Target population and response rates
The New Zealand Medical Council found and provided current registered addresses for 535 UK-trained doctors from the 10 cohorts. This represented 1.4% of all 38,821 UK-trained graduates in the cohorts studied, a percentage which did not differ appreciably by year of graduation (Table ).
UK medical graduates of 1974–2005; and numbers and percentages registered to practise medicine in New Zealand in 2009
Following mailing, 113 questionnaires were returned to us indicating that the doctor was no longer at the address, and three doctors wrote declining to participate. Of the former, 74% (84/113) were recent graduates who graduated between 2000 and 2005. Many of these may have been short-stay doctors or those moving within NZ between junior posts, whose addresses had changed. The response rate from the remainder was 67.3% (282/419), with 206 replying by post and 76 online. The response rate was 83% (152/183) from those who graduated in 1974–1988; 62% (79/127) from those who graduated in 1993–1999; and 47% (51/109) from those who graduated in 2000–2005.
Demographics of responders
Of 282 responders, 53% were men and 47% women. Thirty-two percent were below the age of 40 years, 29% were aged 40–49 years, and 38% were aged 50 years and over (two did not provide their age). Only 2% (5 doctors) had been overseas students, i.e. their homes had been outside the UK when they commenced medical study in the UK; and 8% (22) were graduate students when they entered medical school.
Six responders were not working in medicine and a further two did not give employment details; 109 (39%) were working in general practice, 28 (10%) in anaesthetics, 27 (10%) in hospital medical specialties, 22 (8%) in psychiatry, 21 (8%) in the surgical specialties, 17 (6%) in accident and emergency medicine, 12 (4%) in paediatrics, and 38 (13%) in other specialties. Of the 274 responders who gave details of medical posts, 166 (60%) were in the public sector, 73 (26%) were in the private sector, and 35 (14%) described their work as mixed public and private sector.
Moving to New Zealand
There were 79 responders (28%) who migrated from the UK before the year 1990; 67 (24%) who moved between 1990 and 1999; 63 (22%) who moved between 2000 and 2004; 72 (26%) who moved since 2005; and one responder did not specify the year of move. Figure illustrates the time after graduation at which doctors from different qualifying years moved to NZ; 37% had moved within 3 years of qualification, 21% between 4 and 6 years, 15% between 7 and 9 years, and 26% at 10 years or more. Of those who migrated in or after 2000, only 38% (51/135) were from the cohorts who qualified in 2000 or after.
Year of graduation and year of move to New Zealand
Original intentions about staying in New Zealand
We asked doctors how long they had intended to stay in NZ at the time they left the UK. Only 30% had decided to move to NZ permanently, 48% intended to stay for a limited time and return to the UK, and 22% had intended to experience NZ and decide later. There was a rising trend by year of move in the percentage who had intended to move permanently: only 21% (16/78) of those who moved before 1990 had intended to move permanently, as had 28% (19/67) of those who moved between 1990 and 1999, 34% (21/62) of those who moved between 2000 and 2004, and 39% (28/72) of those who moved after 2004 (χ2 test for linear trend = 6.5, 1 df, P = 0.01). Of those who specified that they would stay for a limited time, 68% specified 6 months to one year.
Reasons for going to New Zealand
Participants were asked ‘At the time of first going to New Zealand, what were your reasons for going?’ They were offered five pre-specified reasons and invited to tick more than one if more than one applied. These were: (1) professional, for a medical job; (2) professional, for other work; (3) personal, for a holiday; (4) personal, to be with family or friends; and (5) other reasons.
Those who specified ‘other reasons’ were asked to expand using their own words, and we coded their answers by theme. Some who chose one of the first four options also gave further reasons in their own words. All are included in the totals in Table .
Responses to the question ‘At the time of first going to New Zealand, what were your reasons for going?’: numbers and percentages of respondents
Sixty-nine percent of the doctors moved to take up a medical job and 2% for other work; 25% moved for personal reasons. In addition, 40% specified ‘other reasons’ (Table ) and, in all, 70% gave reasons in their own words. The most frequent related to travel, holiday or being with family or friends (30% of all respondents); wanting a better lifestyle in NZ (23%); or disillusionment with the NHS (16%).
Differences in the reasons given by year of move and graduation year were generally modest, with the following exceptions. Disillusionment with the NHS was cited by 29% (21/72) of the graduates who moved to NZ after 2004 compared with 11% (23/209) of those who moved earlier (χ21 =12.0, P = 0.001). Disillusionment with the NHS was cited by 31% (16/51) of the graduates of 2000–2005 compared with 15% (12/80) of the graduates of the 1990s and 11% (16/151) of earlier graduates (χ22 =12.5, P = 0.002). Seeking a better lifestyle was cited by 33% (44/135) of those who moved to NZ after 1999 compared with 15% (22/146) of those who moved earlier (χ21 =11.0, P = 0.001).
Illustrative quotes under each theme are shown in Box 1
. Some who gave being with family/spouse as a reason for leaving the UK were partners of New Zealanders who wanted to return and others were moving with their spouse (typically, another doctor) for professional reasons. Many who expressed disillusionment with the NHS, particularly those who had recently qualified, mentioned training issues and the Modernising Medical Careers (MMC) initiative was singled out for comment.
