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MCNZ elections

Whilst our attention has been somewhat focused on MECA negotiations, the upcoming MCNZ elections have not gone un-noticed. The right to elect doctors to the medical council, has not always been a “given” and indeed many regulatory authorities such as the nursing council still have no one elected from the profession amongst their number.

For RMOs, the issue of electing doctors to MCNZ started a long time ago, before any of our current membership were even in medical school. At that time, the members of MCNZ were all appointed, and none were RMOs. NZRDA started the campaign for elections in a bid to get some direct RMO input into MCNZ decision-making, so divorced were the then council members from the reality of life for us. MCNZ of the time offered to appoint “someone under the age of 35” which didn’t quite do the trick for us but was overtaken by the introduction of the new Medical Practitioners Act (MPA), a precursor to our current HPCAA.

The MPA saw a new composition of council members incorporating more lay representation, keeping some appointed doctors but also enabling doctors to be elected by the profession. Hot off our successful lobbying, NZRDA worked hard to ensure at least one elected doctor was an RMO, first Dr Marc Adams followed by Dr Kate O’Connor who rose to the position of Deputy Chair. Our relationship with Council improved markedly during this time, with an increased awareness at the table of matters as they affect us in real life.

We did have to defend the right to elect members when the HPCAA came into being. The MPA was a trial for the subsequent HPCAA which covered not just doctors but all health practitioners. When the HPCAA was being written, many of the other professions did not want elected members and the original Act did indeed exclude the right to elect. Further lobbying from the medical profession as a whole however preserved our right; one we should remember is important but by no means automatic.

During the last MCNZ election, maybe we forgot this important history and the basic tenant: no regulation without representation. The elected makeup of Council following the last election could not be described as representative of the profession; all those elected were male, all were pakeha and all were over 50. Following that election the most recent medical graduate on MCNZ qualified in 1987, and notably was an appointed member. Of the elected members the most recent graduate qualified in the 1970’s.

We suggest that with MCNZ elections again on the horizon we need to think a little harder about the process. Underpinning this suggestion is NZRDA’s positive experience of the benefits derived from having someone on MCNZ who knows what it is to be a resident doctor. But the role of MCNZ has changed since the days of Marc Adams and even Kate O’Connor. MCNZ today needs people who are not only well connected with the practicing profession, appreciative of the challenges we face today, they also need to be politically aware and understand not just the role of governance but the benefits of effective leadership.

We are pleased to announce that Dr Curtis Walker, immediate past president of NZRDA will be standing for election to MCNZ. Curtis is known to most of you for his role as President of NZRDA from 2009 to 2014. Prior to that he was a national executive member for Waikato, also working as a medical registrar in Palmerston and Wellington. His commitment to the profession and particularly issues affecting resident doctors is proven and enduring.

With voting opening Feb 17, over the next few weeks you will receive more information about the upcoming elections – who is standing and what they stand for. We urge you to take some time to think about this important issue and who you believe will be best placed to fill this role.

Auckland DHB losses DCCM (ICU) Accreditation

ICU in ACH (Auckland City Hospital) is called DCCM, however the same college accredits it regardless of name and in this case, has notified ADHB that they will lose accreditation this year unless significant concerns are addressed.

ADHB has not communicated with NZRDA directly on this serious issue, one that affects a significant number of our members in a number of training programmes. Unfortunately as is the ADHB way, we have to hear of these things through our networks, nonetheless, we have written to the DHB to find out what is planned, if anything to address the college’s concerns.

Current trainees will not have time lost; however anyone new allocated to DCCM will. With 18 allocations per annum to DCCM, this has widespread implications to not just members at ACH but Waitemata and CMDHB also who may have been rotated to DCCM “next”.

If you wish to check out the letter, go to the training section of www.nzrda.org.nz.

We will keep you informed as to progress or otherwise.

Tis the Flu Season…

Influenza is a significant public health issue in New Zealand. Each year it has a huge impact on our community, with 10-20% of New Zealanders infected, some of whom become so ill that they need hospital care, and some people die. Admittedly, immunisation (the flu jab) is not a perfect remedy but it is the best defence against influenza that we have.

Getting vaccinated is not so much about “me” and whether “I” would survive a dose of the flu, but about protecting those more vulnerable; colleagues, patients, family and community. It might be timely to remind ourselves of such facts as in 2013 the 6 people who died from the flu were all pregnant women. In the 10-14 day period when we are shedding virus but don’t yet know we have it, how many vulnerable people could we infect?

It has therefore been recommended that every fit and healthy person should get the flu jab: yes, in order to protect ourselves but also to protect others in our community.

