Many patients had their referrals rejected, and were never seen by a specialist, with referral rejection or non-acceptance rates reaching around one in five in some districts.
The college is calling for a 10-year National Health Workforce Plan which crosses electoral cycles, and work to build a sustainable specialist workforce through investments in training, support and retention.
It is also calling for stronger rural and regional training.
While 16% of New Zealanders live in rural areas, only 1% of RACP physicians were based there.
Two-thirds of RACP physicians and trainees are based in Auckland, Wellington and Canterbury, while some regions have only a handful of college members – de Zoysa describes these areas as “specialist deserts”.
The West Coast has just three, Marlborough 11 and Tasman 20, leaving many regional communities without timely access to specialists.
It was often up to the patient to travel to the nearest specialist.
Retention was also an issue. International medical graduates made up nearly half of New Zealand’s medical workforce – one of the highest proportions in the OECD.
Only 28% remained in New Zealand after five years, compared with 85% of doctors trained locally.
According to the RCAP, only half receive a formal induction into the health system, and just 3% report receiving any meaningful orientation.
“They don’t feel valued and they don’t feel supported,” de Zoysa said.
“If we can make that investment in people and hang on to them, that’s 30 years of a trained specialist who will provide care to literally thousands of people.”
Another aspect was pay. “I’ve been working as an internal medicine specialist for over 20 years and my salary is less than a junior consultant starting salary in Australia,” said de Zoysa.
Gastroenterologist Dr James Irwin recently resigned from his position at Palmerston North Hospital, where he was the last one left.
Three doctors have now accepted positions there, with one due to start this month.
Staffing regional hospitals was difficult, Irwin said – there was often less support available, and smaller teams, which felt the effect of staff absences more acutely.
“When you’re in a small place and you go from four to three or three to two, all of a sudden it feels unsafe.”
It was also affecting patients.
“There’s no consultation on wards for patients with gastroenterology problems in hospital, like liver transplant patients or patients with acute severe colitis or Crohn’s disease,” he said.
“People miss out.”
Dr Jessica Allen, an adolescent and developmental paediatrician, said things were also hard in her field.
“We’ve seen a dramatic increase in referrals for behavioural and developmental concerns for children.”
But there had been no targeted investment in improving training or capacity.
Diagnoses could be delayed by several years, she said, and children and families were missing out on support, be that funding, or physical aids for disabilities.
Induction for staff was likely “highly varied” around the country, and there was no national plan, which contributed to a lack of support for new staff.
“I would hope that in a local setting that people do their best, but there are a lot of differences about the New Zealand health system, about our culture, about how things work in Aotearoa altogether.”
Associate Health Minister Matt Doocey, who has jurisdiction over this part of the workforce part of the portfolio, said he agreed there needed to be a focus on long-term workforce needs.
The Government already had a health workforce plan in place, which Doocey said was already paying off – and work was also underway on a longer-term workforce strategy.
“We’re also working with medical colleges on integrated rural training pathways and establishing a new medical school at Waikato University focused on training doctors for rural and provincial settings.
“Where you live shouldn’t determine the healthcare you can receive. We’re backing rural clinicians with the training, support and workforce they need, including through the refreshed $6 million National Rural Recruitment and Locum Support Service.”
Health NZ national chief medical officer Dame Helen Stokes-Lampard said the agency recognised workforce planning was vital, and had a focus on retention.
“Building a sustainable health workforce with enough doctors, nurses and allied health professionals on the frontline is a top priority.”
Work was underway to strengthen the rural workforce, including bringing Rural Hospital Medicine training into Health NZ employment and allowing rural clinicians to provide a wide range of care, and increasing the visibility of available roles nationwide to make it easier for doctors to move into specialist roles.
The new Waikato medical school would also increase the home-grown medical workforce.
“Health NZ is committed to working alongside RACP and other vocational colleges to build a co-ordinated approach to rural workforce development.”