Medicine

Profession-specific analysis for Medicine, Health Workforce Plan 2024

Resident medical officers (RMOs, or junior doctors), who start their careers as House Officers, and then become registrars as they progress through their vocational training. Vocational training is by specialty, and ranges in duration; though six years is a standard requirement. RMOs typically work by ‘runs’ in different services, usually lasting between 3 and 6 months.
Senior medical officers (SMOs, consultants or specialists), who are often vocationally registered with a medical college. Specialties might be focused on a particular type of care (like cardiothoracic surgery or renal medicine), on a care setting (like general practice or rural hospital medicine) or a population group (such as paediatrics or geriatrics).

Unlike other workforces, there is a cap on how many doctors we can train in New Zealand – set at 614 as of the start of 2025. The cap was recently increased by 50 in 2024 and by a further 25 in 2025; around an additional 120 are expected to be added over coming years with the launch of new medical school capacity.

This added capacity will have a significant impact on the future sustainability of our medical workforce, and is not yet accounted for in our current workforce models.

	Today Our estimates of current FTE shortages across the health sector, based on current ways of working, are around:		By 2033 Based on current trends, models of care and technology, if we do not change how we work, we estimate that by 2033 we would need additional FTE across the health sector of around:
All doctors*	+1,810	8.5% of our total need	+3,440	14.5% on top of current pipeline
GPs	+220	6.1% of our total need	+870	25.5% on top of current pipeline
SMOs excluding GPs	+1,140	12.2% of our total need	+530	5.5% on top of current pipeline
RMOs	+450	4.2% of our total need	+2,040	19.2% on top of current pipeline

*Note: does not include dentists

Trends in medicine

Based on the data available to us, and based on current service models, we seem to have the greatest workforce gaps in psychiatry, dentistry, dental and oral surgery, oncology, haematology, cardiology, and radiology (where we think our data omits significant shortages). There are also smaller specialties facing acute strain, such as gynaecological oncology and dermatology.

On top of this, we expect additional demand over the next decade as our population and workforce age. We to need to grow our RMO workforce (owing to relatively low historic increases in medical student capacity), and unmatched demand growth in general medicine, radiology, pathology, and a range of surgical specialties.

Because of the nature of medical practice, our medical workforce also faces unique challenges, such as:

Some medical professionals have intense on-call responsibilities, which require appropriate staffing if we are to make these specialties attractive to RMOs choosing where to specialise.
Many doctors practice across the public and private sectors – meaning we need to maintain a good experience of work to retain our doctors’ capacity in the public system.
When we outsource the delivery of care to the private sector, our RMOs at times find it hard to get the exposure they need to progress in their training.

Doctors receiving their first annual practising certificate by year

	Today Our estimates of current FTE shortages across the health sector, based on current ways of working, are around:		By 2033 Based on current trends, models of care and technology, if we do not change how we work, we estimate that by 2033 we would need additional FTE across the health sector of around:
All doctors*	+1,810	8.5%		14.5% on top of current pipeline
SMOs (excl. GPs)	+1,140	12.2%		5.5% on top of current pipeline
General medicine	+40	10.5%		17.5% on top of current pipeline
Rural hospital medicine		Insufficient data available
Adult medical specialties	+130	7.4%		N/A – 4% growth est.
Emergency medicine	+40	9.5%		N/A – 36% growth est.
Intensive care	+40	20.6%		3.5% on top of current pipeline
Urgent care		Insufficient data available
Paediatrics	+40	8.0%		N/A – 25% growth est.
Gastroenterology	+18	10.4%		N/A – 11% growth est.
ENT	+17	10.4%		14.3% on top of current pipeline
Obstetrics and gynaecology	+60	13.8%		N/A – 7% growth est.
Urology	+15	13.3%		4.9% on top of current pipeline
Cardiology	+40	14.9%		N/A – 4% growth est.
Dermatology	+17	18.8%		12.5% on top of current pipeline
Psychiatry	+210	23.4%		11.6% on top of current pipeline
General surgery	+30	6.1%		13.6% on top of current pipeline
Orthopaedic surgery	+50	10.4%		6.2% on top of current pipeline
Plastic and reconstructive surgery	No current modelled shortage			13.7% on top of current pipeline
Cardiothoracic surgery	+4	7.6%		16.8% on top of current pipeline
Vascular surgery	+3	6.6%		35.1% on top of current pipeline
Neurosurgery	+4	10.3%		26.1% on top of current pipeline
Paediatric surgery	+2	5.4%		N/A – 2% growth est.
Anaesthetics	+130	10.6%		2.6% on top of current pipeline
Ophthalmology	+20	10.0%		11.2% on top of current pipeline
Medical oncology	+14	10.9%		N/A – 16% growth est.
Radiation oncology	+5	5.7%		6.8% on top of current pipeline
Radiology (incl. interventional)	+90	13.6%		13.9% on top of current pipeline
Pathology	+30	7.8%		14.7% on top of current pipeline
Clinical haematology	+13	14.4%		No model available
Public health medicine	+20	9.4%		9.3% on top of current pipeline
General practitioners (GPs)	+220	6.1%		25.5% on top of current pipeline
RMOs	+450	4.2%		19.2% on top of current pipeline

*Note: does not include dentists.

