When I think of an unhappy workforce, what usually comes to mind are those in jobs with low job satisfaction – not the highly trained and motivated people working in medicine.

An unhappy workforce is usually due to poor pay or work that's repetitive or uninteresting. Unhappy workers feel devalued.

Surely, there can be few more satisfying jobs than practising medicine. Those working in medicine are highly driven. They generally spend around 13 years training before being vocationally registered.

Doctors in GPs and hospitals make a huge difference to their patients' quality of life – curing or managing chronic illnesses. In the extreme, their work can be the difference between life and death.

This responsibility is demanding and often stressful, but it's also enormously satisfying. Every day, doctors can see the difference they make to their patients, thanks to their commitment and skills, even when they find it emotionally draining.

Health systems can’t perform well if their doctors, nurses and other health professionals find their working environment unsatisfying. These everyday heroes are all part of the glue that holds health systems together.

Alarming survey results

That's why we should be alarmed by the release of the results of a survey of doctors run by Women in Medicine. A little more than half of the under 1,000 respondents were GPs, and a little fewer than half were doctors in the hospital system. 

Despite only being formed recently, Women in Medicine has proved to be an impressive, active and rigorous body, and I trust this survey's results.

The fact that it only surveyed female doctors doesn't detract from the results, in my view. There's no reason to believe male doctors would have answered any differently.

The survey showed widespread malaise, exhaustion and low morale among the medical workforce, who felt ignored over how the health system restructuring was introduced and runs. 

Unsurprisingly, they were not optimistic about the future.

Deteriorating working conditions

The overall conclusion was that doctors rate their working conditions as either no better or worse than when Te Whatu Ora – Health New Zealand took over from district health boards on July 1, 2022, with the coming into force of the Pae Ora Act.

But large numbers of general practitioners (55%) and hospital doctors (71%) said their working conditions were either "worse" or "much worse" now than before July 2022.

Only 6% of GPs and 11% of hospital doctors said they'd seen any improvement. Very few expected working conditions to get any better over the next year.

Disengaged

The survey asked respondents to agree or disagree about whether they had been “given an opportunity to give feedback” on the health reform process in their area of work.

Of the GPs, 87% disagreed with the statement, and 5% agreed with it. For hospital doctors, 76% disagreed, and 14% agreed. Those who neither agreed nor disagreed were 20% and 30%, respectively.

The difference in responses between GPs and hospital doctors is likely due to hospital doctors working in much larger workplaces and teams, with GPs being structurally more distant from Te Whatu Ora.

For both groups, the kindest assessment of the reform process was unflattering to its designers and leaders.

Both GPs and hospital doctors agreed the biggest immediate needs were addressing staff shortages and funding. No surprises there.

From scepticism to disillusionment

In its conclusion, the authors of the survey report said: "There is a sense the workforce is becoming disillusioned and increasingly lacks faith in the ability of the reforms to deliver change."

I disagree with this, but only because it's an understatement. I believe this reform process was seen by many as being like shuffling the deckchairs on the Titanic.

Let's talk about why this is.

In April 2021, health minister Andrew Little surprised the health system by announcing that district health boards would be replaced by Te Whatu Ora – Health NZ less than 15 months later.

There had been no prior discussion or consultation with the health system or the public. It was simply announced as if it were a decree. Effectively, it was. DHBs weren't in a position to give their advice on the announcement or talk about what its implications might be.

Their scepticism was reinforced by the government marginalising those with health system experience. Instead, it relied mainly on consultants to design the new system. That was a fatal error.

Scepticism that was turning to disillusionment just got worse when the restructuring was put in place in the middle of the covid pandemic in July 2022.

Our hospitals and the rest of the health system were already under severe pressure. Dismantling DHBs without anything set up ready to replace them made the government's claims that they were protecting hospitals hollow, in hindsight.

When the debacle actually started

The starting point for this debacle was not the setting up of Te Whatu Ora in July 2022, it was not when Andrew Little announced the abolition of DHBs in April 2021 and nor was it the arrival of covid-19 in early 2020.

Instead, it was the failure of the newly elected Labour-led coalition government in 2017 to tackle the three most serious pressures on the health system:

  • Severe staff shortages.
  • Rising acute patient demand (leading to 100% hospital occupancy).
  • A divisive top-down leadership culture from the ministry of health.

Rather than address these pressures, the government focused on restructuring. This was despite plenty of past experience showing that restructuring doesn't improve health systems. Infinitely more important is changing the culture.

So, nearly six years later, we have:

  • Worse staff shortages.
  • Acute patient demand still going up (leading to even more hospitals fully occupied).
  • The same health ministry culture replicated but made even more top-down under Te Whatu Ora's centralised services.

These survey results are a powerful message that doctors who are central to the delivery of health services have a complete lack of confidence in the restructured health system and its leadership. 

Given the circumstances in which they find themselves, how could they not be?

This survey is depressing to read, but we all should be grateful to Women in Medicine for confirming what we already suspected and bringing it out into the open. 

Those of us who fund health through our taxes value and depend on our health system – and we deserve to know this.

There's everything to suggest that the outcomes for a similar survey of nurses or other health professionals would be just the same as those of the doctors'. 

Does our health system have the unhappiest workforce in NZ? We've just answered that question.