How do New Zealand‐trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

Abstract

Background In the context of increasing shortages in the New Zealand medical specialist workforce, this research seeks to answer the question ‘Are we effectively retaining our New Zealand‐trained general surgeons?’ Methods Semi‐structured interviews were undertaken with 16 general surgeons. Participants work in New Zealand and internationally. Interviews were transcribed, coded and themed. Thematic analysis was used to interpret the findings. Results This research finds that we are failing to effectively retain New Zealand‐trained general surgeons through haphazard workforce planning and a lack of transparent recruitment processes. General surgeons who choose to take their first SMO role overseas are pushed to do so due to a lack of certainty about job opportunities in New Zealand, bullying, and relative ease of negotiation for job composition and conditions at international hospitals. General surgeons who take their first SMO role in New Zealand feel that securing a job is down to luck, existing relationships with influential people in surgical departments and timing. Conclusion The failure to retain New Zealand‐trained general surgeons in the New Zealand specialist workforce is amenable to improvements in workforce planning, improved coordination between clinical and administrative leadership in DHBs, and better career development support for trainees prior to receiving their FRACS and embarking on post‐fellowship subspecialist training. Further research into the experiences of trainees and SMOs in general surgery and other surgical subspecialties is required to build a complete picture of the path from trainee to SMO, and areas where interventions could improve retention of New Zealand‐trained general surgeons.

What are heads of department looking for in new general surgeons in Aotearoa New Zealand?

“…Previous evidence suggests recruitment processes are perceived as obscure and candidates feel outcomes depend on luck, relationships and timing. 11 The findings of the current study provide insight into the selection process, helping trainees make informed decisions regarding their surgical training pathway. They can also assist general surgery departments in training and selecting candidates for consultant positions and provide opportunities for centralized workforce planning.…”

“…11 There is evidence AoNZ is failing to retain AoNZ-trained general surgeons due to poor workforce planning and a lack of transparent recruitment processes. 11 . Consultant surgeon appointments depend on local or employer preferences, which may be opaque, inconsistent, and even biased.…”

“…Consultant surgeon appointments depend on local or employer preferences, which may be opaque, inconsistent, and even biased. 11,12 Consequently, a trainee who tailors their training to a specific job may find themselves ill-qualified for other opportunities. Varying opinions on the value of Royal Australasian College of Surgeons (RACS)-endorsed Post Fellowship Education and Training (PFET) programs and the different skillsets required by tertiary and secondary centres further complicate matters.…”

Surgical selection and Goodhart's law: have we got it right?

“…I ask this question because in this issue, Espiner et al describes the attrition rate of surgical trainees from the Aotearoa New Zealand workforce. 7 The selection process is considered part of the problem. They report that the numbers of medical graduates leaving Aotearoa New Zealand within 5 years of graduation is as high as 10%, considered amongst the highest of OECD countries.…”

“…I ask this question because in this issue, Espiner et al . describes the attrition rate of surgical trainees from the Aotearoa New Zealand workforce 7 . The selection process is considered part of the problem.…”