In switching from the private sector to the public sector, I braced myself for a significant cut in pay. As it turns out, the compensation is actually quite reasonable when matched to the schedule. Based on the current exchange rate of $1 USD equal to $0.75 NZD, the annual salary is about $165,000 USD. You also receive six weeks of vacation, two weeks of CME leave, and a $12,000 CME allowance. All in all, it’s a nice package. (Unfortunately, the pay in Australia is higher, and many Kiwi physicians choose to practice over there.) The resulting shortage of locally educated and trained physicians in New Zealand explains the ongoing need for overseas physicians.
Fewer Resources, So Choose Wisely
The hospital is part of a larger network called a district health board (DHB). The DHBs receive government funding based on population, then must decide how to spend the money. For that reason, there are only a few hospitals that include subspecialties. Smaller sites, such as Whakatane, have no subspecialists at all.
That also means we have no MRI machine, no cardiac catheter lab, no echocardiography, no hemodialysis. So, to do one of these procedures, it involves speaking to a specialist at a tertiary site and requesting a transfer, which, in turn, forces you to explain and justify your request. All of a sudden, the history and the physical exam regain their proper importance rather than being subverted to ordering a confirmatory imaging study or specialist consultation. It’s much different than back home, where the indication to perform coronary angiography can be the presence of a cardiologist and a groin in the same room.
In addition, the community GPs cannot order such testing as exercise treadmills or CT scans without going through a consultant first. Although this inevitably leads to delays, it also means some thought is introduced into the process.
Dialysis is another example. In New Zealand, more than 40% of patients receive peritoneal dialysis, and many of those who get hemodialysis do so at home. The average cost per patient per year is $25,000. By contrast, 93% of U.S. dialysis patients are on hemodialysis at a cost of $67,000 per patient per year.3 The outcomes for the two treatments are generally accepted to be the same; one just costs a whole lot more.
This Is the Only Formulary
U.S. physicians are all too familiar with MRSA, VRE, C. diff, and their ilk. Soon we may have to deal with NDM-1. Over and over again, we hear about how we should curtail our antibiotic use, yet little is actually done. New Zealand has strict antibiotic guidelines in accordance with a patient’s diagnosis. Ordering antibiotics outside the protocol is not accepted, unless you can convince the infectious-disease physician otherwise. It is an eminently reasonable practice that has simply never gained broad acceptance in America. What is the result of the New Zealand practice mandate? The hospital where I work has experienced only rare MRSA cases (9% of all S. aureus vs. 35% in the U.S.), no VRE, and zero cases of C. diff in the past nine months.
New Zealand has one drug-purchasing entity: Pharmac. The entity negotiates prices with suppliers and writes the formulary. If a drug is not on the national formulary, it is not available. Period.
Most drugs are fully subsidized; some drugs are partially subsidized. If it is available and subsidized, a 90-day prescription costs $3. All in all, Kiwi pharmaceutical costs are about 30% of the costs in the U.S. The choices are fewer, yet patients still receive appropriate pharmacologic treatment.