Dermatology Workforce Service Forecast

Current New Zealand Dermatology workforce

Dermatologists

Dermatologists are medical doctors. In New Zealand, after completing six years of medical school, the trainee dermatologist must complete a general medical training programme, which usually takes 3 to 4 years. After a rigorous basic physician training examination, Fellow of the Royal Australian College of Physicians (FRACP), he or she is then eligible to enter advanced training.

The advanced training in dermatology involves at least a further four years of intensive study, research and practice in a variety of approved training centres in New Zealand and overseas. The position is usually that of a registrar or training fellow who is closely supervised by experienced dermatologists.

As of November 2013, there are five training positions in New Zealand (two each in Auckland and Waikato DHBs, and one at Counties Manukau DHB). It is expected that two years of the required four will be spent overseas (usually UK, USA, Australia or Canada). In total, a dermatologist has a minimum of 13 years of training before becoming vocationally registered with the Medical Council ^xv.

A study of the work types of medical doctors in New Zealand carried out by HWNZ in 2009, notes the average hours worked and the average age of practitioners across all doctors.^xvi
The average age for all doctors was 44 years, with dermatologists having an average age of 51 years. The average hours worked by all doctors was 43 hours per week, with dermatologists working an average of 40 hours.
Nine of the practising dermatologists in New Zealand are overseas trained (six in UK, two in USA and one in Canada). Only one of these studied medicine as an undergraduate in New Zealand, the remainder immigrated to New Zealand later in their careers and all are middle aged. This a relatively small proportion compared to other specialties.
A survey of the dermatological workforce carried out in 2010 by the New Zealand Dermatological Society Incorporated (NZDSI) was completed by 85% of those invited to participate. This survey showed that even though 53% of the New Zealand population lives in 4 urban centres; Auckland, Hamilton, Wellington, Christchurch; 75% of dermatologists live in these cities. Most dermatologists carry out a mix of private and public work and are often working in a number of settings - 66.3% of respondents who work in public stating that they worked in two or more public hospitals sites and 51.1% reporting that they worked in two or more private settings.
Dermatologists were providing between < 1 and 9 half-day (~4hrs) private sessions per week and between <1 and 8 public hospital sessions per week.
32.1% of respondents stated that they were planning to reduce their hours, retire or move overseas in the next 5 years, with 20.8% stating that they are planning to increase their hours.^xvii
Requests to all of the DHBs as part of the workforce service forecast demonstrated the distribution of the dermatology workforce across the country. This showed that all DHBs were providing some dermatology services, but often this work was provided by visiting specialists, locums or through private contracts. By looking at publicly funded dermatology by FTE (Fig 1), the limited provision and therefore public access to dermatology is clearly shown, with a ratio of 1:274 146 across the country (based on the current population of 4 496 000 and adding FTE and part time work together, giving a national FTE of 16.4).


2 clinics per month

Population 103 170

Figure 1: Distribution of Dermatologists by DHB (as at Sept 2013)

1.2 FTE

Ratio 1: 562 970

2.3 FTE

Ratio 1: 224 200

2.2 FTE

2.5 FTE

Ratio 1: 149 000

1 FTE

Ratio 1: 110 258

1 clinic per month from Mid-Central

Population: 62 210

1.2 FTE

Ratio 1: 250 000

12 clinics pa

Population 33 055

0.3 FTE

Ratio 1: 533 000

3.1 FTE

Ratio 1: 187 760

0.4 FTE

Ratio 1: 537 000

7 days (14 clinics) pa

Population 46 753

0.3 FTE (locum)

Ratio 1:820 000
6 clinics per month

Ratio 1: 170 200

0.4 FTE

Ratio 1:355 000

2.1 FTE + 0.6 FTE (MO)

Ratio 1: 188 837

Sub contracted to private 53 First Specialist Appointment (FSA) (2012/13)

Population 56 695

78 clinics per annum

Population 154 514

0.5FTE (on contract)

Ratio 1:72 607

Data provided from dermatologists and staff at each DHB. Population data from Ministry of Health http://www.health.govt.New Zealand/new-zealand-health-system/my-dhb (Last accessed 19.11.13)

Dermatology Nurses

Dermatology nursing in New Zealand does not have a defined definition or scope of practice. There is currently no specific dermatology training or qualification for nurses in New Zealand and experience is gained through on the job training and practice.

