NZMSA Guide To Graduation 2012

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New Zealand Medical Students Association

nzmsa@nzmsa.org.nz
How to:
apply for a hous e surge on job

de c ide what DHB is for you
s urvive the ye ar
www.nzmsa.org.nz
ge
t the be st de al you c an
and more !
NZMSA Guide to Graduation Draft
Contents
Contents
From NZMSA
Top ten tips for House Officers
The Ace Scheme
Your future employer
Northland DHB
Auckland Region
10
Waikato DHB
10
Bay of Plenty DHB
11
Lakes DHB
11
Tarawhiti DHB
12
Hawkes Bay DHB
12
Taranaki DHB
13
Whanganui DHB
13
Mid-central DHB
13
Wider Wellington Region
15
Nelson Malborough DHB
15
Canterbury DHB
16
South Canterbury DHB
16
Southland DHB
18
Finances
22
Legal stuff
22
Medical liability
22
The MECA contract
22
Medicolegal matters
23
Avoiding traps for young players
28
Getting registered
30
Professional representation
31
A message from the Residents Doctors Association
34
Looking after yourself
38
Final words
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1 The New Zealand Medical Students Association Incorporated

C/- PO Box 156, Wellington 6140, New Zealand!

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From NZMSA
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Dear!Trainee!Interns,!
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Congratulations!!after!many!years!of!study,!the!significant!milestone!of!graduating!!
from!medical!school!to!becoming!a!doctor!is!on!the!horizon.!I!am!sure!you!will!all!be!!
excited!to!put!your!training!into!practice!and!embark!on!your!medical!career!and!the!!
promising!future!that!awaits!you.!!
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The!first!weeks!as!a!new!doctor!can!be!challenging.!During!this!time,!many!young!doctors!find!it!difficult!to!maintain!a!
balance!between!their!new!work!life!and!the!need!to!look!after!their!own!wellbeing.!Whether!it!is!adjusting!to!fullBtime!
working!hours!for!the!first!time,!or!coming!to!terms!with!the!responsibility!associated!with!providing!care!to!patients!as!
a!fullyBfledged!doctor!!the!medical!student!to!doctor!transition!can!be!stressful!and!at!times!overwhelming.!!!
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With!these!challenges!in!mind,!NZMSA!has!prepared!this!resource!in!an!attempt!to!make!the!transition!from!medical!
student!to!doctor!as!smooth!as!possible.!Filled!with!expert!information!on!a!wide!variety!of!topics!relevant!for!new!
doctors,!such!as!DHB!profiles,!managing!your!finances,!medicoBlegal!issues!and!more!!the!NZMSA!Guide!to!Graduation!
is!a!comprehensive!guide!to!the!first!weeks!and!months!as!a!new!doctor.!!!
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On!behalf!of!the!NZMSA!Executive,!it!has!been!a!real!pleasure!to!represent!you!on!the!key!issues!affecting!medical!
students.!I!hope!you!find!the!information!contained!in!this!resource!useful,!and!I!wish!you!all!the!very!best!for!your!
future!careers.!
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Yours!faithfully,!
Michael(Chen+Xu!
NZMSA!President!2012!
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The New Zealand Medical Students Association Incorporated

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Top ten tips for

house officiers
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Know your rights.!!

It!is!important!that!you!understand!the!MECA!(your!work!contract)!and!what!it!entitles!you!to!like!!
leave!entitlements,!restrictions!on!working!hours!and!the!like.!If!you!decide!to!join!the!Resident!!
Doctors!Association!(RDA)!they!play!a!significant!role!in!helping!you!with!your!legal/employment!!
rights,!and!they!are!your!!advocate!(so!if!you!have!a!problem!with!the!RMO!Office!or!in!the!workplace,!!
they!can!be!your!first!port!of!call).!There!are!other!organisations!that!can!give!you!advice!depending!on!the!context,!like!
Medical!Protection!Society!(again,!if!you!decide!to!join)!!and!the!New!Zealand!Medical!Association!(NZMA).!!
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Know your responsibilities.!!

It!is!important,!and!so!helpful,!to!read!the!run!descriptions!which!your!attachment!is!obliged!to!give!you!before!you!
start.!Not!many!of!us!actually!read!this,!but!it!can!save!you!from!being!dumped!with!responsibilities!that!aren't!yours!
and!clarify!what!is!expected!of!you!(and!what!is!not).!!
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Know where to find out.
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After!six!years!of!cramming!information!into!your!head,!once!you!start!working!there!is!very!little!knowledge!that!you!
actually!carry!around!with!you.!Get!familiar!with!where!you!can!go!for!more!information!and!dont!be!afraid!to!go!
there!when!you!need!to!!No!one!will!think!less!of!you!if!you!take!a!minute!to!double!check!the!dose!of!a!drug!youre!not!
certain!of,!or!quickly!reBread!your!hospitals!policy.!!
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Know that it's all worth it.!!

The!job!can!be!demanding!but!it!is!highly!rewarding!if!you!choose!to!take!that!perspective.!There!is!recognition!to!be!
had!from!your!patients!and!from!colleagues!!and!the!pay!is!pretty!awesome!too!!A!healthy!perspective!is!one!of!the!
best!ways!of!protecting!yourself!from!burnBout.!
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Know that you will have to take the smooth with the rough.!!
The!major!difference!between!the!work!of!a!doctor!and!other!health!professionals!is!that!we!are!paid!to!get!the!job!
done!B!not!work!an!xBhour!shift!(with!the!caveat!that!we!are!not!abused!in!doing!so).!This!means!that!there!may!be!times!
when!you!work!much!harder!than!everyone!else,!but!there!will!(hopefully)!be!equally!many!times!when!you!can!have!a!
few!extra!coffee!breaks.!There!is!a!season!for!everything!in!life!!!
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Know that you are not alone.

There!is!no!reason!to!freak!out!about!having!to!make!tough!calls!by!yourself!or!being!swamped!with!an!unbearable!
workBload.!Seniors,!colleagues!and!nursing!staff!are!all!there!to!help!you!if!you!need.!All!you!have!to!do!is!ask.!!
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Know that being nice takes you a long way. !!

