DEMAND FOR DOCTORS

Evening Star, Issue 22517, 9 December 1936, Page 6

DEMAND FOR DOCTORS

DIFFICULTIES OF DISTRIBUTION PROBLEM HOT ME OF SHORTAGE PfltT-fiMWATE HEM BO ABROAD DEAN OF FACULTY ANALYSES SITUATION “ During the past year the question has been raised in various quarters as to the Medical School of the University of Otago being equal to supplying the demand for practitioners for the Dominion and much has been made of the fact that there is difficulty in finding medical men for isolated practices," remarked Sir Undo Ferguson, Dean of the Medical Faculty, in a statement presented to the University Council yesterday afternoon*

In the cows© of a detailed review of this subject, Sir Lindo said:—“The additions to the register follow the usual laws of supply and demand. For the 15 years, 1900 to 1914, the average addition was about 65, of whom the great majority came from overseas. During the 16 years, 1930 to 1935 inclusive, the total additions to the register were 906, an average of about 56.5 annually, of whom 634, or 70 per cent., were New Zealand graduates. The increase in our output has resulted, not in any marked, increase in the annual additions to the register, but has reduced the number of importations in favour of locally educated practitioners. Our local product must go on the register here; the overseas man does not come unless there is a sufficiently attractive opening to bring him.

DISPROPORTIONATE INCREASE. ■ “ It is freely stated that there is a shortage of medical men in New Zealand and the question arises as to whether the annual increment to the register is sufficient. As a matter of fact the numbers on the register have increased much more rapidly than the numbers of the' population they serve. In January, 1918, there were 969 names on the register with a population of about 1,171,000. In 1936 the numbers are 1,410 for a population of rather over 1,400,000.

The question is not one of shortage of medical men, but of their distribution. If one medical man to a population of 1,500 suffices in Britain, one to 1,000 should be ample here, and as soon as this tendency to overcrowding of the profession is generally recognised there will be a falling off in the size of our classes with a possible recurrence of the shortage of graduates for house surgeon duties that has been creating so much clamour during the past five or six years.

SEEKING OUTLETS ABROAD. The annual demand for house surgeons in New Zealand is nearly 50, and, provided our entering classes do not fall below this number, we can meet the 1 demand, but, owing to small entries in the years 1921 to 1929, there was a consequent shortage in house surgeons from 1926 to 1935. This year the graduating number is 39, which did not fill all requirements. In 1937 the graduating class will be about 56, and from 1937 till 1943 or 1944 there will probably be 30 graduates in excess of the number there are house appointments for. These fluctuations in numbers come In cycles and are dependent on economic conditions which are world wide. ' “ The position so far as the school is concerned is that we can educate, and are educating, efficiently a larger number of graduates than the community can find work for, and an increasing number of our graduates, after holding resi* dent positions, are seeking outlets beyond the Dominion. Of the class of 33 graduating in 1933, 27 are this year in London obtaining ' post-graduate experience and most of them holding useful appointments.

“ A large number of these will take higher qualifications, but we have no certainty as to how many of them will return to New Zealand. Some will certainly seek a career in the Army, Navy, Air Force, or colonial or Indian medical services or find openings at Home\in large centres where the prizes are greater than is the case in a small community such as ours. “ Recent legislation as to rates of wages and hours of work are likely to • play an important part in shaping their views as to the desirability of returning. They will not unnaturally think that if a clerk at the age of 26 must receive £6 10s, for a 40-hour week with a holiday on full pay, their nine or ten years’ work at an outlay of some £1,500 should command a better reward than a colliery practice grossing £6OO or £7OO, but involving considerable professional expenses, liability to be called on at any hour of the day or night from year’s end to year’s end, and no provision for holiday pay or for periods of refresher study. The position with regard to these unattractive practices would be the same if we were to graduate 100 men. annually.

“ It Is certain that there will always be an influx of British graduates into New Zealand. Men who have acquired special training in certain subjects will be imported as teachers or experts. Radiologists, alienists, cdministrators, some will come for reasons of health or for family reasons, and it is desirable that the profession should have a certain admixture of men trained in other schools, but if the door were closed to all overseas arrivals the school can provide all the medical men the country can employ, and can claim to be amply justifying the courage of its founders.

