Bullying of senior doctors rife in public health system, report finds
A survey published of senior doctors and dentists working in New Zealand’s public health system found more than a third had been bullied at work, and two-thirds had witnessed others being bullied.
The Association of Salaried Medical Specialists (ASMS) report, Bullying in the New Zealand senior medical workforce: prevalence, correlates and consequences, is available on the ASMS website at https://www.asms.org.nz/wp-content/uploads/2017/11/ASMS-Health-Dialogue-Bullying-WEB.pdf. The survey of ASMS members was carried out in June 2017, with a response rate of 40.8%.
Key findings included:
- More than a third of respondents (37.2%) said they had been bullied, and more than two-thirds (67.5%) reported witnessing bullying of colleagues.
- The prevalence of bullying in New Zealand’s senior doctors appears higher than shown in comparable international surveys of health sector workers.
- The prevalence of bullying is strongly associated with high workplace demands, and low peer and non-clinical managerial support.
- Workplace bullying occurs more often, and in different forms, for certain groups of senior doctors, eg overseas-trained doctors working in New Zealand, women, doctors aged 40 to 59, and in some specialties (emergency medicine, general surgery and specialist surgery).
- Only a third of doctors who said they had been bullied reported what had happened, with the main reasons for not reporting being fear of not being supported, and concern that reporting would make the situation worse.
ASMS Executive Director Ian Powell says the survey findings are very concerning and the union would be discussing them further with DHB chief executives and senior managers. Copies of the report had been sent to all DHB Chief Executives, as well as new Minister of Health, Dr David Clark.
“The prevalence of bullying, coupled with the findings of our previous research into burnout and SMO presenteeism, is yet another symptom of a health system groaning under the pressure of years of neglect and under-resourcing. A number of DHBs are already making very positive moves in taking up initiatives to address bullying and other unprofessional behaviour, but much more is required at a systemic level to provide adequate levels of workforce resourcing and to bring about meaningful culture change within hospitals.”
SPANZA advisories on Tramadol
Following the FDA announcement on 20 April 2017 regarding the use of Codeine and Tramadol in children and in breastfeeding women (read here) the Society of Paediatric Anaesthesia in New Zealand and Australia (SPANZA) asked groups of experts to review the literature and produce advisory statements. The first is regarding the use of Tramadol in children and was circulated in May. The second is regarding the use of Tramadol during breastfeeding and in the neonate.
NIB First Choice Network
Launched on 1 September, the network is designed to control costs for policy holders by promoting the use of specialists within the First Choice Network to reduce claim costs. Specialists are included/excluded from the network based on historical cost analysis for services already provided. NIB estimates that 90% of specialists currently used by NIB policy holders are within the First Choice Network. The efficient market price (EMP) is the set (maximum) price that NIB will pay for certain services. If a specialist is not included in the network, please note that the EMP is all that NIB will pay and there will be a portion that the customer will have to pay (called a gap payment).
The EMP is divided by NIB into two components: the Hospital EMP, and a combined surgeon and anaesthetist EMP. In the latter category both the surgeon and the anaesthetist are individually assessed and if either are outside the EMP then they are spoken to individually by NIB, not as a grouping. If there is any suggestion made from sources outside NIB that your fee is too high then contact NIB directly to discuss this.
Essentially nothing will change from a billing perspective and there is no need to negotiate any contracts.
NIB will not be pursuing the establishment of contracts for procedures with hospitals as they cannot control the portion that is paid to surgeons and anaesthetists. The maximum amount payable for a procedure will continue to be policy based. A policy holder can choose the services of a specialist who is not within the First Choice Network, but will need to pay a portion to cover the gap payment.
Practices can set up portals to process invoices directly to NIB, but they will first need to discuss this with NIB. More about the network and process can be read here. Click here to find out which procedures will initially be included in this new process. Other procedures will be included over time.
Affiliated Provider funding for anaesthesia consultations
Southern Cross has advised that anaesthetic and intensivist consultations will not be part of its Affiliated Provider (AP) only funding services for 2017. They say that while these are the only exceptions under their AP-only specialist consultation programme, they will continue their discussions with anaesthetists to investigate appropriate models of contracting with these two specialist groups. Pain specialists will be listed in Southern Cross’ Health Care Finder directory and members will be using this to identify AP-only providers that they should use to be reimbursed.
Decision to delist tramadol hydrochloride oral drops 100 mg per ml
The NZSA welcomes PHARMAC’s decision to progress the proposal to delist tramadol hydrochloride oral drops 100 mg per ml from Part II of Section H of the Pharmaceutical Schedule, and instead list a 10 mg per ml strength of tramadol hydrochloride oral solution for use in DHB hospitals. This was the subject of a consultation letter dated 4 October 2016. In summary, the effect of the decision is that:
– tramadol hydrochloride oral solution 10 mg per ml was listed for use in DHB
hospitals from 1 January 2017.
– tramadol hydrochloride oral drops 100 mg per ml will be delisted from 30 June 2017.
Burnout rife among DHB senior doctors
Burnout is rife among senior doctors in New Zealand’s public hospitals and higher than in comparable international studies, according to the Association of Salaried Medical Specialists, with half of senior doctors and dentists surveyed reporting very high levels of burnout.
Key findings of the survey include:
- Half (50.1%) of hospital specialists reported symptoms of burnout – i.e, high levels of fatigue and exhaustion.
- 42.1% said this was due to their work, and cited frustrations with management, intense and unrelenting workloads, under-staffing, and onerous on-call duties.
- 15.7% attributed their burnout to their interactions with patients.
- Three out of five female specialists (59.4%) were likely to be experiencing burnout, compared with 43.9% of male specialists.
- Burnout was even more prevalent among female doctors aged 30-39, with (70.5%) experiencing burnout. More than half (51.1%) attributed this to their work.
- Some medical specialties reported higher levels of burnout than others – in particular, emergency medicine, psychiatry and dentistry.
The full report can be read here
Sole supply of propofol
Sole Supply Contracts (Hospital Supply Status) have been awarded to two suppliers for propofol:
• AFT Pharmaceuticals’ Provive brand MCT-LCT 1% inj 10 mg per ml, 20 ml vial;
• Fresenius Kabi (NZ)’s Fresofol brand 1% MCT/LCT inj 10 mg per ml, 50 ml vial and inj 10 mg per ml, 100 ml vial.
These products will be the only brands of propofol that can be used in DHB hospitals from 1 June 2016 until 30 June 2019. The 50ml and 100ml vials of Fresofol were introduced on 1 April. All other presentations of propofol currently listed were delisted from 1 June 2016. The NZSA wrote a submission to Pharmac earlier in the year expressing strong support for continued availability of Provive and Fresofol and said consistency of supply for NZ’s leading anaesthetic drug is essential.