Work!is!a!lot!easier!with!the!goodwill!of!nursing!staff!especially,!and!medical!and!allied!health!workers!as!well.!Not!to!
mention!patients!and!their!families.!It!requires!patience!but!its!well!worth!it!in!the!long!run.!!
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Know that you are entitled to a ginormous tax refund3 at the

end of the financial year.
Because!you!only!start!work!in!November,!but!you!get!taxed!as!if!you!have!been!working!the!entire!year,!you!are!
entitled!to!a!tax!refund!!depending!on!which!DHB/pay!category!you!are!working!in!!in!the!couple!thousand!dollars!
mark.!All!you!have!to!do!is!call!the!Inland!Revenue!Department!(IRD)!and!request!a!personal!tax!summary;!it!takes!about!
six!weeks!to!process,!but!its!well!worth!it!!Consider!it!a!bonus!for!getting!through!your!first!half!year.!!
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Know that everyone will make mistakes, including you.

Its!part!of!being!human,!its!part!of!the!art!of!medicine,!and!most!importantly,!its!how!we!learn.!So!do!just!that,!learn!
from!it!and!become!a!better!doctor!as!a!result.!!
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Know that vital signs are vital.

Its!not!just!talk.!Never!brush!off!an!acute!change!in!vitals.!
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The Ace Scheme

key information
Key dates for ACE 2012
ACE!website!open!for!applications!
DHB!Road!Show!and!NZMA!sponsored!Trainee!Intern!ACE!evening!
ACE!applications!close!
ACE!match!
Offer!of!employment!sent!by!DHBs!
Applicants!accept!offer!of!employment!by!
February!2012!
Dunedin!!30!April!
Christchurch!!01!May!
Wellington!!02!May!
Auckland!!03!May!
25!June!2012!
31!July!2012!
6!August!2012!
13!August!2012!
How to apply
Applicants! should! head! to! www.healthcareers.org.nz/ace! which! will! take!
them!to!the!ACE!home!page.!In!the!top!right!hand!corner!there!will!be!a!box!
that! says! Apply! Now! ! click! here! to! apply! for! first! year! House! Officer!
positions! in! the! 2012! training! year.! ! Applicants! should! click! on! this! and!
follow! the! instructions! to! apply.! On! the! above! website,! under! the!
documents!section,!applicants!will!find!the!ACE!Applicant!Manual!and!this!
will!take!them!through!the!application!process!and!answer!their!questions.!
If! they! are! still! unsure! they! can! contact! the! ACE! Coordinator! via! email! or!
phone!and!they!will!assist.!
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International students and the One

Match process:
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Key contact for ACE

ACE!Coordinator!
ACE!Candidate!Consultant!
Phone:!0800!ACE!CENTRE!(0800!223!236)!
Email:!ace@healthcareers.org.nz!
Address:!!
ACE!Centre!
Private!Bag!92189!
Level!3!Building!14!
Greenlane!Clinical!Centre!
Greenlane!
Auckland!
With!the!introduction!in!2011!of!a!one!match!process,!all!applicants!will!be!ranked!in!one!match.!Part!of!the!DHBs!
ranking!process!will!include!eligibility!and!applicants!should!be!ranked!in!the!order!below.!!
1. Graduates!from!New!Zealand!medical!schools!who!are!citizens!or!permanent!residents!of!New!Zealand/Australia.!
2. Graduates!from!Australian!medical!schools!who!are!citizens!or!permanent!residents!of!New!Zealand/Australia.!
3. Applicants!who!have!passed!the!NZRex!clinical!exam!and!are!citizens!or!permanent!residents!of!New!
Zealand/Australia!or!hold!an!unconditional!work!permit!to!work!in!New!Zealand.!
4. Graduates!from!New!Zealand!medical!schools!who!are!not!permanent!residents!of!New!Zealand/Australia.!
5. Applicants!who!have!passed!the!NZRex!clinical!exam!and!are!not!permanent!residents!of!New!Zealand/Australia.!
6. Graduates!from!Australian!medical!schools!who!are!not!permanent!residents!of!New!Zealand/Australia.!
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International!students!should!be!aware!that!they!may!need!to!be!flexible!with!their!location!and!rank!as!many!places!as!
they!are!prepared!to!work!at.!However,!ACE!strongly!recommends!that!they!do!not!rank!a!location!that!they!are!not!
prepared!to!work!at!as!the!expectation!is!that!all!offered!positions!will!be!accepted.!They!should!also!be!aware!that!a!
large!volume!of!applicants!apply!through!ACE!and!this!number!exceeds!the!number!of!positions!available.!To!improve!
their!chances!of!being!successful!they!should:!complete!their!application!on!time!and!to!the!best!of!their!ability.!Good!


