The silver tsunami is happening now

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The silver tsunami is happening now

Lucy O'Hagan photo

Lucy O'Hagan

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Retired GP in a cafe
The long-predicted wave of GP retirements is under way, and solutions could lie in new ways of thinking

We are on our summer break and the editorial office is closed until 17 January. In the meantime, please enjoy our Summer Hiatus series, an eclectic mix from our news and clinical archives and articles from The Conversation throughout the year. This article was first published in the 28 April edition

JUST WONDERING

Lucy O’Hagan finds a dearth of doctors when she tries to enrol at a local practice, and touts the idea of healthcare assistants to allow GPs to see more patients in their busy days

Of course, bring on the nurse practitioners and upskill the practice nurses, but they need help too

Yesterday, I trotted along to enrol at my local gener­al practice. I’ve moved to an area of about 12,000 people so it’s a big practice. But a slightly indifferent receptionist said, “Sorry, we aren’t taking new patients, we don’t have enough GPs.”

I was a bit taken aback but luckily found a smaller practice which had just recruited a GP from overseas and that one doctor was accepting new patients.

A few days before this, I had been visiting a city of around 130,000, and a GP told me how desperately short of doctors they were. A 20-doctor practice was down by five doctors. “Everyone is retiring.”

Then last night, I was chatting to a lovely young GP in a provincial town of 60,000, who said, “We are the only practice in town enrolling new patients and we don’t have enough doctors, but we feel someone has to take them.”

This is serious. We’ve been told the GP workforce will shrink due to retirement and not enough new GPs being trained, but this is getting critical. Are we nearing the point where, nationwide, general practices won’t be accepting new patients?

Obviously, I asked my under-doctored local practice if they had nurse practitioners – which they didn’t. Growing the primary care workforce is a whole other complex problem which I hope someone is working on. While we wait, I wonder if we could work smarter?

How about each GP has a healthcare assistant (HCA) working with them all the time. GPs are doing a whole lot of things in a day that could be done by someone else.

I am probably spending an hour or two a day labelling chlamydia tubes, dip-sticking urine, taking blood pressure, finding the form for a parking permit or working out which social service is right for which ethnic group. I’m not quite ready to have the HCA in the room with me, but imagine if all that was done before or after I saw the patient?

And could my HCA stock my room, because about five times yesterday I went looking for equipment or forms or swabs or pregnancy tests. With about three minutes for each search that amounts to one appointment slot.

The practice where I work is also 25 per cent down in doctors, so it’s kind of silly for me to be doing that, don’t you think?

Why am I even spending time collecting patients from the waiting room? Don’t get me wrong, I love the greeting, but when they have three handbags and a walking frame, it’s a long process.

Go figure

Let’s say it’s two minutes per patient, at 24 patients that’s nearly an hour spent getting people in and out of my room.

Don’t get me started on my inbox. Could I send recalls to a well-trained HCA? When those insurance medicals pile up, couldn’t my HCA just ring the patient and tell them they have consented to sending 10 years of medical notes, then fill in the form, copy in the notes and send it to me for check and sign off?

Couldn’t my HCA ring the lab and find out the histolo­gy result that the hospital says I am to follow up, but has never been sent to me? Can’t my HCA call the patient to arrange the ECG and weight assessment that the ortho­paedic clinic has decided they need before they will see the patient?

My GPEP2/3 learning groups tell me they are spending six to eight hours a week on paperwork at home, over and above the allocated paperwork time in their nine-to-five day. This is eight hours of voluntary work a week, and GPs suck up all this extra work because we are trained to push on. We admire copers, but if we carry on doing this, nothing will change except our burnout rates.

Of course, bring on the nurse practitioners and upskill the practice nurses, but they need help too. Couldn’t an HCA do the ordering, BP checks, sterilising, and maybe even recalls?

And can we find more GPs quickly? You would think half the world’s doctors would be wanting to come to New Zealand in a global pandemic.

But what I have heard is that hundreds of doctors are already here, and can’t get jobs. They must first pass the NZREX exam and the language test, but to gain provision­al registration you need to get a PGY1 job with a DHB.

But it can be very hard to get a DHB job. One doctor told me she waited four years for a job, then could only get the jobs no one else wanted. Her friend waited 12 years and some qualified overseas-trained doctors, including cardiologists and surgeons, have given up and are working as HCAs in GP practices.

Really? I thought we had a GP shortage. Go figure.

Lucy O’Hagan is a GP living on the Kapiti Coast

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