A sojourn to the land of the Kiwis used to be easy for British doctors to arrange, but recent changes to registration procedures will affect those who seek either temporary or permanent work.
New Zealand's two main islands (North and South) are located in the South Pacific to the south east of Australia. The population of 3.4 million is predominately of European origin but Maoris and Pacific Islanders form substantial minorities. The history of the health service has many parallels with that of the NHS, and New Zealanders introduced universal health care nine years before the creation of the British NHS.1 The country was divided into 14 area health boards that integrated the planning and provision of publicly funded health care in the same way as district health authorities in England, before the so called internal market.
As in Britain, economic liberalisation in the 1980s was accompanied by the introduction of market forces to the health service. Developments included the introduction of a purchaser-provider split, in which four regional health authorities purchased health care from provider units in the public, independent, or voluntary sectors. Health service trusts (known as crown health enterprises, or CHEs in the Kiwi jargon) were given enhanced powers to negotiate individual employment contracts with medical staff. Although the process is similar to that in Britain, it is further advanced in New Zealand, so that it is no longer possible to negotiate national terms and conditions of service that cover all the crown health enterprises.
The situation is in flux, as a further change of government will mean the replacement of the internal market with a more collaborative model. The purchaser-provider split will be retained, but the four regional health authorities will be replaced by a central funding agency. The crown health enterprises will be replaced by a smaller number of regional services.1
Medical training is very similar to that in the UK and Australia.2 The award of a primary medical degree is followed by a year as an intern (equivalent to the pre-registration house officer year). Thereafter, postgraduate training is overseen by the relevant medical royal college or faculty. In many cases these are the same colleges or faculties that cover Australia, and the training in both countries is identical.
A period of basic specialist training of two to three years as a resident within a teaching hospital is usually completed by part 1 or some other primary examination of the relevant medical royal college. Afterwards, trainees spend a further two to four years in advanced specialist training-analogous to British specialist registrar training-at the end of which they attempt part 2 of the membership or fellowship examination.
In several cases-such as general practice-there is a separate New Zealand college with different regulations. Even where there is only one Australasian college or faculty, there is often a degree of autonomy between the two constituent parts. The hurdles to arranging work in New Zealand are similar to those in Australia: you will need medical registration, work permits, and recognition of specialist qualifications.
Medical Council of New Zealand, PO Box 11-649, Wellington, New Zealand
Association of Salaried Medical Practitioners, PO Box 5251,Wellington, New Zealand
New Zealand High Commission, 80 Haymarket, London SW1 4TQ Tel 0171 930 8422
International Department, BMA House, Tavistock Square, London WClH 9JP (tel 0171 387 4499)
The Medical Council of New Zealand is responsible for the registration of doctors in New Zealand. Until 1996 New Zealand was one of the few remaining countries outside the European Union that still accepted UK or Irish medical degrees for full registration accompanied by a certificate of good standing from the medical council of either country. Similar arrangements applied to medical graduates from Canadian and South African universities. However, the passage of a revised Medical Practitioners Act has introduced several additional hurdles. Graduates of medical schools from outside Australasia will now be eligible only for two types of registration: temporary registration or probationary registration. Temporary registration without examination will be available for a maximum of three years for doctors visiting New Zealand to teach, receive approved postgraduate training, or serve in shortage specialities for a limited period.
A further route to temporary registration will remain available for graduates of medical schools in Britain, Ireland, Canada, and South Africa till July 1998. These graduates will be eligible for temporary registration without examination for a maximum period of three years after which they must pass the New Zealand Registration Examination (NZREX), or apply for admission to the vocational register (see below). Probationary registration will be available to overseas graduates by two methods: passing the registration examination or being assessed as being eligible for admission to the vocational register.
The registration examination consists of oral, written, and clinical examinations and is held twice a year in New Zealand. The oral and written components are to be phased out in favour of a pass in steps 1 and 2 of the United States medical licensing examination (USMLE), administered by the United States Educational Commission for Foreign Medical Graduates (ECFMG). A pass in the clinical component of the registration examination will still be necessary for probationary registration within New Zealand.
The alternative to the examination is to apply for admission to the vocational register, which is a much easier process. Postgraduate qualifications that are recognised include the Australasian or New Zealand qualifications or their equivalent as approved by the Medical Council of New Zealand. In practice this means that the council will take advice from the relevant Australasian or New Zealand college about overseas training.