solid!references!are!essential.!Attend!the!ACE!Road!Show!so!that!they!can!talk!to!as!many!DHBs!as!possible.!!If!they!are!
unable!to!do!this!they!should!contact!the!DHBs!directly!so!that!they!are!aware!of!who!they!are!when!the!time!comes!for!
them!to!rank!
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References
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Special circumstances
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ACE!can!hold!up!to!five!references!on!your!file!for!you!but!
Paire d applic ations
you!may!only!submit!three!with!your!ACE!application.!Do!
You!can!choose!to!apply!with!a!partner!through!the!ACE!
not!ask!for!more!than!five!as!they!will!not!be!stored!for!
programme!and!there!are!a!few!details!that!you!should!
you.!!!
be!aware!of.!
You!may!only!request!a!reference!from!a!Consultant!
1. Your!partner!must!be!a!TI!too!!ACE!cannot!assist!a!
GP/Consultant!Specialist.!Please!do!not!ask!for!a!reference!
joint!application!with!anyone!in!a!higher!year.!
from!someone!who!does!not!fit!into!these!categories!as!
2. DHBs!must!rank!you!next!to!each!other!on!their!
you!will!not!be!able!to!use!it.!You!are!able!to!get!references!
lists!and!they!are!advised!to!rank!pairs!in!line!with!
from!overseas!locum!consultants!working!in!New!Zealand!
the!lowest!ranking!score!of!the!two.!!!
i.e.!listed!on!the!Medical!Council!of!New!Zealand!(MCNZ)!
3. You!must!ensure!that!your!list!of!ranked!DHBs!
vocationally!registered!database.!!
matches!the!list!of!your!partners!exactly,!by!the!
Of!your!three!references!two!must!come!from!your!TI!year.!
deadline!date,!or!you!will!not!be!ranked!as!a!pair.!
The!third!can!either!be!a!further!TI!year!reference!or!one!
Share d applic atio ns
from!your!fifth!year.!You!may!use!a!reference!from!your!
You!are!able!to!apply!through!ACE!in!a!job!share!
overseas!elective!if!the!country!you!have!worked!in!is!on!
capacity!and!there!are!a!few!details!that!you!should!be!
the!MCNZ!list!of!comparable!health!system!countries.!The!
aware!of.!
list!of!countries!can!be!found!on!the!MCNZ!website!at!
1. You!should!contact!the!hospitals!you!are!interested!
http://www.mcnz.org.nz.!!
in!working!at!to!explain!your!situation!and!ensure!
There!are!two!ways!that!you!can!request!an!ACE!reference.!
that!they!have!the!capacity!to!fully!assist!your!
At!www.healthcareers.org.nz/ace!in!the!documents!
training!on!a!partBtime!basis.!
section,!there!is!a!template!that!you!can!either!print!or!
2. DHBs!must!rank!you!next!to!each!other!on!their!
email!for!your!referee.!Alternatively,!you!can!type!their!
lists!and!they!are!advised!to!rank!pairs!in!line!with!
details!into!your!ACE!application,!making!sure!you!fill!in!
the!lowest!ranking!score!of!the!two.!!!
every!section!(if!you!dont!have!all!the!details!type!TBC!in!
3. You!must!ensure!that!your!list!of!ranked!DHBs!
any!empty!boxes)!and!follow!the!instructions!for!a!referee!
matches!the!list!of!your!partners!exactly,!by!the!
request!to!be!sent.!Please!be!aware!that!if!you!choose!the!
deadline!date,!or!you!will!not!be!ranked!as!a!pair.!
second!option!the!ACE!computer!programme!requires!all!
the!boxes!in!all!three!referee!sections!to!be!filled!in!!if!this!is!not!done!correctly!the!page!will!not!save!and!the!
reference!request!will!not!be!sent.!!To!check!that!this!has!worked,!refresh!the!page.!If!the!information!is!still!there!
then!you!have!completed!the!exercise!correctly.!!
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Making your application easier for you and the

ACE Coordinator!
B
B
B
Fill!in!as!much!as!possible!of!the!personal!details!as!early!as!you!can,!it!will!make!it!easier!for!you!to!be!
contacted!and!your!application!can!begin!to!be!processed!quicker.!
There!is!only!one!ACE!CoBordinator,!not!a!whole!team,!so!unless!your!question!is!urgent,!email!is!the!best!
method!of!contact.!Your!email!will!be!replied!to!within!24!hours,!but!usually!much!quicker!than!that.!
Dont!leave!your!references!to!the!last!minute!!your!references!are!likely!to!be!better!if!you!havent!rushed!
the!consultant.!If!you!do!not!have!three!references!by!the!deadline!date!your!application!cannot!be!entered!
into!the!match.!
The!ACE!deadline!is!a!nationally!fixed!date!and!there!is!no!flexibility!with!it!!all!applications!must!be!
completed!by!5pm!on!the!deadline!day.!Failure!to!do!this!will!result!in!the!application!being!declined.!
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Your future
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RMO units at a glance

