Health of the Health Workforce

Midwives

The supply of midwives has improved, but there continue to be workforce shortages, especially in rural areas. Demand for senior midwives is still very strong, with an ongoing reliance on overseas-trained practitioners.
As at 31 March 2013, there were 3072 midwives with annual practising certificates on the Midwifery Council of New Zealand’s register – up from 2823 in 2009. At that date, there were 33.6 midwives per 10,000 women of childbearing age, up from 2009’s ratio of 30.9.
Fewer babies are being born in New Zealand. Statistics New Zealand figures show 58,717 live births in 2013 and 61,568 in 2012, down from annual averages of about 64,100 between 2007 and 2010.
Table 3: Midwifery workforce statistics

Midwifery workforce*
Size	Age 50+	Gender split	Ethnicity^	Workplace#	Qualified outside New Zealand
3072	42.4%	Female 99.8% Male 0.2%	European 88.9% Māori 5.2%	DHB employed 54% Self-employed LMC 32%	34%

* Annual practising certificates, 31 March 2013, and the Midwifery Council’s September 2012 survey.

^ This figure relates to primary identified ethnicity.

# Main place of employment.
Midwifery is an almost exclusively female profession, with just six men in the workforce as at 31 March 2013. Three are self-employed lead maternity carers (LMCs),¹⁹ and three are hospital employees working shifts in maternity units.
Other figures in this section are from the Midwifery Council’s September 2012 workforce survey – the most recent available – unless otherwise stated.
The average age for midwives in 2012 was 46.8 years, down from 47 in 2009 and 47.2 in 2010. Almost six in 10 midwives (58%) had been in practice for more than 15 years, and about four in 10 midwives (42.4%) were aged over 50.
The age profile for midwives is slowly changing, in part due to an increase in student numbers enrolled in midwifery degrees in New Zealand. The proportions of midwives aged 20–24 and 25–29 have risen since 2010, when 126 new midwives – the first graduates of the expanded student intake – joined the workforce, compared with the previous annual average of 106. Graduate numbers have risen steadily since then, up to 147 in 2013/14. Midwifery is a profession that traditionally attracts older trainees, but midwifery schools report that the average age of students is falling.
The percentage of midwives identifying Māori as their first ethnicity in 2012 was 5.2 percent, up from 4.6 percent in 2009. Māori midwives are in demand, particularly in rural areas, where anecdotal reports suggest workloads are rising due to the increasing expectations of whānau.²⁰
About four in 10 midwives (42%) worked 32 hours a week or less in 2012 (0.75 FTE based on a 40-hour week) – a slight rise on 2009’s figure of 39.8 percent.²¹ That year LMC midwives cared for an average of 42 women a year. The recommended caseload is 40 to 60.
Midwives provide the majority of maternity services in rural areas, either as self-employed LMCs – who may travel from the nearest city – or as core midwives, who work shifts in hospitals.
About two-thirds of practising midwives work in the North Island, where a number of DHBs report staff shortages, according to the Midwifery and Maternity Provider Organisation’s (MMPO) annual workforce mapping project.²²
Figure 6: Hard-to-staff communities for midwives on the 2015 Voluntary Bonding Scheme


The South Island’s workforce is more stable, but rural communities across the country are vulnerable to shortages should a midwife retire or leave the area. It can take up to two years to recruit a replacement – especially if an experienced midwife with a large caseload departs. The Voluntary Bonding Scheme signals hard-to-staff communities for midwives – see Figure 6.
The MMPO’s mapping project found the number of hospital midwives dropped by 99 in the two years between 2011 and 2013, down from 1444 to 1345. This was in part due to some midwives in rural areas choosing to become self- employed LMCs.
Overseas-trained midwives made up 34 percent of the midwifery workforce in 2012 (down from 36.6 percent in 2009). The majority were from the UK, followed by Australia.
New Zealand graduates tend to stay in the workforce longer; a number of overseas-trained midwives come to New Zealand for international experience or a working holiday.

Allied health workers

There are more than 40 professions in the allied health, science and technical workforce,²³ which includes those who provide technical and scientific expertise to support the diagnosis, monitoring, management and treatment of health conditions.
This workforce is becoming critical for addressing health targets, especially the diagnosis of chronic and non-communicable conditions such as cancer and heart disease.
About 20 allied health professions are regulated under the HPCA Act 2003. A list of these professions can be found in Appendix 4.
Table 4: Allied health workforce statistics

Allied health workforce
23,966* in professions with annual practising certificates, for example:
555	dietitians	(527 in March 2009)
607	dental hygienists	(403)
791	dental therapists	(670)
1706	medical laboratory scientists	(1621)
169	magnetic resonance imaging (MRI) technicians		(77)
2296	occupational therapists		(2095)
661	optometrists		(675)
3351	pharmacists		(3076)
4265	physiotherapists		(4016)
538	psychotherapists		(502)
348	radiation therapists		(281)

* Annual practising certificates as of 31 March 2013 (the most recent information available), unless otherwise stated.
Workforce data tends to be scarce, particularly for the professions not regulated under the HPCA Act. (Self-regulation does not imply a lack of professional standards in comparison to professions regulated by this legislation.)
Many occupational groups in the allied health workforce are small, numbering in the tens or hundreds, and work autonomously or behind the scenes. This may contribute to a perception among allied health workers that their roles do not feature strongly when service delivery plans are developed.
These professions can quickly become vulnerable because of their small size and extended periods of training. Risk factors include:

staff leaving the workforce

a lack of training courses or positions

technological advances, which may require additional training.

For example, there are about 20 perfusionists in New Zealand. During operations such as open-heart surgery, a perfusionist uses a machine that takes over from the heart and lungs to pump oxygenated blood through the body. If just one leaves the workforce, there will be a disproportionate impact on the delivery of health services.
A number of allied health professions appear on Immigration New Zealand’s long-term skill shortage list. Because there are too few home-grown professionals to fill vacancies in these professions at present, the percentage of overseas-trained practitioners tends to be high.
To address some critical shortages, sonographers, medical physicists and radiation therapists are included in 2015’s Voluntary Bonding Scheme (VBS). To be eligible for the VBS’s annual incentive payments, allied health applicants must work in New Zealand for three to five years. See www.health.govt.nz for more details.
Rapid scientific and technical advances mean new allied health careers are likely to arise in coming years, or existing roles will be transformed. Providing viable education and training programmes is likely to become a challenge.
HWNZ is developing an allied health taskforce and work programme, alongside work already under way to streamline training. See our companion report, The Role of Health Workforce New Zealand, for more information on the new multi-disciplinary framework for a number of allied health qualifications.
A particular challenge facing this workforce is that school students are typically unaware of the wide range of health careers. The majority think only of medicine or nursing, or of well-known allied health professions such as physiotherapy or dental hygiene.
More Māori and Pacific dental therapists working with children in deprived areas – in which proportions of Māori and Pacific peoples are typically higher – may help to address the inequalities in oral health and access to services identified in the 2009 New Zealand Oral Health Survey.²⁴
For information on dentists, see the Medical workforce section.