SDHB scapegoats doctors in desperate scramble to fix deficit

SDHB scapegoats doctors in desperate scramble to fix deficit

“The bosses of the troubled Southern District Health Boards have turned on their own medical staff as they desperately scramble to save their hides and patch up the region’s deficit,” says Ian Powell, Executive of the Association of Salaried Medical Specialists (ASMS).

He says the DHB’s new draft strategic services plan includes an unprincipled attack on the hospital doctors who diagnose, treat and care for thousands of Otago and Southland patients each year.

The draft plan misuses highly dubious data to claim the DHB spends a higher percentage of total funding on medical staff than other DHBs, that medical staffing costs have grown significantly since 2009, and that the DHB’s financial position would have been “materially improved” if it had been able to contain the growth in these costs.

“What the DHB’s mis-leaders are doing in effect is pointing the finger at their doctors and saying they’re to blame for the DHB being so deeply in the red,” says Mr Powell.

“This will be deeply upsetting to the doctors there who are passionate about health care and who work long hours to provide the best possible care for people. They don’t deserve to be scapegoated like this.

“Ironically the draft plan reports that in terms of quality and accessibility of care, Otago and Southland patients overall do well compared with other DHBs. Instead of commending their doctors (and their other health professionals) for this achievement, the plan unfairly blames them for the deficit.”

He says the DHB’s data is presented out of context, making it useless for the purpose they have used it for, for three main reasons:
1. Comparing Southern DHB’s spend on doctors with Waikato and Capital & Coast DHBs – or, in fact, any other DHB – is meaningless. Only Southern DHB has two large base hospitals so far apart, which creates quite a different set of pressures on the medical workforce from other DHBs.

2. Southern DHB is geographically the largest DHB in New Zealand, with the population spread over a large area. That poses particular challenges for doctors and others providing health care – far more so than any other DHB. There is less scope for economy of scales.

3. Lumping together senior doctors and resident medical officers (‘junior doctors’) presents a skewed picture that makes the data useless. A small difference in configuration between house surgeons, registrars and specialists can completely change the comparisons with other DHBs.

Other factors that make the DHB’s use of the data meaningless to the plan include:

• The ASMS has not seen any evidence that hospital specialists are overpaid compared with doctors at other DHBs. In fact, information provided by the DHBs to ASMS as part of our annual salary survey shows that Southern DHB is ranked 8th out of all DHBs for base salary rates for specialists (based on headcount). That puts it roughly in the middle of the pack. The survey results are available from http://www.asms.org.nz/wp-content/uploads/2014/10/Salary-Survey-2014-Analysis_162271.1.pdf
• As well, DHBs measure senior doctor costs differently, with some including a management component as part of the medical workforce data, and others leaving it out.

• The draft plan doesn’t mention the number or proportion of locums (temporary medical staff) at the DHB. These people fill gaps in the medical workforce and can disguise the true picture of workforce shortages. The costs of using locums can be very significant and this may alter the numbers if these costs are included – and it’s not clear from the draft plan whether they have been. If Southern’s use of locums is above the national average, then the comparison with Waikato and Capital & Coast would be quite different.

• The plan neglects to mention the increase in medical school graduates going into public hospitals as young doctors, especially from 2013 onwards.

“Southern DHB’s management needs to develop a long-term strategy to address the deficit and other problems in its region,” says Mr Powell. “That strategy needs to be based on a culture of comprehensive clinical leadership, accurate analysis of the options available and the likely consequences for patients in the region.

“We’ll be looking in more detail at the overall direction and tone of the draft plan but by attacking their medical staff – the most specialised part of the DHB’s workforce – it seems as if the DHB is choosing what it perceives as short-term easy options over the hard work required getting the DHB operating effectively. We need fewer cheap shots and more engagement with the people actually providing health care.”
ENDS
Ian Powell
EXECUTIVE DIRECTOR

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