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DHB profiles
The!following!information!about!each!DHB!and!hospital!has!been!sourced!from!a!previous!or!current!RMO!where!
possible.!The!information!given!is!purely!subjective!and!we!encourage!graduates!to!try!and!source!as!much!information!
as!possible.!Each!year!the!RDA!put!out!a!thorough!review!of!each!DHB!!find!more!information!at!
http://www.nzrda.org.nz.!
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Northland DHB
Auc kland re gion
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Whangarei!Hospital!
Contact:!
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Tania!Vaile!
PO!Box!9742,!Whangarei!
Ph:!+64!9!430!4101!ext!7399!
Fax:!+64!9!470!0028!
Email:!tania.vaile@northlanddhb.org.nz!
Web:!www.northlanddhb.org.nz!
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Waitakere(Hospital(
Dr.!Vikash!Patel!!PGY1!2011/2012!
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Nestled!in!the!West!of!Auckland!is!a!small!hospital!attached!to!Waitemata!
DHB!known!as!Waitakere!Hospital.!It!is!mainly!General!Medicine!based!with!
four!gen!med!wards!but!does!now!have!a!24hr!ED,!AT+R!and!some!elective!
Orthopedics!and!Gastroscopies.!!It!is!a!pretty!friendly!place!with!everyone!
quickly!becoming!familiar!faces.!In!medicine,!there!is!an!interesting!system!
where!by!only!one!team!takes!new!patients!and!the!cap!for!admissions!on!a!
Whangarei(Hospital(
weekday!is!23!and!on!the!weekend!it!is!15!each!day!!everyone!else,!or!all!sick!
Number!of!positions!in!2011:!10!!
patients!go!to!North!Shore!as!there!is!no!HDU!at!Waitakere.!
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All!the!consultants!are!friendly!and!helpful,!with!some!presenting!at!the!weekly!journal!club.!They!seem!to!swap!
between!Waitakere!and!the!shore!every!six!months.!The!house!officer!teaching!and!grand!round!are!both!unfortunately!
videoBlinked!which!is!less!than!ideal.!
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Your!meal!choice!at!the!cafe!is!a!bit!limited!but!the!
Auckland,!Middlemore,!North!Shore!and!Waitakere!hospitals!
cooked!option!is!normally!tasty!and!very!good,!with!
NoRTH!(Northern!Region!Training!Hub)!!
real!gems!like!chicken!kebabs!on!couscous.!Beware!of!
Private!Bag!92189,!Greenlane!
the!basil!pesto!quiche!though.!The!staff!are!awesome!
Ph:!+64!9!631!0707!
and!often!start!making!your!coffee!as!soon!as!you!
Fax:!+64!9!623!4644!
walk!through!the!door.!
Email:!rmorecruitment@north.co.nz!
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Web:!www.aucklanddoctors.co.nz!
In!terms!of!Geriatrics,!there!are!around!four!teams!
with!no!onBcall!during!the!week!but!you!cover!one!half!of!the!gen!med!
Hospital(
Number(of(Positions(
wards!on!the!weekends.!With!two!or!more!house!officers!on!each!team!
(2011)(
and!only!having!to!do!a!10!day!stretch!instead!of!12,!the!slower!paced!
North(Shore(+(
51!
life!of!Waitakere!makes!it!a!good!destination.!Don't!be!fooled!though,!
Waitakere(
you!will!run!into!your!fair!share!of!work!and!pile!of!discharge!
Auckland(
48!
summaries.!Unfortunately!the!RMO!room!is!so!far!from!the!wards!that!
Middlemore(
41!
it!is!rarely!visited!!it!does!however!have!Sky!and!a!flat!screen!TV.!
Total(
140!
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The!only!runs!for!first!years!are!general!medicine,!geriatrics,!and!psychiatry!so!you!will!inevitably!spend!time!at!the!
hospital's!big!brother!!North!Shore!!as!well.!Enjoy.!
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North(Shore(Hospital(
Dr.!Yanan!Hu!
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After!being!exceptionally!impressed!by!my!only!run!as!a!student!at!North!Shore!Hospital,!I!decided!to!work!there!in!my!
PGY1!year.!It!was!a!decision!I!have!yet!to!regret.!Myths!about!North!Shore!have!extinguished!over!the!years!and!it!is!
now!one!of!the!best!DHBs!to!work!at!as!an!RMO.!Runs!on!offer!as!a!first!year!HO!include!general!medicine,!general!
surgery,!cardiology,!geriatrics,!psychiatry,!orthopaedics,!and!psych!geris.!!
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Although!being!a!large!tertiary!hospital!in!Auckland,!North!Shore!exerts!the!friendliness!and!relaxed!atmosphere!of!
peripheral!hospitals.!The!consultants!(whether!your!own!or!other!specialties)!are!extremely!approachable!and!are!
always!a!phoneBcall!away.!All!the!other!staff!members!are!also!infinitely!helpful!when!you!need!something!done.!!
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Teaching!at!North!Shore!is!abundant.!There!is!a!set!two!hours!of!house!officer!teaching!(with!great!food!provided,!
although!its!the!same!every!time)!every!week!and!topics!will!range!from!how!to!put!in!catheters!to!palliative!care.!Each!
department!will!also!have!their!own!weekly!grand!rounds,!journal!clubs,!radiology!conferences!and!much!more.!All!the!
registrars!are!very!willing!teach!as!are!most!of!the!consultants.!!
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Living!in!Auckland!brings!many!advantages!and!disadvantages.!Most!are!selfBexplanatory.!North!Shore!Hospital!is!easy!to!
commute!to!even!if!you!live!on!the!other!side!of!the!bridge!(the!city!centre!side)!as!youre!going!against!the!traffic!rush!
both!ways.!The!hospital!is!situated!minutes!away!from!beautiful!beaches!and!nice!cafes,!and!whats!more,!theres!a!lake!
right!outside!the!cafeteria!complete!with!ducks,!swans!and!pukekos.!Whats!quite!surprising!when!I!started!work!here!is!
how!supportive!the!RMO!unit!is.!They!genuinely!try!to!look!after!the!welfare!of!everyone!and!work!hard!to!give!you!
what!you!ask!for!in!terms!of!leave!and!payroll!issues.!It!is!only!after!you!start!work!that!you!realise!how!important!these!
things!are.!!
!
In!general,!my!experience!at!North!Shore!Hospital!has!been!nothing!but!pleasant!except!for!the!food!they!serve!at!the!
cafeteria.!The!hospital!has!steadily!improved!over!the!last!few!years!and!you!would!feel!well!supported!working!there!as!
a!new!grad.!!
!
Auckland(Hospital((
Dr.!Thalib!Mowjood!
!
On!reflecting!back!on!my!year!at!Auckland!City!Hospital!I!realise!that!much!of!what!has!made!my!experience!there!most!
different!to!what!I!might!have!experienced!at!any!other!hospital!has!been,!for!better!or!worse,!!a!consequence!of!!the!
sheer!size!of!the!place.!It!is,!after!all,!the!countrys!largest!hospital,!housing!some!700!beds.!
!
Being!a!tertiaryBreferral!centre,!many!of!the!hospitals!departments!are!centres!of!excellence,!and!it!has!been!a!pleasure!
being!a!part!of!teams!that!have!delivered!such!excellent!standards!of!care!to!the!patients!I!have!been!involved!with.!
Such!centres!of!excellence!tend!to!attract!leaders!in!their!fields!who!are,!on!the!whole,!very!capable!in!
sharing!their!skills!and!knowledge.!ADHBs!clinical!education!and!training!unit!(CETU)!does!a!particularly!good!job!of!
utilising!these!experts!for!the!delivery!of!high!quality!formal!teaching!sessions.!
!
There!is!a!high!level!of!support!available!from!senior!RMOs!and!consultants.!After!hours,!clinical!nurse!advisors!are!
exceptionally!helpful!in!providing!advice!and!practical!support.!As!result,!I!have!rarely!felt!out!of!my!depth.!
Unfortunately,!such!a!large!institution!is!inevitably!superBspecialised,!which!in!turn!limits!the!breadth!of!clinical!exposure!
for!junior!doctors.!For!example,!there!is!only!one!house!officer!in!the!department!of!general!surgery!attached!
to!a!team!that!is!truly!general!in!its!scope!of!practice.!Perhaps!even!more!frustrating,!is!the!inordinate!amount!
10
of!time!spent!doing!lowBlevel!administrative!tasks!(discharge!summaries,!requesting!investigations!etc)!while!
RMOs!pursuing!their!subBspecialty!training!do!the!real!medicine.!
!
That!said!I!feel!that!my!year!at!ADHB!has!maintained!my!enthusiasm!for!clinical!medicine!and!set!me!up!with!the!skills!I!
need!to!take!on!higher!levels!of!clinical!responsibility.!
!
Middlemore(Hospital(
Dr!A.!Anna!Choi!
!
Middlemore!may!one!of!the!busiest!hospitals!in!the!country,!but!at!the!same!time!it!is!one!of!the!friendliest,!liveliest,!
loveliest!places!to!work!in.!The!unspoken!work!ethos!is!one!of,!"we're!in!it!together."!The!fact!that!is!has!such!a!highB
turnover!of!patients!is!what!attracts!some!of!the!most!renowned!consultant!specialists!to!Middlemore,!and!the!unique!
community!we!serve!is!what!keeps!every!day!so!very!interesting!!
!
!!