EMBARRASSING INCREASE. “ The economic depression of the past four or five years has led large numbers of boys who would normally have found careers in business to seek admission to professions, with the result that our classes have increased to such an extent as to embarrass us in their clinical training. We have been endeavouring to obtain extra teaching facilities in connection with tho hospital, and the University and Hospital Board have shared the cost of a lecture theatre which is needed by the school for the students and by the hoard for its nurses, while the hospital staff has contributed £SOO from the staff fund for the extension. of side rooms for teaching purposes in connection with one of the hospital blocks. A second theatre to seat combined classes numbering up to 200 is required for school purposes, and the staff has voted £1,500 towards the cost of its erection. It cannot possibly be available for the first term of 1937, but it is hoped that it will be completed at the earliest practicable date. The extension of the facilities for teaching involves the erection of a new outpatient department, .and the Hospital Board has shown a most willing desire to help the school in this, as in other directions. Negotiations for these improvements have been very tedious, as nothing could be done without permission and funds from the Government. When these increased teaching facilities have been obtained in the hospital w© shall be able to deal with large classes up to the end of their fifth year of training, but during the final year, which is a purely clinical one, we shall have to depend as we have been doing during the past 12 years on the clinical material of all four centres. Strong representations have been made that the entire final year class should be concentrated in one hospital other than Dunedin, and suggestions of classes of 80 to 100 have been put forward as the probable numbers to be dealt with. Such numbers are so far in excess of the possible openings in practice that they are not likely till our population is at least twice what it is at present, but, assuming that we have to deal with such numbers, the suggestion that it should be done in one centre is impracticable, as no centre has the requisite number of maternity cases to train 100 students. CLINICAL INSTRUCTION. “ Apart from this the three main hospitals outside Dunedin have for 12 years appreciated the advantages of having clinical teaching carried on in the wards, and, none will be prepared to lose the stimulus to a high standard of clinical work which is afforded by the presence of a class of students. Up to the present we have been dependent on the goodwill and kindly interest of the staffs of the hospitals in their voluntary efforts on behalf of the profession and the public, but the time has come when some step will have to be taken to correlate the teaching and endeavours made to establish uniformity of standard in the scattered centres. The school will have to be represented on each hospital staff by an officer with a definitely recognised position on the school staff whose duties with regard to supervision of the students’ work and the teaching given to them will have to bo paid for by the school. The clinical teachers should be accorded recognition as members of our clinical teaching staff with some payment for their services. The school should have a voice in the selection .of these teachers, and it is very important that close personal touch should be maintained between the school authorities in Dunedin and their deputies in the other centres. I personally think that- this result can be best reached by periodical visits of the dean of the school to the, other centres, and consider that such visits should be looked upon as part of the dean’s duties. The school representative or local sub-dean in each centre should probably also be recognised as a member of the medical faculty to increase his status though it is unlikely that any of them would attend faculty meetings. If they were members and received copies of the agenda and minutes they would feel themselves more a part of the team and would, no doubt; forward comments that might be of value to the executive. VITAL DEVELOPMENTS. “ These developments must come to enable us to give the best training to the profession of the future, but can only be brought about by means of the co-operation of the governing bodies and staff of the main hospitals. They will probably involve a considerable_ increase in the cost of medical education, and will certainly mean increased responsibility and work for the responsible head of the school. “ The year 1936 has been a busy one in many ways, more especially in consequence of the criticism of our medical course and the need for answering our critics. The number of students on our rolls has risen to 422, and during the year 39 students have qualified. These have all been absorbed by hospitals in need of resident officers, and we could have placed a greater number as house surgeons had they been available, “ Our graduating class in 1937 will be 56, a number which should meet fully all requirements for house surgeons, and in 1938 the number of graduates will be in excess of the demand, and probably special steps will have to be taken to secure the necessary postgraduate training for the surplus can- ’ VALUABLE REPORT. The Chancellor (Mr W. J. Morrell) remarked that this was a very interesting and valuable report, and the council was greatly indebted to the dean for its presentation.