Understanding medical specialties

Each medical specialty is unique – and the sustainability of our medical specialties is tied closely to the sustainability of services. Because doctors take so long to train, and we have lower control over training volumes, it is hard to replace or add capacity to our medical workforce when we discover that we need it.

For the purposes of this Plan, we’ve considered three clusters of medical specialties as a way to look at specialisations systematically:

Specialist generalists

Including general practice, general medicine, general surgery, rural hospital medicine, psychiatry and geriatrics.

Because of New Zealand’s size and shape, we often need more generalist workforces than larger countries, particularly those with more densely packed urban areas. With many New Zealanders living rurally or provincially and a relatively small population overall, more generalist specialties are essential to ensuring everyone gets the care they need.

This doesn’t mean these doctors aren’t specialists – but rather that they specialise in a wider range of care than other specialists.

While we are still working on hospital networks and future models of care, we know with confidence that we will need more generalists and need to start growing them now. We’ll need these relative generalists to:

Deliver more care in rural and provincial centres, where it may not make most sense to employ full-time specialist teams. We already have models of this working in place, like with rural generalists on the West Coast of the South Island.
Manage growth where population aging will impact demand, like in palliative care.
Support wrap-around care for people who have a range of complex conditions – and so need doctors with a range of expertise.

Larger specialties

Including cardiology; oncology; renal medicine; endocrinology; orthopaedics, vascular, plastic and cardiothoracic surgery; anaesthetics; radiology; pathology; and paediatrics.

Our large specialties have several advantages in their sustainability. They have historically received larger increases to training volumes than other specialties, and have tended to receive more interest from junior doctors choosing where to specialise – in part because relative specialisation is seen as more prestigious in some places, and because most medical students and House Officers get some exposure to larger specialties.

This means our larger specialties tend to have relatively accurate workforce data with reasonable matching of training capacity to need. In many of our large specialties there are opportunities to improve models of care to make better use of technology, and generalist medical and allied workforces, to reduce future capacity which might otherwise overwhelm these services (for example, our aging population is likely to create mounting load on vascular and neurosurgery).

Not all large specialties are in the same position – radiology, notably, has faced particularly acute demand growth as scanning volumes have grown driven by the advent of new scanning technology.

Smaller specialties (and sub-specialties)

Including dermatology; rheumatology; immunology; gynaecological oncology; maternal-foetal and neonatal medicine; dental, oral and maxillofacial surgery; sexual health medicine; and clinical genetics.

In the same way that New Zealand’s size drives the need for generalists, it also means that some of our specialties and sub-specialties are very small. This often manifests in services which are reliant on small numbers of people, and where the decisions of individuals (for example, to retire or move overseas) can have a big impact on service sustainability.

Many of our smaller services need a thorough look at our models of care and the service delivery models we use to deliver national services – though the nature of these reviews will vary by specialty. For example:

In some areas – like dermatology, immunology and sexual health medicine – we don’t have strong models for public provision, resulting in low levels of care and fragile workforce capacity.
Other areas require better national network design – such as neonatology – to ensure we make best use of capacity across our national network to provide the right level of specialist care.

The opportunity

Our medical workforce needs to adapt to demand which we know is coming because of trends in population aging and the burden of disease caused by long-term conditions. By 2033 we expect to see a significant increase in demand on our medical workforce, unless something changes. This is driven by two factors:

Relatively constrained domestic medical supply – and mounting global competition for doctors. We have already taken good steps to address this, with commitments to grow medical intakes by nearly 200 through increases to current medical school cohorts and through new medical capacity.
Areas of misallocation of our specialist capacity against areas of future need. This is a very complex challenge with many facets:
- Training capacity often reflects historic DHB service needs and local decisions about which services need more training capacity. We could do more to match training volumes to future demand, which would close the gap between specialties looking at different levels of future sustainability.
- There are opportunities to make our training of specialists more efficient, including to retain junior doctors before stepping up into SMO roles (for example, by making guaranteed offers of employment before RMOs go overseas on fellowship); and to maximise the capacity of our training pipelines.
- As we reorganise around hospital networks, the level and type of care we deliver in different centres will change to get the right level of specialisation across tertiary, secondary and primary care. This might change some expectations about the relative level of specialisation needed to provide New Zealanders with great care at different sites. We think this will result in us needing more general medics, general surgeons, rural hospital medicine specialists and interventional radiologists than population trends would suggest – among other specialties.