There is one practicing Dermatology Nurse Specialist in the Dermatology Clinic at Christchurch Hospital.
The Nursing Council does not have a training pathway to be called a Nurse Specialist in Dermatology. Most employers would expect a nurse in that position to have or be working towards a Master degree or equivalent qualification.^xviii Individual DHBs may have positions for Speciality Clinic nurses, but these are defined by standards and criteria determined by each DHB.
Specific dermatology nurses work in a range of clinical settings across New Zealand. (See Figure 2)
An article in the International Journal of Dermatology (2011) ‘argues for the need to develop a service delivery model in dermatology care that utilizes specialist- nursing expertise to cascade dermatological knowledge and skill through primary care… The paper specifically focuses on the development work led by the International Skin Care Nursing Group (ISNG) to stimulate and develop the capacity of nursing to respond to these widespread needs through promoting service delivery models that operate interdependently with dermatologist-led care.’ ^xix
The New Zealand Dermatology Nurses Society (NSDNZ), a recognised formal organisation, was discussed at the inaugural dermatology nurses and allied health professional’s conference in 2006, and the society was incorporated in January 2010. The NZDNS currently has 54 members and organises conferences and events as well as supporting and sharing information.
Figure 2: Distribution of Dermatology Nurses by DHB (as at Sept 2013)

DHB	Dedicated dermatology nurse
Auckland	Dedicated RNs 1.2FTE Non nursing phototherapy 0.6FTE
Canterbury	Dedicated nurse specialist 1 FTE General nurse trained to undertake phototherapy 0.4FTE
Counties Manukau	Dedicated RN 0.5FTE Dedicated HCA phototherapy 0.6 FTE

DHB	Number of Dedicated dermatology nurses
Northland	Nil
Waitemata	North Shore: Dermatology General Outpatient nurse rostered to Clinic Waitakere: 0.05FTE Outpatient nurse for dermatology clinic
Waikato	3.7 FTE
Lakes	General Outpatient nurse 0.05FTE
Tairawhiti	General nurse 0.025 FTE
Taranaki	General Outpatient nurse 0.07FTE
Hawkes Bay	General Outpatient RN 0.3FTE
Whanganui	General Outpatient nurse 0.025 FTE
MidCentral	General Outpatient RN 0.15 FTE
Capital and Coast	General Outpatient nurse 0.375 FTE
Hutt	General Outpatient nurse 0.75 FTE
Wairarapa	Nil
Nelson Marlborough	General Outpatient RN 0.1 FTE
West Coast	General Outpatient enrolled nurse 0.05 FTE
South Canterbury	Subcontracted to private provider
Southern	General Outpatient RN 0.25 FTE for clinical and 0.4 FTE for phototherapy Health Care Assistant covers for absence

General Practitioners

In New Zealand, GPs provide most dermatologic services, with one in six (15%) of all visits to the GP involving a skin problem.^xx

Several reviews have been carried out looking at the role of GPs in carrying out surgical removal of skin lesions, including a scheme in Auckland, involving 21 accredited GPs carrying out 1200 procedures annually. In addition, the Southern Primary Health Organisations scheme allowed for 350 procedures to be carried out by GPs in 2011/12 and is looking to fund a similar number of procedures in 2012/13.
A GP can advertise their services as a skin specialist, without any recognised training, or achievement of dermatology standards equivalent to vocationally registered dermatologists. This is an anomaly compared to other specialties and can be confusing for patients to determine where dermatology expertise lies. GPs also do not have the same requirements of Continuing Professional Development for dermatoses as dermatologists.

Pharmacists

Pharmacists provide advice and over the counter treatments for skin conditions and are often the first health care professional that patients consult. In addition to this, hospital pharmacists may be involved in the treatment of inpatients.