The!good:!
Genuine,!approachable,!downBtoBearth!consultants!BB!who!are!up!for!the!challenge!and!are!at!Middlemore!by!
choice!!
Friendly,!lively!environment,!where!everyone!smiles!and!says!hello!to!one!another!in!the!corridor,!from!orderlies!
to!cafe!staff,!to!allied!health!professionals,!to!medics!at!all!levels.!
Registrars!who!know!their!stuff.!And!who!are,!on!the!whole,!amazingly!approachable!and!helpful.!9
There!is!always!someone!you!can!ask!for!help;!you!are!never!alone,!you!are!never!without!someone!you!can!
call,!and!the!emergency!team!(made!up!of!ICU!reg,!med!reg,!med!house!officer,!and!specialist!nurses)!are!only!a!
phone!call!away.!
Amazing!pathology,!conditions,!lateBpresenting!diseases,!all!confounded!by!many!coBmorbidities.!That,!and!the!
high!turnover!of!patients!mean!you!will!see!and!learn!more!than!you!could!ever!imagine!in!your!first!year.!
"Getting!down!to!the!nitty!gritty"!!everyone!is!busy!so!they!just!get!on!with!it!and!get!the!job!done.!
A!real!sense!of!service!to!the!community.!
Great!for!getting!to!"know!the!players"!for!various!vocational!pathways!(especially!for!the!surgical!disciplines;!
impressing!them!is!the!next!challenge!).!
Protected!house!officer!teaching!time!one!hr/week!(which!the!organisation!is!really!pushing!to!get!ingrained!
into!work/ward!culture),!and!three!twoBday!workshops!throughout!the!year!which!is!protected!time!off!the!
wards!(HOTShop!=!house!officers!as!teachers!workshop;!SMARTShop!=!!health!and!wellbeing!workshop;!and!
PROShop!=!professional!development!workshop).!
Teaching!hospital,!with!close!ties!to!South!Auckland!Clinical!School!
Living!in!a!big!city!like!Auckland!has!its!appeal:!gigs,!shows,!festivals,!the!main!international!airport!makes!
travelling!overseas!that!much!simpler,!warmer!weather...!
Parking!for!$7.50/week!!Train!station!literally!at!the!doorstep!of!the!hospital.!
!!
The!notBsoBgood:!
It!is!not!uncommon!for!the!hospital!to!be!at!120%!capacity!during!the!winter.!
Busy!hospital!means!long!hours.!And!with!what!seems!like!a!constant!shortage!of!doctors!no!doubt!you!will!have!
some!long!weeks.!
RMO!Unit!onBsite!struggles!with!high!turnover!of!staff,!meaning!
W aikato DHB
varying!levels!of!experience!and!helpfulness!(we're!working!on!this!).!
Contact:!
For!Auckland!City!Hospital!and!Middlemore,!working!the!weekend!
Paul!Miller!
means!12Bdays!in!a!row.!
Pembroke!Street,!Hamilton!3240!
Ph:!+64!7!858!0946!ext!4946!
Leave!is!difficult!to!get!!so!get!your!requests!in!early,!and!be!
Fax:!+64!7!585!0941!
persistent.!
Email:!paul.miller@waikatodhb.org.nz!
!
Web:!www.waikatodhb.org.nz!
I!have!loved!working!at!Middlemore,!but!when!people!ask!me!if!I!would!
!
recommend!it!my!response!is!laden!with!cautious!optimism!!yes,!I!would!
recommend!Middlemore,!handsBdown,!but!only!if!you!know!what!you're!
!
getting!yourself!in!to!!You!will!be!busy,!but!there!is!a!real!sense!of!
Hamilton(Waikato(Hospital(
camaraderie,!and!after!doing!your!first!year!of!work!at!Middlemore,!very!
little!will!phase!you!for!the!rest!of!your!career.!
Bay o f Ple nty DHB

(
Whakatane(Hospital(
Dr.!Emily!Gill!
!