Box 1. Illustrative quotes for reasons for leaving the UK
|Lifestyle (cited by 66 doctors, or 23% of all responders)||‘Better lifestyle – outdoor sports and activities… better weather. More relaxed. Less uptight. Good place to bring up children (no children at time of move), Kiwi values are similar to my own.’ 2000 graduate, moved in 2003|
|‘Lifestyle. Leisure. Outdoor pursuits.’ 1999 graduate, moved in 2001|
|‘Better lifestyle. Better weather. Less crowded.’ 2002 graduate, moved in 2006|
|‘For a better life style and future for my family.’ 1977 graduate, moved in 1996|
|Travel/holiday/to be with family or friends (84 doctors, 30% of responders)||‘Desire to travel, but continue medical training.’ 1977 graduate, moved in 1978|
|‘… to travel through India and SE Asia (1 year) and then earn enough money to come home.’ 1974 graduate, moved in 1976|
|‘Wanted to go abroad for a while before embarking on exams, etc. for orthopaedic training. NZ seemed like a great place to go.’ 1977 graduate, moved in 1980|
|‘My husband has dual UK/NZ nationality, and he wanted to move back to NZ.’ 1993 graduate, moved in 2005|
|‘Husband from NZ. Moved so he could complete paediatric training.’ 1996 graduate, moved in 2003|
|‘Husband unable to get consultant post in the UK so moved to NZ.’ 1983 graduate, moved in 1987|
|Better opportunities in NZ (18, 7%)||‘To start training scheme in anaesthesia.’ 1988 graduate, moved in 1991|
|‘Excellent funding opportunities to set up a research department.’ 1983 graduate, moved in 1999|
|‘To go there to work for a year in Obs and Gynae but wanted a change and a new challenge.’ 2002 graduate, moved in 2005|
|‘Wanted training in Intensive Care Medicine and there was no proper training route in UK.’ 1993 graduate, moved in 2000|
|Lack of jobs in NHS (20, 7%)||‘I wished to have a permanent job; I was tired of only having locum work. There were no advertised jobs in [named small specialty].’ 1993 graduate, moved in 2007|
|‘Training not available in [named small specialty, different from previous quote] in UK in 1994.’ 1983 graduate, moved in 1994|
|‘Husband is an anaesthetist and there were no consultant positions in the UK.’ 2002 graduate, moved in 2008|
|‘… to get away from the lottery and uncertainty of finding jobs in the NHS.’ 2005 graduate, moved in 2007|
|Disillusioned with the NHS (44, 16%)||‘Being betrayed by the training system and the implementation of MMC… the lost generation.’ 2000 graduate, moved in 2008|
|‘Disenchantment with consultant posts in the NHS. I was single-handed in three posts until the end.’ 1974 graduate, moved in 1999|
|‘Frustration with job selection system.’ 1974 graduate, moved in 1976|
|‘To escape the NHS and MMC.’ 2005 graduate, moved in 2007|
|‘Chaos of MTAS. Inability for me and my wife to find work in same part of country.’ 2005 graduate, moved in 2007|
|‘Left due to the breakdown of medical training in the UK.’ 2005 graduate, moved in 2007|
|‘Disillusioned with NHS. Not sure what career pathway to enter – NHS pushing to make specialty choice after 2 years.’ 2005 graduate, moved in 2007|
|‘Frustration at the application process and blind governmental restructuring of the training scheme.’ 2005 graduate, moved in 2007|
|Change of environment (24, 9%)||‘To get away from the UK for a while before starting SpR rotation.’ 1993 graduate, moved in 1997|
|‘Overseas experience in intensive care medicine.’ 1988 graduate, moved in 1994|
|‘Wanting a working holiday – felt burnt out and I never worked overseas before, felt the change would do me good.’ 1996 graduate, moved in 2006|
|‘To have an experience of a different health system.’ 1996 graduate, moved in 2008|
Satisfaction with work and leisure
The doctors were asked how much they enjoyed their current position in NZ and how satisfied they were with the amount of time their work left them for family, social and recreational activities. The mean score for enjoyment of work in their current position was 8.1 on a scale from 1 (not enjoying it at all) to 10 (enjoying it greatly). The mean score for satisfaction with time left for recreational activity was 7.8 on a scale from 1 (not satisfied at all) to 10 (extremely satisfied). The results were compared with data from our surveys of UK-trained doctors in the NHS in the same graduation year cohorts (Table ). Both job satisfaction and leisure time satisfaction scores were scored significantly more highly by NZ than by NHS doctors, with leisure time satisfaction scores markedly higher for NZ than for NHS doctors.
Job satisfaction* and satisfaction with leisure time†, comparing UK graduates who have emigrated to New Zealand doctors with their contemporaries in the UK NHS
Future career intentions
We asked ‘Apart from temporary visits away from NZ, do you intend to practise medicine in NZ for the foreseeable future?’ with five closed answers: yes, definitely; yes, probably; undecided; no, probably not; no, definitely not. We did not assume that the doctors' only options were to work either in NZ or the UK, so we also asked: ‘How likely are you to return to practise in the UK in the foreseeable future?’ with five answers: very likely; likely; undecided; unlikely; and very unlikely.
