title: The rural hospital doctors workforce in New Zealand.
abstract: BACKGROUND
  The sustainability of New Zealand's rural hospitals has been in question for some years. Increasingly, clinical services have been centralised and specialist staff have moved to bigger centres. As well as clinical services, the governance of these hospitals has shifted, often due to a shortage of vocationally registered medical practitioners available to lead the clinical services. In 2009 the Medical Council of New Zealand (MCNZ) approved a new vocational scope of practice in Rural Hospital Medicine (RHM). The present study was designed to establish the current composition of the rural hospital medical workforce at the introduction of this new scope of practice.
  
  
  METHODS
  This study was a 2009 cross-sectional survey of rural hospitals approved for RHM training by the MCNZ. Hospital managers were surveyed using a mailed questionnaire. All medical practitioners providing medical care in these hospitals in 2009 were identified, and each was mailed an additional questionnaire.
  
  
  RESULTS
  In all, 28 rural hospitals and 107 medical practitioners who provided clinical services were identified; 28 responses (100%) were received to the hospital managers' survey and 69 responses (64%) to the doctors' survey. The managers' survey revealed a shortage of medical practitioners and significant use of locum staff. The workforce had a median age of 47 years, was predominantly male (75%) and principally trained overseas (68%), and 54% was vocationally registered. A proportion of the hospitals (35%) did not have a recognised clinical leader or an active process for credentialing new medical staff.
  
  
  CONCLUSIONS
  The findings were not unexpected but do quantify the shortage of medical practitioners and the governance issues facing small rural hospitals in New Zealand. The scope of RHM has the potential to attract new doctors into practice, providing greater stability and clinical leadership for these important facilities. The study provides a baseline for a future evaluation of the effectiveness of the introduction of the new scope of practice.
authors.affiliation: University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand. Ross.Lawrenson@waikatodhb.health.nz
authors.forename: Ross A
authors.initials: RA
authors.lastname: Lawrenson
authors.forename: Garry
authors.initials: G
authors.lastname: Nixon
authors.forename: Robin H
authors.initials: RH
authors.lastname: Steed
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010820:Physicians / Q000600:supply & distribution*; D012423:Rural Health; D011795:Surveys and Questionnaires; D000078329:Workforce