Vaccinators will shortly appear around our hospitals enticing you to get a jab. Our overall vaccination rates for hospital employees have been improving over the years; from 45% in 2010 to 61% in 2014. Doctors have the highest vaccination rates of all health professionals at just under 70%, however even we are still short of the 80% target.

NZRDA will shortly survey members to find out more about our attitude towards the flu jab and seek some answers to some surprising statistics:

• Why did Auckland and Wairarapa DHBs make the most significant improvements in vaccination rates (over 10%) amongst doctors in 2014?
• Why do Lakes, Midcentral, South Canterbury and Waitemata have the lowest vaccination rates (under 60%) whilst over 75% of doctors at Bay of Plenty and Hutt were vaccinated in 2014?

The survey is as always anonymous, and seeks to know if you did not get vaccinated, why not? If for instance the simple answer to why Waitemata only got 55% of their doctors vaccinated is – we were too busy to stop, or vaccinations were only available if we made it to the Occ Health clinic, then we can do something about that! It is a short survey – three questions – so won’t take up much of your time. Please help us to help you with this important public health issue.

How many of us are there?

You may think this is a silly question: of course we know how many RMOs are employed in NZ! We are willing to bet most of you would think our system also knows what types of RMOs are out there, as well as how many of each type.

Until recently however, you would have been wrong. During negotiations, repeated RDA executives have been left wondering if the DHBs can even count (a rhetorical question folks!), so one of the first things the medical taskforce or “Pipeline” as we call it, had to find out was exactly this. We have to report they have done a remarkably good job, so congratulations to the people down in HWNZ for that. What does it tell us? A few facts that might be of interest (Note: this data is recorded in FTE not head count but given the hours we work lets not split hairs!)…
• There are 3346 RMO FTEs employed in NZ of which 1253 are house officers and 2093 registrars.
• For first year house officers of which we have 429, there are still 692 potential positions (understanding that whilst a run may be MCNZ accredited the DHB may not place a first year in it for operational reasons). By contrast we have more second years and above employed than non first year HO positions.
• Of the registrars, 501 are in non training positions.
• The following specialties consistently across the 4 regions have fewer RMOs training than positions available: psychiatry, ICU, endocrinology, haematology, renal and respiratory medicine.
• By contrast the number of RMOs exceeded positions in Anaesthesia, internal medicine and ED.
• We have just over 40 Australians working in NZ.
• We have just over 500 colleagues here on working (temporary) visa’s: 136 in first and second year HO positions, 142 SHO’s and 256 working as registrars.

Pipeline has far more detailed information by type and DHB available to it from which further work will shortly commence to both align registrar opportunities with the increased medical school output (which is still largely in house officer ranks) and provide more information to you on workforce and specialty trends and predictions.

Guidelines on smart devices

We use them all the time – for fun and for work. To us it is business as usual, so why are management, and only now, writing policy on how we should use smart devices when transmitting patient information – honestly do they have nothing better to do?

The cynical answer to the latter question is “no, it is what they do” however this time it is NZRDA who has written if not a policy then certainly a guideline around some things we might want to think about.

If you take a picture of a wound, a rash, a drug chart…. On your smart phone and maybe send it to another registrar or SMO for advice, do you record that advice (and what it was based on) in the medical record? Are you aware that when you take a snap it is part of the medical record? How do you keep these images safe? Are there ever patient identifying features and what if you lose your phone; could someone else access the images….?

And that is before we get onto the stuff you download and carry with you which may or may not be consistent with your current hospital’s protocol…! The RMO who used Starship protocols handily recorded on their iPhone in a much… smaller provincial hospital found the conflict with that hospital’s (albeit out of date) protocols, a trial to unravel. On this experience we can record a good ending however as the latter hospital took the opportunity to undertake a refreshing of their protocols…

For a copy of the full document please go to the “Hot Topics” section of the website. We would welcome your thoughts and further input on the issue – do you have any comments, issues, questions or experiences to share?

The document has been provided to the national CMO group who welcomed the fact someone had started to do some work on the issue. We have also engaged (through NBAG) with the national Directors of Nursing and Directors of Allied Scientific and Technical Health Practitioners (same as CMOs but for the other two groups of health professionals) plus the national IT board.

We have also raised the issue of DHBs supplying us with smart devices for work, which would resolve some of the issues, however funding seems to be a significant barrier regardless of the efficiencies we might gain. Is it worth us pursuing this initiative or are you happy enough to use your own phones?

Overall this is still a work in progress so any feedback would be welcomed.

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