!
10

Whakatane,!being!a!small!hospital,!has!a!wonderful!community!feel.!!You!know!everyone,!and!even!recognise!their!
voices!over!the!phone!!My!first!impression!was!the!telephonist!coming!out!behind!her!desk!to!greet!me,!wishing!me!
well!and!taking!me!to!the!RMO!unit.!
!!
Joy,!the!RMO!coordinator,!has!a!wonderful!personality!with!RMO!interests!at!
Tauranga(Hospital(
10
heart.!!However,!Whakatane!management!is!dictated!by!Tauranga!which!makes!
Contact:!
things!tricky!at!times.!For!instance!decisions!about!rostering,!leave!approval!and!
Jan!Simeon!
the!like!must!have!Tauranga!approval.!
Private!Bag!12024,!Tauranga!
!!
Ph:!+64!7!579!8542!
Since!Whakatane!is!small,!your!experience!depends!on!your!peers.!If!
Fax:!+64!7!579!4523!
12
you're!friends!with!all!the!house!surgeons!and!you!are!all!social,!
Email:!jan.simeon@bopdhb.govt.nz!
Whakatane!is!a!fabulous!place!to!begin!your!medical!career.!!Likewise,!
Web:!www.bopdhb.govt.nz!!
the!support!from!the!SMOs!depends!on!the!collection!of!SMOs!at!the!
!
time.!Unfortunately,!a!high!turnBover!rate!of!SMOs!means!many!are!
Whakatane(Hospital(
locums!for!only!one!year.!As!of!2011,!there!were!some!great!SMOs.!The!nursing!
Contact:!
staff!is!more!stable,!with!many!excellent,!experienced!and!lovely!people!to!teach!
Joy!Sunich!
you!loads.!By!and!large,!the!nurses!understand!the!role!of!junior!doctors.!!!
PO!Box!241,!Whakatane!
!!
Ph:!+64!7!306!0850!
The!DHB!is!determined!to!provide!a!good!teaching!environment.!There!is!
Fax:!+64!7!306!0973!
significant!effort!made!to!have!daily!lunchBtime!teaching!and!nursing!staff!do!
joysunich@bopdhb.govt.nz!
appreciate!this!protected!time.!Indeed!Joy!
www.bopdhb.govt.nz!
Lake s DHB
holds!the!pagers.!Teaching!can!be!variable,!
depending!on!the!collection!of!SMOs!
Contact:!
Hospital(
Number(of(Positions(
at!the!time.!There!is!strong!political!
Jo!Phipps!
(2011)(
will!to!make!Whakatane!an!excellent!
Private!Bag!3023,!Rotorua!
Tauranga(
16!
teaching!facility!but!staff!shortages!
Ph:!+64!7!343!8711!
Whakatane(
4!
can!prohibit!this.!
Fax:!+64!7!349!7663!
Total(
20!
!!
Email:!jo.phipps@lakesdhb.govt.nz!
You'd!be!hard!pressed!to!find!a!nicer!spot!to!live!!There's!beaches,!bushBwalks,!
Web:!www.lakesdhb.govt.nz!!
an!hour's!drive!to!many!great!spots!(like!Rotorua,!Tauranga,!East!Cape)!and!even!
!
a!good!range!of!restaurants.!If!your!fellow!house!surgeons!are!a!social!bunch,!
Rotorua(Hospital(
there's!plenty!to!do.!Many!doctors!pay!a!bit!more!and!live!on!the!beautiful!beach! Number!of!positions!in!2011:!10!!
of!Ohope.!Being!a!small!town,!there!aren't!many!young!professionals,!but!
several!house!surgeons!I!knew!found!reasonable!flatting!situations.!A!tip,!though,!is!to!look!for!accommodation!once!
you've!arrived.!Trade!Me!doesn't!seem!the!best!way!to!find!a!flat!in!Whakatane.!Better!to!use!newspaper,!wordBofB
mouth!or!go!to!a!realBestate!agent.!
Tarawhiti DHB
Contact:!
Natalie!Barrett!
(
Private!Bag!7001,!Gisborne!
Gisborne(Hospital(
Ph:!+64!6!869!0500!ext!8026!
Dr.!Matt!Rowe!
Fax:!+64!6!869!0553!
!
Gizzy!(aka!Gisborne)!is!as!close!as!you!can!get!in!PGY1!to!lifestyle!and!work!paradise.! Email:!natalie.barrett@tdh.org.nz!
Web:!www.tdh.org.nz!
For!the!price!of!a!mouldy!South!Auckland!dungeon!you!can!live!in!a!nice!house,!right!
!
on!the!beach,!just!10minutes!drive!from!work.!There!are!ample!cafes/bars!in!town!
Gisborne(Hospital(
and!on!the!waterfront,!plus!all!the!necessary!shops,!amenities!and!sports!clubs!to!
Number!of!positions!in!2011:!8!
keep!you!happy.!
!!
Gizzy!is!a!handsBon!job,!you!spend!heaps!of!time!in!ED!or!in!theatre,!and!with!no!registrars!you!do!the!pleural!taps/chest!
drains/LPs/joint!aspirates/resus!calls;!if!youre!keen!a!few!of!you!will!even!do!intubations/central!lines!etc.!No!registrars!


also!means!you!work!directly!with!the!consultants;!its!not!scary!its!ideal,!and!all!of!them!except!maybe!one,!are!really!
supportive,!approachable!and!keen!to!teach.!You!also!get!handsBon!paeds!experience!in!ED!and!on!the!wards!when!you!
cover!paeds!on!long!days!and!weekends.!Plus!the!RMO!coordinator!is!great!and!very!rarely!denies!your!leave!requests.!
!!
In!Gizzy!youll!also!get!a!unique!richness!of!culture;!every!second!patient!in!ED!is!Maori,!and!many!of!them!have!
11
travelled!hours!from!the!east!coast,!a!stretch!of!coastline!loaded!with!gems.!Plus!everyone!who!comes!to!Gizzy!is!cool,!
so!come!here!and!you'll!have!a!great!time!!
!
Taranaki DHB
(
New(Plymouth(Hospital(
Contact:!
Dr.!Ryan!Tatnell!
Karlina!Nickson!
!
Private!Bag!2016,!New!Plymouth!
Kia!ora!from!Taranaki!!
Ph:!+64!6!753!6139!ext!8829!
Working!in!Taranaki!is!much!like!the!weather:!wake!up!on!a!wet!morning,!take! Fax:!+64!6!753!7860!
Email!:!karlina.nickson@tdhb.org.nz!
an!afternoon!nap!in!the!sunshine.!A!few!changes!to!make!in!lifestyle!and!
Web:!www.tdhb.org.nz!!
some!acclimatisation!may!be!required,!but!can!be!spectacular!if!its!your!
!
thing.!!
New(Plymouth(Hospital(
!
!
The!good!
The!less!good:!!
Hospital!
Hospital!
B Extremely!supportive!RMO!unit,!probably!one!
B Its!small.!!
of!the!best!around.!
B If!you!dont!click!with!a!personality,!it!may!be!
B Sweet!hospital!cafe,!like!damn.!!
impossible!to!escape.!
B Closely!knit!hospital!community,!true!sense!of!
B Formal!teaching!is!a!bit!average.!!
teamwork,!collegiality,!and!everyone!working!
!
together!(usually)!for!the!common!interests.!
The!region!
B Seniors!who!try!to!make!your!life!easier!
B Its!a!town!of!70,000!populated!primarily!by!
(usually).!
working!class!farmers,!manufacturing!and!
B Big!enough!to!get!your!feet!wet,!but!not!big!
tradespeople!and!employees!of!the!
enough!to!lose!sense!in!subspecialty.!Great!
petrochemical!industry.!Dont!expect!an!
opportunities!for!learning!on!the!job.!!
Auckland,!Christchurch,!Welly!or!Dunners!social!
!
scene.!
The!region!
B If!youre!from!outBofBtown!it!can!be!hard!to!
B Surf,!beaches,!mountains,!biking,!hiking,!and!a!
leave!family!and!friends.!!
community!that!loves!the!outdoors.!
B When!its!winter:!if!you!dont!like!snow!sports,!I!
B PunchingBaboveBitsBweight!cafe!and!bar!scene.!
hope!you!like!knitting.!!
B When!its!summer:!theres!no!place!youd!rather!
be.!
!
Overall,!TDHB!is!great!and!the!good!far!outweighs!the!downsides.!But!it!may!not!suit!everyone,!so!come!on!down!(or!up)!
with!an!open!mind!and!a!bright!smile!!We!will!make!you!feel!welcome!!!
!
!
!
!
!
!
!
12
Contact:!
Barbara!Rowe!
Private!Bag!9014,!Hastings!
Ph:!+64!6!878!8109!ext!5884!
Fax:!+64!6!878!1301!
Email:!barbara.rowe@hawkesbaydhb.govt.nz!
1
Web:!www.tdh.org.nz!!
!
Hawke s Bay DHB

