Initial Thoughts on Medicine In New Zealand

So far I've done 4 days of orientation and seen patients for 6 days so these are my initial observations. As I get to know the system better I'm sure I'll have new or different observations. I've only seen one clinic here so don't know how representative my experience is of the larger system.

I'm working in a clinic called Whai Oranga O Te Iwi Health Centre which loosely translated from Maori means "to the health of our people/tribe." The clinic is located in Wainuiomata a small town about 20-25 minutes outside of Wellington. The clinic was set up 10-15 years ago to better serve the higher needs population of Wainuiomata and currently sees ~50-60% Maori with some Somoan, Fijiian, other Pacific Islanders, Chinese, Indian, and the rest European "Pakeha;" about 6000 patients are enrolled in our clinic. New Zealand has a national health system so the government funds health care for everybody. Visits to the GP are free (with a copay), medications generally cost a $3 copay, hospitalizations are free as are visits to the specialists. (More on all this later). Since our population is of a lower decile (all the areas are ranked from 1-10 here as far as level of income in the area, 10 being the highest and 1 being the lowest--this information is readily available when looking at areas, schools, housing, etc.) the government funds our visits at a higher level allowing us to charge a lower copay. We charge a $15 copay for doctor visits, kids up to 18 have no copay and there's no charge to see the nurse. From doctors I've talked to the copays would typically be $30-50 in more affluent areas.

We don't have any medical assistants, just doctors, nurses and receptionists. (There's no business office either--we get a set amount per patient registered with the practice and the visit information is downloaded once a month to the local District Health Board--no coding for level of service for visits, no insurance companies to bill, etc. which makes it very simple.) The nurses here operate more independently, run their own clinics such as blood pressure clinics, wound care clinics, do diabetes teaching, asthma clinics, smoking cessation clinics, see the most fragile patients on a frequent basis to prevent ED visits and hospitalizations, do some mental health visits, etc. We use an electronic medical record system that is built for Primary Care docs and is called MedTech 32, and the same program is used throughout the country. When your patient arrives you get them from the waiting room and bring them into your office that has a desk with a computer, two chairs and an exam table and a sink. The doctor doesn't move from room to room, the entire visit is done in the doctor's office with the doctor rooming the patient and doing their own vital signs. I'm told this is a little old school and there are some practices here that are moving more to the model of multiple exam rooms with a medical assistant rooming the patient and the doctor moving from room to room.

Medicine seems to happen at a more relaxed pace here--the doctors start at 8:30 or 9:00 and at 10:15 and 3:15 everyone stops for tea to chat, read the newspaper, relax, etc. At 5:00 everyone is out the door. I left 10 minutes late last Friday and they had to show me how to set the security alarm because I was the last person in the building!

To practice medicine in New Zealand you have to be registered with the Medical Council of New Zealand. One of their stipulations for GP's is that everyone has to have 15 hours a year of peer review. So once a month all the doctors in our clinic sit down for an hour or two and discuss difficult cases to benefit from each others experience and advice. I think this is a wonderful idea. I've only participated in one so far but found it to be extremely valuable. It's also nice that it's mandated because otherwise competing time demands would make it difficult to do on an ongoing basis.

Will write more later about the way government financed health care works here as well as some observations about their accident compensation system and how this relates to the medical malpractice experience.

The photos are of the outside of the clinic and the surrounding area. The photo with water in the foreground, if you look in the background you'll see a road up and over a large hill to the right. Wainuiomata is on the far side of the hill to the right.