Semi-retiree John Malcolm, who holds an emeritus paediatrician position at Whakatāne Hospital as a researcher, examines the staffing challenges faced by the hospital.

four obstetrician-gynaecologists have resigned in recent months from Te Whatu Ora’s Whakatāne Hospital is tragic for expectant whānau in the Eastern Bay, a vast area from Cape Runaway in the East to perhaps Pikowai in the west and Te Mahoe in the south.

Dr Vijay, consultant obstetrician gynaecologist of many years standing, retired almost a year ago.

The long-term contract of one obstetrician-gynaecologist was not renewed. The gaps in consultant obstetrician surgeon cover had already begun.

There are clearly issues of both recruitment and retention: getting staff, appreciating, and holding on to those coming to Whakatāne Hospital.

The intended and unintended consequences of current Health NZ staffing policy and management of Whakatāne Hospital front-line appointments is affecting all departments, including all those departments which were heroic during the Whakaari eruption aftermath.

One colleague likened the hospital to a stool where every leg affects the others, who might manage for a while on three but not two legs.

Another useful image is of the knock-on effects of dominos. Staff observe there is effectively no replacement of staff who leave, with snail-pace impractical processes, and interim locums are offered unacceptable years-old rates.

The obstetrics and gynaecology news published in the Beacon on December 18, obstetrics downgrade shocks community, is of great concern to Mayors Victor Luca and David Moore, many members of the public, retired paediatrician Dr Chris Moyes, and our local member of Parliament Dana Kirkpatrick.  

Reuben Araroa, Ngāti Awa chief executive, described the undermining of health equity, the unacceptable risks, estimating the numbers affected and supported the community response to Health NZ and the Government.  

The dismay of EBOP midwifes (Lisa Power and Lisa Kelly, Beacon December 20), who support most mothers in labour, is understandable as obstetricians are their back-up and at times the mother and infants’ saving grace when complications are known and, most importantly, when unexpected complications arise, needing timely anaesthetic and or obstetric procedures such as caesarean delivery.

Paediatricians have a profound respect for the skills of both professions and the need for both but can only assist materially once the infant is born.

The timing of the news just prior to Christmas risked a loss of impetus for community responses which, fortunately, continued in the Beacon of December 27, given the gravity and longstanding concerns.

Pre-election May 2023, Dr Shane Reti was aware of rural health professional shortages, supported pathways for International Medical Graduates (IMG) to speed registration and said the midwifery shortage needed to be addressed.

Minister Matt Doocey in July 2024 announced a rural health strategy emphasising services closer to “communities in need”, concerned that rural people were not receiving equitable health services compared to their urban cousins.

Dr Reti supported a more regionalised health system to ease “dire staffing problems” in August and announced, fast tracking specialist registrations in October and regional hospital funding, including maternity, in November.

The Medical Specialists Association’s Sarah Dalton responded that the health system needed appropriate funding and “needed workforce projections should be tied to (specialty) budgets”. Other smaller hospitals, Gisborne, Masterton, Greymouth, are likely to be similarly affected.

Whakatāne Hospital has been indebted to International Medical Graduates for all their obstetric staff, half of their current paediatric consultant staff, and most of the hospital’s consultants in anaesthetics, emergency medicine, surgery, medicine, and psychiatry.

Karen Smith was based in Whakatāne and retired in 2024 from her management post for Women Child and Family services. With her experienced listening ears, sound plans were possible and she was often our conduit to higher management controlling Whakatāne, not locally but from Tauranga, and now also from Hamilton, as well as Wellington.

While international medical graduates are noticeably absent from Whakatane’ Hospital’s 100-year history corridor, they were appreciated in the Beacon’s centennial publication, including consultant surgeon Des Collins’ retirement.

The corridor highlights many health milestones, eg, Chris Moyes and Sandy Milne’s work on Hepatitis B, Hohepa Kereopa and Amohaere Tangitu, aspects of the Journey to Culturally appropriate Health Care, and feature pictures of former Minister of Health Tony Ryall and former East Coast MP Anne Tolley opening the renewed hospital in 2014. They secured, no doubt through hard work in Wellington, our Whakatāne Hospital’s $70 million Project Waka re-development. Other options had included closure.

The contribution of international medical graduates to Whakatāne Hospital is most important, more so while we have the long wait for New Zealand graduate numbers to increase and be attracted to stay.

The Association of Salaried Medical Specialists, in a 2017 research brief, pointed out that New Zealand was 27th of 34 OECD countries for medical graduates per head of population and lost on average 240 New Zealand specialists/year 2010-15.

International graduates were at that time 43 percent of the specialist workforce, the second highest behind Israel of OECD countries, with dependency greater in some specialties, eg, 23 percent in orthopaedics and 55 percent  the second highest in obstetrics and gynaecology, the highest being psychiatry.

IMG dependency is greater in smaller provincial DHBs such as the Bay of plenty, 66 percent, and much greater in Whakatāne than Tauranga.  

It is important to note that 78 percent of registered IMG doctors come from six countries, United Kingdom, South Africa, India, Australia, the US and Sri Lanka.

Most of Whakatāne Hospital’s consultants came from those countries. While a quarter leave New Zealand within three years and a third within five years, this is similar to New Zealand-trained anaesthetist retention of two thirds after seven years.

As India retains more of its own, and UK National Health Service conditions improve, New Zealand will be even more challenged.

When I was appointed a consultant paediatrician in 2007, I was the first New Zealand graduate consultant appointed to Whakatāne in 15 years.

Other factors affecting staffing include the ageing workforce, increased women in the workforce and need for flexibility in contracts, and the need for work-life balance.

While recruitment is paramount, with appropriate incentives, retention is equally important and extensively studied by the research staff of the specialists’ association ASMS in a series of reports.

Of interest to local employers, a survey of New Zealand-trained anaesthetists identified salaries as most important to respondents overseas, while lifestyle and family ties most important to those staying in New Zealand.

Many specialists in New Zealand surveys report burnout and fatigue.Poor retention of staff is likely to continue until these lessen.

Perhaps the most telling WHO and ASMS specialists’ findings reported from 2014-16 are likely to remain important when obstetricians and gynaecologists consider coming to Whakatāne and, once here, whether they stay.

Three factors were found that affect retention, employment, work, and organisational quality.

Employment quality includes pay, terms, conditions, flexibility, work-life balance pension provisions, and child-care provisions.

Work quality addresses inappropriate or unsafe work, administrative burden, work stress and load.

Organisational quality includes leadership, management styles, specialists’ limited influence over work, perceptions of not being heard, management-clinical disconnects, limited shared decision-making and recognition.

These themes are likely to still be important in local Whakatāne specialist obstetrician recruitment and retention.

Health New Zealand, Te Whatu Ora Tauranga and Manawa Taki Hamilton’s managers will need to heed local voices, listen in Wellington and have seats at their tables for Whakatāne clinical and administrative staff to achieve the goal of medical, nursing, and allied staff retention in Whakatāne Hospital.

There are clearly important issues including recruitment, retention and rural health where MP Ms Kirkpatrick and others might walk with cross-party support in her own and Ms Tolley and Mr Ryall’s shoes to Wellington.

Ask Mr Reti and his colleagues to prioritise and prepare offers weighted to working here in Obstetrics and Gynaecology, for this community with demonstrated needs.  

It is likely that most of the East Coast electorate would support a vote for that should Ms Kirkpatrick and the representatives of all parties make that journey.

Many locals have advocated clearly already. Do they and we need a public meeting’s backing?