First Impressions

Adrian here, with some first impressions of living and working in NZ. Since I have been at work less than 2 weeks, these are very preliminary observations, so I reserve the right to change my mind! It has, though, been a remarkable change to move from working in a large group covering multiple hospitals in a fee for service environment to a single hospital practice in a socialized system. A truly upside down world! Here we are gatekeepers to the system with the incentive to do less and where radiologists say NO if they think the exam is inappropriate - and they do! Last night I was on call for the first time, with a very expert 3rd year resident riding shotgun. We did 1 US for possible torsion and 1 CTA for a cold leg. Both phone calls requesting the exams came from the attending physicians, not residents. The ER probably saw 60 people.

The hospital has 300 beds, draws from a population base of about half a million and is a regional cancer centre. Equipment levels are good, with 1 16 slice CT going to be replaced by a 64 slice scanner within the year, good US and the rest. Exams are heavily prioritized. There are x number of US spots on the schedule in a given session, half a day, and when they are filled, that's it, on for tomorrow. Everyone accepts this. You can wait a year for a non urgent US. CT waiting times are much better, now less than 2 weeks for non urgent cases. There are several locums who are here for a variety of reasons, mainly the adventure. There is a heavy sprinkling of Scandinavians (not much money in medicine in Sweden and Finland ) as well as another American, all with different skill sets. Most of the Kiwi radiologists work part time in private practise where they say they make only slightly more money but see a different case mix. One of these is a remarkably talented transplanted Englishman who is the best sonographer and interventionalist I have ever seen who has free rein to do whatever he wants. He was sclerosing varicose veins, injecting shoulders etc etc in the only US session I have been with him. The surgeons are only too happy, otherwise they would have to do it. There are multiple meetings with the clinicians every week with an extremely collegial atmosphere. Everyone is on a first name basis.

Work starts between 8 and 8:30 and continues to around 4:30 to 5 with an hour off for lunch. I walk home for lunch. I get 2 half days off a week. My education allowance is about US$ 13K, with most meetings held in Australia and the Far East. One of my colleagues is off to Cambodia next week for a meeting. Another is taking off 4 weeks to work as medical officer on a scientific cruise ship in the Antarctic. You only have to get special permission if you want to take off more than 4 weeks at any one time. It is definitely a work-to-live environment.

Palmerston North is the butt of some jokes in NZ, probably because it's not on the coast and is set in flat farm land. There is some spectacular scenery close by, however, with 2 mountain ranges within 45 minutes drive and a great beach 20 minutes away. It is the friendliest place I have ever been. We rented a cottage in Hawkes Bay last week and never did see the owner, who lived down the street. I called him  when we were leaving and asked him how he wanted to be paid. He laughed and said just leave it under the cutlery. The lock didn't work and wasn't needed.

So far, then, so good. There are not many negatives. The cost of living is high, with grocery shopping usually ending at the check-out with sweaty palms and anxious checking of the bank balance, but we are living a much healthier life style and feeling the better for it. Our horizons have expanded. My next CME will be in Sydney, our next holiday will be a 2 week trip to the South Island in April, with other trips to Cambodia, China etc in early planning. Oh, and my malpractice insurance is $1200. Whats not to like? If you are the kind of person who frets about not being able to find the right pumpkin for Thanksgiving, this is probably not the right place for you, otherwise it's fantastic mate. No worries! We're off and laughing! (Kiwi for everything's OK).