Model of care change offers opportunities to use our medical workforce more efficiently, too. These can make better use of relatively generalist medical workforces, or of nursing and allied workforces like nurse practitioners and advanced scope radiation therapists.

What will it take?

For the coming three years, our priorities for our medical workforce are:

Growth in small, “easier-to-help” specialties. We have a handful of specialties – like dermatology and gynaecological oncology – where we train relatively few doctors. In these areas, adding capacity to train even one or two more doctors a year can fundamentally change our future workforce picture, so we’re going to get on with making those changes now.
Needed growth while we work on models of care. As our population ages and technology improves, and as global competition for medical workforce mounts, we will have to seize opportunities to work differently. We want to start the process of reshaping those models of care now, starting with areas which are ripe for improvement – including those where the impact of our current workforce state has the greatest impacts on flow and patient outcomes. Alongside this early shift, there are areas where we know growth will continue to be necessary to meet population demand – such as in general medical workforce – which we want to continue prioritising as non-regrettable investment in our workforce capacity.

We want to start the process of reshaping those models of care now, starting with areas which are ripe for improvement – including those where the impact of our current workforce state has the greatest impacts on flow and patient outcomes.

Improving the experience and pathways of our resident doctors. We lose too many of our RMOs overseas for reasons which are avoidable. We want to stem that flow by focusing on our junior doctors’ experience of work, and ensuring we get them the training they need, and into SMO roles when they’re ready.

Longer-term, we will need more domestic training to get sustainability in our medical workforce. New Zealanders trained here are much more likely to stay working here – or to come home after working overseas:

Increases in the number of medical students we train here will make a big difference. From 2029 New Zealand will graduate an additional 50 new RMOs; another 50 from 2030; and another 120 from 2031 (subject to the establishment of a new medical school or equivalent capacity). This will address around 40% of the enduring, additional capacity we need in the system.
Long-term, we will need even more domestic medical capacity. Establishing new medical school capacity will allow us to better scale over time. As a nation, we will either need to continue expanding our medical capacity – or get much more competitive against comparator jurisdictions in poaching overseas medical talent.

Action	What we'll do
1.8 Continue improving reimbursements	Where we fund our staff’s practising fees, move to pay these directly; and reduce our average processing times for large reimbursements.
1.9 Plan medical training capacity nationally	Develop a national map and adopt national planning of medical training volumes, so we can align future increases in training numbers to specialties where need is greatest.
2.1 Adapt specialist models of care	Review models of care and service delivery models across priority specialist areas, including dermatology and radiology, and get started implementing improved models. Add 50FTE of additional SMO capacity to services that need it, to support innovation and sustainability, and to drive improved specialist models of care.
3.5 Grow our GP and community medical workforce	Establish a new primary care pathway for House Officers, offering 50% of runs in community settings. Move to publicly employ public health medicine and rural hospital medicine registrars to smooth their employment pathways and reduce attrition. Continue to target 300 GP trainees into the GP Education Programme (GPEP) as an annual intake. Support the development of new medical school clinical placements in line with business case processes. Support community initiatives targeting local workforce sustainability in hard-to-staff areas.
4.1 Focus international recruitment	Target international recruitment investment at our most severe workforce demands, and areas of insufficient domestic supply.
4.2 Expand medical training in vulnerable specialties	Offer employment to all New Zealand-trained new medical graduates from 2026, including international students who want to work in New Zealand. Establish a pool of funding for small, vulnerable specialties to support training sustainability – including dermatology, rheumatology and gynaecological oncology. Add 5 radiology and 6 dental advanced training roles in Health NZ services. Establish new House Officer runs in high-need specialties such as psychiatry. Grow to 50 psychiatry training roles in Health NZ services from 2025 onwards.
4.5 Create private training capacity	Reach agreement with our major private providers of public health services (e.g. private hospitals delivering public surgical lists) to allow training in private settings, with consistent terms.
4.6 Make better use of overseas-trained staff	Continue to support 10 NZREX doctors per year through each of the Primary Care Pathway and NZREX Bridging Programme.
4.7 Keep our people while on fellowship	Make advanced employment offers for Health NZ health workers going overseas for vocational training, where we know we will have national need by the time they return.
5.7 Establish rural training hubs	Establish three rural training hubs at sites across New Zealand, employing long-term rural placements for students.