!
Hastings(Hospital(
Dr!Jun!Kwon!
!
I'm!just!a!first!year!house!surgeon!partway!through!my!first!run,!so!
everything!I!write!needs!to!be!taken!with!a!grain!of!salt,!but!I've!been!
really!happy!with!my!choice!to!come!to!Hawke's!Bay!this!year.!
!
The!good!
W hanganui DHB
B Protected!teaching!time!one!hr/week!for!PGY1!+!weekly!grand!rounds,!registrar!
Contact:!
presentations!on!general!medicine,!and!radiology!teaching.!
Lisa!Flood!
B Everyone!is!really!friendly!and!approachable,!including!consultants!from!all!
Private!Bag!3003,!Whanganui!
specialties.!Relaxed!work!environment.!
Ph:!+64!6!348!3436!
B Cheap!living!costs.!Cheap!rent!compared!to!Auckland/Wellington.!A!group!of!first!
Fax:!+64!6!348!1316!
years!are!paying!$150!for!a!modern!mansion,!on!the!hill!looking!over!the!city,!
Email!:!Lisa.Flood@wdhb.org.nz!
with!a!swimming!pool.!
Web:!www.wdhb.org.nz!!
B Medical!house!surgeons!see!and!clerk!patients!in!ED!while!on!call,!a!great!
!
learning!experience.!
Whanganui(Hospital(
B RMO!Unit!generally!ok!granting!leave,!though!there!have!been!disputes.!
B Sweet!colleagues!who!hang!out!together.!
B Weather!is!awesome!!bring!your!sunnies!for!lunchtime!when!you!sit!out!in!the!
sun.!
B Good!food!at!the!cafe!!no!monetary!restrictions!on!food,!though!choices!can!be!low!at!dinnertime.!!
B Big!enough!to!have!registrars!for!support,!small!enough!so!
everyone!knows!everyone.!
Mid-c e ntral DHB
B Sweet!doctor's!mess!!old,!but!spacious,!with!Sky!TV,!Wii,!table!
Contact:!
tennis,!snooker!table,!washing!machine!and!dryer,!kitchen,!fridge,!
Moira!Eathorne!
computers,!bedrooms!for!on!call!regs.!
Private!Bag!11!036,!Palmerston!North!
B Hawke's!Bay!is!a!really!awesome!part!of!NZ!!wine,!walks,!beaches,!
Ph:!+64!6!350!8849!ext!5884!
sun,!good!biking!courses!(lots!of!docs!bike!into!work).!
Fax:!+64!6!350!8627!
B Easy!parking,!sometimes.!Secured!car!parks!are!a!bit!difficult!to!get,! Email:!Rmo.vacancies@midcentraldhb.govt.nz!
but!there!is!plenty!of!on!street!parking!near!the!hospital.!
Web:!www.midcentraldhb.govt.nz!!
B Rural!pay!scale!(despite!being!less!busy!on!average!than!other!
!
centres).!
Palmerston(North(Hospital(
!
The!bad!
B Rosters!always!come!out!at!the!last!minute.!
B Hastings!(where!the!hospital!is)!is!rather!quiet.!Most!docs!live!in!Napier,!a!20B30min!commute!(or!50min!bike!ride).!
B Workload!fluctuates!!but!usually!you!can!finish!at!4pm.!
B Older!persons!health!has!no!registrars,!and!with!only!two!consultant!rounds!a!week,!it!can!be!daunting!for!the!
house!surgeon!running!the!ship.!!
!

