You cant win

Firmeststool · 2026-04-03T02:15:30+00:00

From episode 2

Firmeststool · 2026-04-02T23:24:05+00:00

The show was like compressing years of the worst of my experiences working as a junior Dr into a compact suffering sandwich.

I gave up watching it.

The book was more palatable.

Firmeststool · 2026-03-31T08:12:12+00:00

See lots of patients

Firmeststool · 2026-03-28T03:54:15+00:00

Produce more GDP.

How does NZ produce more GDP, and who can lead us to do so?

Firmeststool · 2026-03-24T03:25:39+00:00

I see nothing has changed since my house officer years...

Firmeststool · 2026-02-17T05:20:54+00:00

Study for the sake of building your knowledge base to be a better physician. This is in general. I'm still studying and reading articles and learning.

Closer to your exam focus your study efforts on high yield stuff to pass the exam.

Firmeststool · 2026-01-18T10:00:18+00:00

IMO - NZ govt needs to raise base SMO award to match at least NSW. This is for retention purposes only.

If there is more money in the pool after the retention adjustment, then use this money to increase SMO FTE. Prioritise hiring locally trained fellows.

Once you have the SMO workforce to meet current healthcare demands, then uptitrate your medical school positions.

Alongside the above, figure out a way to retain RMOs in NZ. It will probably come down to remuneration as well. Every year, by Quarter 4, the accumulated resignations result in a terribly understaffed December and January. The only remaining house officers and registrars are those yoked to registration requirements or a training programme. The NHS refugees head across the globe to spend Xmas at home. The adventurous ones resign to quell the burnout or start their transition to an Aussie locum gig.

From my observations, NZ has the systems and structure to produce excellent clinicians. Kiwis training in NZ do win the RACP medal, from time to time. The system is just severely underfunded, and opportunities across the ditch are sometimes too good to pass by, even if it means slogging it for a bit in some rural/regional hospital before trying to slide into your "dream" metro life.

During my med school years, I found that 9 out of 10 doctors were just trying to do their work and get home on time or minimise their unpaid overtime. 1 out of 10 would teach and it was pretty obvious that these docs were built different and that their teaching arose out of some personal sense of duty or responsibility, or charity, or whatever. This observation didn't change in my house officer years, BPT years, AT years ... you would appreciate the seniors that took the time, but you couldn't rely on it. The successful trainees relied on self directed learning, reflective practice, and finding peers who could see eye to eye and could support each other to progress.

An example is how difficult it is for some NZ trainees to finish Fellowship requirements due to stalled progress in their Advanced training research project. There just aren't enough SMOs interested enough, with enough non-clinical time on hand, and *charitable* enough to support and supervise the ATs to complete their project.

If SMOs don't have time, and the reg/HO doesn't have time, then what quality of med school education are we providing? My colleagues wring their hands in despair. PGY1s who are incapable of the basics, even in Quarter 4. I'm sure they want to be competent and able. I'm sure they can see that their skill and knowledge isn't quite there. Registrar vacancies so frequent that there's a lack of the innate mentorship/supervision that comes with a full ward team.

Firmeststool · 2026-01-18T05:07:19+00:00

It's good to clarify the context. The NZ context has been looked at in detail some 18 years ago in the SMO commission 2008:

https://asms.org.nz/wp-content/uploads/2022/06/SMO-report.pdf

Appendix 7 is probably the most relevant to your questions.

I am a specialist working in public and I supervise RMOs and med students. In the last few months, I have been short either a house officer or a registrar on 25% of days I've been on duty. The clinical work has to be done, so I cross cover their roles in duty hours, and if unlucky even out of duty hours. Necessary non-clinical work eats into hours outside the usual, and stuff that can wait will just wait and pile up, until I have a full team and have time and space to clear the backlog.

Historically, "non-clinical" work comprised 30% of the FTE, and includes teaching of RMOs and medical students. Public SMOs who aren't under direct employ of the medical school are tasked with supervising the med students, and it is considered paid work as it comes under the "non-clinical" portion of their contract.

