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!
