4 million in the whole country) costs for everything are high. A pint of beer in a bar is typically $8-9, a gallon of gas is 8 dollars, clothes and books cost 2-3 times what you'd pay in the States. People tend to have small houses, drive small cars, buy things used if possible. Many people put their retirement money into a "bach" or beach house where they spend weekends and several weeks over the Christmas summer holidays. Get togethers are often over a "barbie" or beers and a barbecue.
Overall, it was a fantastic year for the whole family. It was fun practicing in a different setting and with a different population (my clinic was primarily Maori and Pacific Islander). Our children went to school in a new country, got a chance to play rugby, and were accepted into a great group of friends. It made the world seem like a smaller place and allowed us to look at our life in the states from afar with more objectivity. I feel grateful to everyone that helped make this possible--my partners at work who covered my patients, the many people who looked after our home and land, and all the people in New Zealand who welcomed us so warmly. A great experience and one I would recommend highly to anyone who is so inclined!
Sunday, July 29, 2012
Saturday, May 5, 2012
Onslow College Rugby
Thursday, March 29, 2012
Banks Peninsula
Michele and her sister Alicia and a friend Margaret Basta went to the Banks Peninsula south of Christchurch for a five day hike or tramp as it's called here. It was more luxurious than most of the tramps around here, only about 12 people stay in a house each night. Most of the spots are converted farm houses and have kitchens and showers and real beds. You can even buy steaks or wine if you'd like.
Kapiti Island
Michele and I went to Kapiti Island today. It is currently uninhabited, but in the 1800's it was a whaling station with a population of 3500. Over the last 100 years they've made it into a nature sanctuary and eliminated all the introduced pests--goats, rats, stoats, possums. The native bush and birds have made an amazing comeback, and they're using the thriving bird populations here to reintroduce threatened birds back onto the mainland to increase their population.
Wednesday, March 28, 2012
Thomas Friedman visits down under
Very interesting analysis about the differences between the current political situation in NZ and the US.
http://www.nytimes.com/2012/03/28/opinion/friedman-elephants-down-under.html
OP-ED COLUMNIST
Elephants Down Under
By THOMAS L. FRIEDMAN
Published: March 27, 2012
Christchurch, New Zealand
Josh Haner/The New York Times
Thomas L. Friedman
Readers’ Comments
Share your thoughts.
I’ve learned three things visiting New Zealand and Australia: There is a place in the world where rugby is front-page news. There is a place in the world — the Auckland airport — where the restrooms have digital clocks in the entryway telling you hourly when they were last cleaned and when they will be cleaned again. And there is a place in the world where moderate Republicans still exist — unfortunately, you have to take a 13-hour flight from Los Angeles to get there.
Indeed, to go from America — amid the G.O.P. primaries — to Down Under is to experience both jet lag and a political shock. In New Zealand and Australia, you could almost fit their entire political spectrum — from conservatives to liberals — inside the U.S. Democratic Party.
Or as Paul Quinn, a parliamentarian from New Zealand’s conservative National Party, once told a group of visiting American Fulbright scholars: “I will explain to you how our system works compared to yours: You have Democrats and Republicans. My Labor opponents would be Democrats. I am a member of the National Party, and we would be ... Democrats” as well.
For instance, there is much debate here over climate policy — Australia has a carbon tax, New Zealand has cap and trade — but there is no serious debate about climate science. Whereas in today’s G.O.P. it is political suicide to take climate change seriously, in Australia and New Zealand it is political suicide for conservatives not to.
In Australia and New Zealand, “there are plenty of climate skeptics in politics, but they know it’s a political loser to say so,” explained the Australian environmentalist Paul Gilding. “This became the case after Australia suffered its worst-ever drought, lasting more than a decade.” Now, “there is strong public acceptance of the basic scientific conclusion that the climate is changing and humans are a significant contributor.”
Tony Abbott, the current leader of Australia’s main conservative party, once crudely dismissed climate change, but after he became the party boss, even he embraced the need to bring down emissions. Instead of cap and trade, though, he argued for industry friendly taxpayer-funded incentives to cut carbon.
Malcolm Turnbull, Abbott’s predecessor, supported cap and trade, as did his predecessor. “On climate,” Turnbull told me, “there has been an assault on the science, and it has had an impact, but not to the point of the center-right parties adopting a ‘climate-change-science-is-bunk’ platform the way the G.O.P. appears to have done.”
Conservatives in Australia and New Zealand have also long accepted single-payer national health care systems. The Labor Party ruled New Zealand from 1999 to 2008, when it was replaced by the conservative National Party. During Labor’s tenure, it passed legislation legalizing civil unions, giving prostitutes the same health and safety protections as other workers, and extending income subsidies for families with children, noted Jon Johansson, a political scientist at Victoria University of Wellington. While these moves were resisted by conservatives when in opposition, he said, they have “not tried to repeal any of them” now that they are in power.
There are many reasons for the narrowness of the political spectrum here, Johansson added. Neither New Zealand nor Australia are strong churchgoing countries, so social issues don’t resonate as much. Both being isolated, sparsely populated, pioneering communities — New Zealand has only 4.5 million people — they have strong egalitarian traditions and believe the state has a role to play in making sure everyone gets a fair shake.
“We also have compulsory voting,” said Turnbull. You get fined if you don’t vote. “In a voluntary voting system like yours, there is always the temptation to run hard on hot-button issues that will fire up the base and get them out to vote. In a compulsory voting system, your base has to vote — as does everyone else — and so the goal is to target the middle ground.”
To be sure, conservatives out here have all the low-tax, free-market, free-trade, less-government instincts of their American colleagues, but it is tempered by the fact that campaign donations and lobbying are much more restricted.
Looking at America from here, makes me feel as though we have the worst of all worlds right now. The days when there were liberal Republicans and conservative Democrats, who nudged the two parties together, appear over. We don’t have compulsory voting. Special interest money is out of control, and we lack any credible Third Party that could capture enough of the center to force both Democrats and Republicans to compete for votes there. So we’ve lost our ability to do big, hard things together. Yet everything we have to do — tax reform, fiscal reform, health care reform, energy policy — is big and hard and can only be done together.
“A lot of us who love your country,” said Johansson, “do not see where change can come from” in America these days. “We see all the barriers you have now to structural and fundamental change. It feels like you’ve lost your amazing ability to adapt politically.
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