Not as Good

By Jim McVeagh 25/08/2010

I see Paul Henry is in trouble again. This time over suggesting that foreign doctors aren’t as good as those trained in New Zealand. I suspect he makes stupid comments like this deliberately, because he knows they are good for ratings. As a foreign-trained doctor myself, I find it hard to take offense at Henry’s remark, simply because I have zero regard for his opinion. However, the topic is interesting because I have heard many patient reiterating the same sentiments, blissfully unaware that I am South-African-trained  (because I am originally an ex-Brit and do not have much of a South African accent).

Like all prejudices, there are some elements of truth in the belief (it is very hard to believe in something demonstrably completely false). There are some countries whose medical training regimes are significantly less robust than New Zealand’s. However, Medical Council place sufficient numbers of hurdles in the way of these doctors being registered, that they either do not register as doctors, or they bring themselves up to New Zealand standards. There are also a number of medical training regimes overseas that have very different emphases than the New Zealand one. For instance, both the US and the Indian systems produce specialists at a relatively early stage in the training process, making it difficult for these doctors to perform as non-specialists while they await registration in their speciality (often a lengthy process requiring rewriting exams). Note that specialists find it very difficult to perform as generalists if they have been specialists for more than 5-10 years, anyway.

Once a doctor is registered to practice here then there is also the question of adaptation to New Zealand ways. This usually extends far beyond language barriers. There is a lack of familiarity with the New Zealand Medical system, that can take a year or so to overcome. There is a lack of familiarity with New Zealand cultural differences which may take much, much longer. For instance, the South African sense of humour tends to be fairly bluff. I have seen a number of New Zealand patients walk away from a consultation mortally offended, simply because the doctor has been overly direct with them ( you eat like a bird? What kind of bird are we talking about? An ostrich?). At the other end of the spectrum, Asian doctors tend to be overly technical and oblique in their explanations to patients because they do not want to give offense. Neither of these tendencies detract from the doctors skills, but they do sometimes produce dissatisfied patients.

Of course, what people sometimes forget is that there are some areas where foreign-trained doctors are actually better than New-Zealand-trained ones. The most obvious example of this is the ability of most South African doctors to handle major trauma. Experience counts in such situation and there is no doubt that South African doctors experience far more major trauma than New Zealand doctors (the same is true for US emergency doctors who have worked in city trauma units). Rural areas love South African doctors, because they can usually do almost any procedure imaginable and are highly autonomous. This, of course, gets SA doctors into trouble with the HDC and, occasionally, medical council, disproportionately often. A cursory glance at these complaints will show that the vast bulk are extremely minor, bearing out that these doctors are “as good as Kiwi ones” but, perhaps, not as cautious.

New Zealand is very reliant on foreign-trained doctors. This is not likely to change any time soon. By the time they have passed through the registration system, there is no doubt that these doctors are every bit as good as their kiwi-trained counterparts. But they are not the same and probably never will be the same. This is only a problem if we let xenophobia dictate our choice of doctor.


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