Overall, 89% (249/280) definitely or probably intended to continue to practise in NZ, and 81% (228/280) were unlikely or very unlikely to return to the UK. Only 5% would definitely or probably not continue working in NZ, and only 9% were likely or very likely to return to the UK. More recent movers to NZ, and more recent graduates, were slightly less likely to intend to stay in NZ and slightly more likely to intend to return to the UK.
Factors which might increase the likelihood of return to the UK NHS
We asked respondents what incentives or changes to the NHS would increase the likelihood of their return. Although most did not intend to return, 69% (194 responders) offered comments. We coded their responses under nine themes, which we categorized and list here in order of frequency: ‘better working conditions’ (74 doctors); ‘changes to the NHS – including changes to training, management, government policy’ (66); ‘nothing would make me return’ (43); ‘administrative changes to make it easier to return and/or greater recognition of Australasian qualifications’ (33); ‘better work/financial incentives’ (33); ‘change in personal circumstances or family needs’ (17); ‘improved job security’ (13); ‘lifestyle changes’ (12); and ‘change of government or changes in social attitudes in the UK’ (9).
Illustrative quotes are given in Box 2
. Comments about work–life balance were categorized under ‘better working conditions’. ‘Changes to the NHS’ was a broad category which encompassed changes to management, government policy and training. The category of ‘administrative changes’ that would make return easier included comments about re-registration with the UK General Medical Council, re-training and recognition of Australasian qualifications and experience.
Box 2. Illustrative quotes for incentives and changes to the NHS that would increase the likelihood of return to the UK
|Better working conditions (cited by 74 doctors, or 26% of all responders)||‘Better work–life balance. The low morale and apparent dissatisfaction among the consultant staff that was a big motivator to leave. I'm not sure that has changed.’ 2002 graduate, moved in 2005|
|‘Better working conditions with longer appointments and protected administration time as we have in NZ.’ 1983 graduate, moved in 2006|
|‘More flexible hours. Less demand on GPs to provide early morning/evening surgeries.’ 1999 graduate, moved in 2007|
|‘A permanent post, more relaxed working environment. Very unlikely to return.’ 1993 graduate, moved in 2007|
|Changes to the NHS (66 doctors, 23% of responders)||‘Less Government targets and interference. Better management. Better job satisfaction.’ 1988 graduate, moved in 2004|
|‘Less “red tape” and bureaucracy. Less of a political “football”. 1993 graduate, moved in 1994|
|‘Less rigidity in terms of training. More support from employers, managers, peers. More opportunities for study/broadening experiences. Any incentives really – I found there were none while working for the NHS.’ 2005 graduate, moved in 2007|
|‘A sensible application process based on clinical experience and curriculum vitae rather than “75 words or less” empathy questions. A medical-based hierarchy rather than a managerial one… recognition for the countless hours of overtime that are aggressively ignored by the management/government.’ 2005 graduate, moved in 2007|
|Administrative changes to make it easier to return/recognition of NZ qualifications (33, 12%)||‘I am currently going through the PMETB bureaucratic process to get on the specialist register in the UK (in case I need to work). It is stressful and a nightmare. I have trained and worked in the UK for many years and have an immaculate training record in NZ. I can't see how this awful process can add any value to the NHS or incentive to return to the UK.’ 1996 graduate, moved in 2002|
|‘Easier acceptance of NZ qualifications/experience years for registration with UK GP councils.’ 2000 graduate, moved in 2001|
|‘Hassle-free acceptance of my specialty training and GMC registration.’ 1993 graduate, moved in 1995|
|‘Acceptance of experience/accreditation/seniority/training obtained from 22 years Consultant [named specialty] practice in NZ (… NOT about to re-sit exams, etc.).’ 1974 graduate, moved in 1988|
|‘Would be difficult at present as I am currently in a training scheme here and would have to take a step backwards and would be difficult to get into training in the UK.’ 2000 graduate, moved in 2002|
|‘NZ husband able to work more easily without EU regulations.’ 1996 graduate, moved in 1998|
|Better work incentives and/or financial remuneration (33, 12%)||‘Better pay. Job-sharing opportunities for women including surgical specialties.’ 2005 graduate, moved in 2007|
|‘Increased funding for staff and research facilities.’ 1983 graduate, moved in 1999|
|‘An interesting job near my family. One that offers a balance of clinical, research and service development in the role. My perception is that this is unlikely given the direction the NHS has been taking and that it will have only been made worse by the financial crisis.’ 1996 graduate, moved in 2008|
Analysis by year of qualification showed that, for the most recent cohorts of 2000, 2002 and 2005, 30% of respondents commented on the importance of reducing barriers to re-entry and of the UK accepting Australasian qualifications. This compares with an overall figure of 12%, and it highlights the importance of perceived barriers to re-entry to doctors at relatively early stages in their careers when they may still be considering returning to the UK.