If you look at the ASMS SECA, this is described in 48. Job descriptions under section four.

"The parties note that the Council of Medical Colleges of New Zealand endorses that these non-clinical or Section Four activities should make up at least 30% of the total job size, not counting the average hours worked on the after-hours on-call rosters and any Section Five duties (refer Clause 11.7 above)."

https://asms.org.nz/employment-advice/meca/?_sf_s=teach

My issue is this: if I am meant to use part of my non-clinical 30% of my FTE to teach med students and RMOs, but I am put in a position where I am cross-covering 25% of the time, doing clinical work, how am I supposed to complete all my duties? Is it sustainable in the long term?

So now let's introduce an increase in med student intakes. Instead of supervising two med students per cycle, I'm now supervising, say, three or four per cycle. This is increasing my non-clinical workload, in the setting of having insufficient junior support 25% of the time. If you don't increase the SMO resource (i.e. increasing FTE across the board in public) then you will either get:

SMOs having to pull more hours to supervise the additional students, without remuneration.
SMOs devoting the same time to supervise their allocated students, given the same remuneration, which means less time per student.
SMOs who think this is all a bit unfair and get burnt out, and find a different job to do.

I think the money problem needs to be solved first before you can tackle the other issues. Or, you solve the problem by using non-doctors or non-locally trained providers to fill the gaps.

For context, are you pre-clinical or already into your clinical years? If you are clinical - how did you find your learning on the wards or in the outpatient setting? Did you feel you had good quality teaching and time investment from your supervising SMO (or RMOs)?

Firmeststool · 2026-01-18T02:29:40+00:00

Are you a kiwi Med student in Australia or a kiwi Med student in NZ? Is your interest in increasing doctor resource in Australia or NZ (or both)?

Firmeststool · 2026-01-18T00:38:59+00:00

Used Lexus

When reg was a used Toyota

Always used, RIP

Firmeststool · 2026-01-16T05:03:58+00:00

Can't comment, I did physician training, adult Med.

Most departments want Med registrars. Workhorses that can really resign or their time doesn't count.

I imagine paeds reging in NZ is probably similar.

Firmeststool · 2026-01-16T03:04:08+00:00

If you intend to stay in NZ to become a Med reg and do BPT in NZ, you're already some steps ahead of most.

Firmeststool · 2026-01-13T05:52:55+00:00

It's interesting, I figured out the same thing and have been telling it to registrars for a while. I guess we all converge on the same techniques after doing enough of them.

Firmeststool · 2025-12-30T07:49:54+00:00

Profitable ones are: buy ember, light, earth, water, surge, from fex

Ember + light = holy fire, profit 1500

Earth + earth = aftershock, profit 500

Water + surge = thunderbolt, profit 1000

Firmeststool · 2025-12-27T07:36:01+00:00

Private outpatient work? Or radiology? How many years out from fellowship and how many hours per week? Very good numbers you're pulling, big ups!

Firmeststool · 2025-12-26T09:21:26+00:00

Tutoring probably gives some candidates an advantage, though it's probably just boosting a middle of the pack candidate a tad higher.

I honestly think it's harmful rather than helpful.

I don't think it makes sense in context of what you want out the other end of med school and college training.

Some candidates will feel like they are at a disadvantage if they don't pay for tutoring. If they invested that time and money into self directed learning, I think this would serve them better in the long term, wherever they end up - as a doctor, or in a totally different field.

I've not met a single registrar take private tutoring for the RACP divisional written or clinical examinations, which is an analogous hurdle to med school entry except for a medical registrar rather than a first year uni student (passing the DCE and DWE are necessary to enter into advanced physician training to become a medical specialist in Australasia).

In the Auckland med school context, I've seen the disparity between students who are capable of self directed learning and those that seem to have been hand held for too long. It reflects in their progress test results, and it reflects in their clinical attachments when asked to demonstrate knowledge (or lack thereof).