In both cases (passing NZREX or eligibility for admission to the vocational register), foreign doctors will need to complete a supervised probationary period of 12 months before probationary registration can be converted to general registration. Only at this point can full vocational registration as a specialist be activated. Irrespective of the type of registration gained, registration and practising certificates are issued on arrival in New Zealand only after a compulsory interview. Immigration
The New Zealand High Commission in London can give advice on temporary work permits and permanent residence (see useful contacts). The immigration process entails both an interview and medical examination. In the case of either temporary work experience or permanent settlement, doctors will also need to prove eligibility for the appropriate form of registration before immigration procedures can be completed.
Dr L Wilson, Australian and New Zealand College of Anaesthetists, PO Box 7451 Wellington South, New Zealand
Australasian College of Dermatologists, PO Box B65, Boronia Park, NSW 2111, Australia
Australasian College for Emergency Medicine, 17 Grattan Street, Carlton, Victoria 3053, Australia
Dr G Coster, Royal New Zealand College of General Practitioners, 23 Palmer Street, Wellington, New Zealand
Dr Helen Sill, Royal New Zealand College of Obstetricians and Gynaecologists, PO Box 5377, Christchurch, New Zealand
Australasian Faculty of Occupational Medicine, 145 Macquarie Street, Sydney, NSW 2000, Australia
Royal College of Pathologists of Australasia, 207 Albion Street, Surry Hills, NSW 2010, Australia
Dr L Hans, Royal Australasian College of Physicians, 5th Floor, St Johns House, 99 The Terrace, Wellington, New Zealand
Dr D Drysdale, Royal Australian and New Zealand College of Psychiatrists, Private Bag 93-503, Takapuna, New Zealand
Australasian Faculty of Public Health Medicine, 145 Macquarie Street, Sydney, NSW 2000, Australia
Dr M Leadbitter, Royal Australasian College of Radiologists, Department of Radiology, Wellington Hospital, Private Bag, Wellington, New Zealand
Australasian Faculty of Rehabilitation Medicine, 145 Macquarie Street, Sydney, NSW 2000, Australia
Mr Simpson, Royal Australasian College of Surgeons, Box 7451, Wellington South, New Zealand
Specialist recognition is important if a permanent move is contemplated. From July 1998, when transitional arrangements end for graduates from the Britain, Ireland, Canada, and South Africa, specialist recognition will become even more important as a route to medical registration.
Specialist registration and admission to the vocational register is administered by the relevant royal college or faculty. The assessment procedure varies from college to college but can include an formal interview, parts 1 and 2 of the membership or fellowship examination, or further specialist training. When the college covers Australia and New Zealand, broadly similar rules apply to both countries.
Most vacancies are advertised in the New Zealand Medical Journal, and jobs also appear in the overseas section of the BMJ's classified advertisements. A list of addresses of Crown Health Enterprises is also available through the International Department of the BMA.
As with working in Australia, it is important to clarify with the relevant Australasian or New Zealand College that experience will be recognised if a post is to count as part of training.
If you are considering a more permanent move there are a number of pitfalls to avoid in both the medical registration process and in obtaining acceptable terms and conditions of service in post.
Doctors who wish to stay permanently in New Zealand will have to apply for probationary registration as opposed to temporary registration, and it is in their interests to check about their eligibility to do so before leaving Britain. This means that the temporary concession granted to British and Irish doctors (temporary registration) is not appropriate for doctors wishing permanent residence. Temporary registration is also available in shortage specialities, such as psychiatry, but only on the basis that the doctor concerned will leave the country once that experience is concluded. New Zealand is oversupplied with foreign doctors who are unable to practise because their qualifications are not recognised by the Medical Council of New Zealand, and at least 600 are unemployed.3
Conditions of service.
As in NHS Trusts, crown health enterprises (while they still exist) have been exploiting their freedoms to vary terms and conditions of service. Variations in contract exist in terms of salary, annual leave, study leave and superannuation.3 The Association of Salaried Medical Practitioners will vet contracts offered by crown health enterprises (see box).
Living in New Zealand
Medical practice is very similar to that in the UK, and British trained doctors will find that drug names and treatment regimens are very similar. Pay is comparable to that in Britain but the cost of living is lower. In comparison with Australia, New Zealand is rather quiet, but opportunities for outdoor pursuits such as walking and skiing unsurpassable, especially on the South Island.