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It's Called Primary Care for a Reason

New Zealand prioritizes primary care, cutting down on the excess expenditures, discontinuity, and lack of access that too often characterize health care in the U.S.

Like almost all developed nations, New Zealand has a shortage of qualified primary care physicians. Why is this important? It’s because the efficiency, cost-effectiveness, and overall success of a health care delivery system—measured in health outcomes—are all directly related to the successful delivery of primary care. Without organized universal access and rational implementation of effective primary care strategies, costs soar and outcomes worsen. And in real terms, it is patients who suffer in proportion to the unavailability of this vital building block of any health system.

Why the worldwide shortage? The reasons are as varied as the health systems themselves, but it has a lot to do with the hard work, long hours, low prestige, lower pay, socially disadvantaged patient populations, and non-urban settings that are often part and parcel to the practice of primary care.

As with many aspects of health care in the United States, issues surrounding primary care are complicated. On one hand, the United States represents the world’s single largest net recipient of primary care physicians trained overseas, often in countries that can ill afford to lose these physicians. On the other hand, there persists in the United States perhaps the greatest maldistribution of primary care vis-a-vis specialty physicians in any health care system in the developed world. The World Health Organization recommends that approximate 70 percent of the physician workforce focus on primary care. In the U.S. the proportion is almost the opposite, with a predictable outcome: the excess expenditures, discontinuity, and general lack of access that all too often characterize U.S. health care.

In New Zealand there are far fewer organizational and systemic impediments to the provision of adequate primary care. With the legislative establishment of primary care organizations (PHOs) in 2001, which provided the organizational basis for the entire country, the philosophical, political, and, to some degree, economic commitment to primary care was made. Unfortunately, there is still a significant net loss of primary care physicians to countries with higher pay scales, most notably Australia and Canada. In an attempt to provide short-term (and ultimately long-term) coverage, the use of temporary physicians known as "locum tenens" is common.

There are several for-profit and nonprofit agencies that seek to facilitate the placement of both New Zealand and foreign physicians in such positions. I opted to utilize an agency known as NZ Locums, a nonprofit affiliated with The New Zealand Rural General Practice Network, NZRGPN.

The final component of my placement entailed a three day orientation, during which I was briefed by representatives of various agencies and organizations that a practicing physician must deal with. The sessions included presentations by PHARMAC, the New Zealand national formulary (supplier of pharmaceutical medicines); ACC, the New Zealand accident compensation scheme; WINZ, the national income and disability program; the Medical Protection Society, a physician advocacy organization in the event of disciplinary action (it should be noted that in the event of malpractice, patient compensation and physician liability are separate and not subject to the contingency-based litigation).

Finally, to round out my medical immersion in the New Zealand primary care world, I had the opportunity to attend the annual New Zealand Rural General Practice Network conference for two days in Christchurch. It began with a traditional Maori Mihi Whakatau, an invocation ceremony of welcome and thanks that includes Waita (song) and the performance of Hongi, the pressing of the nose, a symbolic sharing of the breath of life. I was able to meet numerous doctors and even have conversations with a few colleagues from the U.S. who have made longer-term commitments to practice here. Indicative of the personal scale of this country, there was a two-hour session during which New Zealand's minister of health,Tony Ryall, addressed the conferees and detailed concrete political measures being taken by the New Zealand government to address primary care shortages. (Imagine Kathleen Sibelius speaking to a convention of rural primary care physicians with actual policies to address actual needs!). Most inspirational was the chance to meet New Zealand medical students and registrars (what we call residents), whose intelligence and enthusiasm were really quite inspirational and cannot help but bode well for the future primary care here.

Today I arrived at my first rural placement where I begin on Monday morning. I plan to use my Sunday to practice left-sided driving on the quiet country roads and to gear up for day one.


Dr. Ken Fabert wrote this article for YES! Magazine, a national, nonprofit media organization that fuses powerful ideas with practical actions. Ken has been a practicing primary care physician in the United States for 28 years, from rural New England and South Carolina to urban Chicago and metro Seattle. A member of Physicians for a National Health Program, he is spending three months as a roving clinician in New Zealand to find more about how their single-payer health care system works.

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Read more of Ken Fabert's blogs from New Zealand here.

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