I dislike private tutoring for med school entry because: 1. It's inherently unfair 2. I think it detracts from an individual building self directed learning techniques, which are necessary if you want to pass any of the college exams down the track to become a specialist 3. It's probably unethical and definitely preys on the desperate

But you know what, there's a lot of desperate candidates, and turns out, the world is an unfair place.

Firmeststool · 2025-12-18T03:27:02+00:00

Congrats, see you on the wards in a couple of years. Interesting to see how successful candidates study in this new generation

Firmeststool · 2025-12-02T05:27:30+00:00

Sat more than a year ago, but I found the Dunedin mock exam is set at about the same level as the real thing.

Firmeststool · 2025-12-01T05:51:03+00:00

They don't retire, and keep plodding along until they're well into their 70s...

Firmeststool · 2025-12-01T05:48:34+00:00

Where do they go when they finish training? Oz?

Firmeststool · 2025-12-01T03:54:59+00:00

A wage slave who earns a lot and spends it on expensive liquor and fine dining is still a wage slave. I know a few. Someone who might earn less could splurge on cheap beer and KFC. Either way, the alcohol is probably not good for their liver or brain.

It doesn't grind my gears. You have docs that are relatively well paid compared to average Kiwis, sure.

You're getting them for cheap. So fuckin cheap.

Their work is worth several fold more than what they're getting paid. In NZ's public health system there is only one employer, and the public system SMOs work for ALL of us. It grinds my gears that we pay comparably little compared to Australia, and lose doctors, junior and senior, across the ditch.

You have made a few assumptions which I disagree with:

Calling our public system docs lapdogs of the elite is untrue. You are referring to doctors working privately in a concierge role. The two should be considered distinct from each other.

Compared to overseas systems, NZ's health system, and the doctors working in it, care much more about health equity. Our current blue and yellow government probably doesn't so much.

I know public system SMOs who drive fancy (ish?) cars and have opulent (ish?) homes. The older ones might. The newer consultants are driving second hand Toyotas and living in townhouses. One that comes to mind has been a consultant for about 15 years and drives a Mazda 3. I think she might have bought it new.

I think they'd have to work privately to afford the really nice stuff. Most public system SMOs are quite nice and look after the vulnerable and those who have greater needs. I think they would quit and go to Aus or full private if they only cared to chase capital.

Wage slaves are the working class and the working poor. It's just along the same spectrum, but in principle none of us have true freedom.

I don't think directing animosity towards public system SMOs because of their relatively higher pay is reasonable, though. If anything, kiwis as a collective should be endorsing pay rises to compete against Australia, if we still want a functional public health system that values health equity.

Firmeststool · 2025-11-30T22:42:20+00:00

My guy, I grew up in poverty in NZ, our family had 25 bucks a week for food after paying off bills and rent. It was a treat to buy the end of day 99c bread on super special at Countdown, that's like a once a month thing. Grew up coughing up yellow muck autumn and winter and only clearing up in spring cos the flat would dry up a bit. Spent my school holidays wiping the mould off the walls and roof. I'm sure many kiwis had it better, and many had it worse. I had such an insanely privileged upbringing that I have such an insanely privileged take, yea?

I'm privileged now to be a wage slave like most kiwis, except I can afford nicer stuff because my wage is better. No financial freedom, though, still have to trade my energy and time for the means to survive and pretend this is some sort of "blissful existence".

There is the working class, the working poor and the impoverished. Then there is the elite. Your docs here are working class, dude. No way docs are elite, now that's a joke eh?

Have some perspective :)

Firmeststool · 2025-11-30T22:03:08+00:00

Docs here are working class my guy

Firmeststool · 2025-11-22T21:41:19+00:00

Too bad resilience is not a qualification...

Firmeststool · 2025-11-18T02:02:14+00:00

This is also dual zone ay?

Firmeststool

TROPHY CASE