Capital and Co as t, Hutt Valle y and W airarapa DHB

(
Wellington,(Hutt(and(Masterton(hospitals(
Dr.!Ravi!Mistry!
!
2
Like!many!house!surgeons!in!Wellington!I!entered!the!working!life!there!as!an!easy!passage!through!my!clinical!years!at!
the!Wellington!School!of!Medicine.!The!reputation!that!Wellington!Hospital!enjoyed!at!that!time!was!mixed,!but!the!
attraction!remained!due!to!the!fantastic!city!backdrop.!!
!
Now,!having!nearly!put!my!first!year!behind!me,!I!feel!that!I!can!honestly!recommend!Wellington!and!her!hospital!as!a!
great!city!for!work!and!play.!The!new!hospital!is!large!and!modern!with!nearly!all!major!subspecialties!
16
available.!Here!you!have!the!opportunity!to!work!alongside!great!
Contact:!
seniors,!many!stemming!from!a!medical!education!background.!But!
Russell!Holder!
being!a!large!tertiary!hospital,!it!inevitably!leads!to!the!time!old!issue!of!
Private!Bag!7902,!Wellington!
limited!contact!with!consultants.!
Ph:!+64!4!806!2531!
!
Fax:!+64!4!385!5371!
A!lot!of!this!has!been!greatly!helped!by!having!a!large!population!of!
Email:!rmo_recruitment@ccdhb.org.nz!
keen!registrars!who!can!be!easily!goaded!to!teach.!And!despite!the!
Web:!www.capitalhealthcareers.org.nz!
perceived!distance!from!the!consultants,!many!of!them!remain!very!
!
keen!to!assist!juniors!and!also!to!encourage!those!who!show!any!
Wellington,(Hutt(and(Masterton(hospitals(
interest!or!sparkle.!Obviously!egos!do!exist,!and!some!departments!are!
notorious!for!this,!but!overall!they!remain!an!exception!rather!than!the!
rule.!In!addition!issues!seem!to!be!taken!relatively!seriously!by!the!new!
set!of!intern!supervisors!(who!also!happen!to!be!an!involved!and!supportive!bunch).!
!
More!significant!problems!do!exist.!Procedures!are!more!scant!for!PGY1s,!but!the!opportunities!exist!if!you!show!
initiative.!There!are!some!very!real!runs!of!concern!where!support!is!scarce!and!opportunities!to!exercise!any!supported!
medicine!even!rarer.!Having!said!that,!these!runs!are!well!known!and!there!are!moves!to!improve!their!staffing.!Some!
house!surgeons!even!speak!positively!of!these!runs!in!retrospect.!The!formalised!teaching!sessions!seem!to!have!had!an!
overhaul!but!are!of!variable!quality!in!comparison!to!the!sister!DHBs!of!Hutt!Valley!and!Wairarapa.!
!
Good!accommodation!can!be!a!strain!to!find!due!to!the!anomalous!starting!date!of!PGY1.!The!majority!of!RMOs!end!up!
living!in!the!surrounding!Newtown!or!in!the!city!proper.!The!rent!can!be!more!extravagant!than!you!might!expect!and!
the!cost!of!living!is!high.!This!is!perhaps!not!fully!paired!to!the!city!pay!scale!!especially!in!comparison!to!some!of!the!
smaller!provincial!hospitals!where!you!probably!wont!be!working!as!hard.!The!flipside!is!that!the!city!is!compact!and!can!
be!easily!utilised!by!people!wanting!to!make!the!most!of!the!urban!lifestyle,!or!enjoy!the!surrounding!outdoors.!
Wellington!is!a!hands!down!great!place!to!work.!If!youre!willing!to!go!the!extra!mile!you!will!stand!to!gain!much!
technical!medical!knowledge!and!solid!fundamentals!as!a!junior.!In!addition!you!get!the!star!attraction!of!living!in!a!great!
accessible!city,!which!boasts!a!trendy!nightlife,!well!known!annual!events!and!various!cultural!and!culinary!festivals.!If!
you!are!willing!to!go!the!extra!mile!I!recommend!you!put!Wellington!on!your!differential!!
!
Dr.!Elizabeth!Carr!!
!
Working!at!CCDHB!and!HVDHB!has!offered!me!a!good!foundation!for!medicine!and!has!extended!my!skills!and!
experiences.!Although!a!busy!hospital,!the!Wellington!general!medical!and!general!surgical!wards!are!well!used!to!first!
year!house!surgeons,!and!there!is!support!from!the!other!staff!as!you!learn!the!variety!of!skills!required!to!be!successful!!
(both!medical!and!nonBmedical).!Since!the!hospital!is!busy,!you!will!find!that!you!need!to!be!proactive!and!organised!to!
get!the!most!out!of!your!time,!but!if!you!can!do!this!there!are!many!opportunities!to!be!had.!!
!

!
14

There!are!a!large!number!of!house!surgeons!around!to!help!out!!certainly!on!busy!days!it!was!nice!to!have!an!extra!
helping!hand,!and!it!is!usually!easy!to!organise!shift!swaps.!You!get!to!eat!lunch!and!"debrief"!with!the!house!surgeons!
and!registrars!which!adds!to!the!feeling!of!camaraderie.!There!is!also!the!medical!school!on!site!so!there!are!medical!
students!on!your!team!and!the!medical!library!is!also!available!if!needed.!You!need!to!apply!early!for!leave,!but!I!was!
able!to!get!leave!for!Christmas,!a!holiday!in!January!and!also!in!June!without!any!trouble.!
3
!
It!is!worth!talking!to!recent!house!surgeons!as!some!runs!are!notoriously!busy!and!others!more!sedate.!Some!people!
seem!to!fit!some!runs!better!than!others!and!it!is!worth!knowing!what!will!make!you!happy!and!trying!to!organise!the!
runs!you!want!to!do.!Living!in!Wellington!is!a!lot!of!fun!and!there!is!always!heaps!going!on!!starting!in!November!means!
you!get!the!best!of!the!summer!when!you!first!arrive.!Flatting!in!Newtown!is!affordable!and!within!walking!distance!of!
the!hospital.!There!are!many!houses!which!are!not!student!flats!and!are!quite!nice!!!!
!
The!orientation!week!has!been!vastly!improved!in!recent!years!and!now!
Ne ls o n Marlb orough DHB
includes!both!a!refresher!of!the!CPR!course!and!the!ALERT!course!which!
are!very!helpful!training!for!your!first!days!on!call.!Teaching!in!first!year!is!
Nelson(Hospital(
relatively!ad!hoc,!although!there!have!been!significant!improvements!
Contact:!
recently.!There!is!protected!house!surgeon!teaching!time!(as!per!the!
Loretta!Matheson!
MECA!contract)!which!is!reasonably!useful.!Only!occasionally!are!there!
Private!Bag!18,!Nelson!
clinical!skills!teaching!sessions!and!these!get!booked!out!quickly.!The!RMO! Ph:!+64!3!546!1875!
unit!is!staffed!by!a!wonderfully!supportive!team!who!really!try!to!help!you!
Fax:!+64!3!546!1811!
find!your!place!in!the!hospital.!The!intern!supervisors!are!also!
Email:!loretta.matheson@nmhs.govt.nz!
approachable!and!are!available!for!a!range!of!useful!advice!and!support.!!
Web!:!www.nmdhb.govt.nz!
!
Overall,!Wellington!and!Hutt!Valley!have!been!what!I!expected!from!
!
talking!to!medical!students!and!recent!house!surgeons!without!any!major!
Wairau(Hospital(
surprises.!I!have!enjoyed!a!very!good!work!life!balance,!have!been!able!to!
Contact:!
undertake!a!diploma!paper!on!top!of!working!and!have!felt!supported!
Pip!Smith!
whenever!there!were!clinical!issues!I!couldn't!solve!for!myself.!There!have!
PO!Box!46,!Blenheim!
been!busy!and!stressful!days!(and!even!a!couple!of!whole!stressful!weeks)!
Ph:!+64!3!520!9677!
but!certainly!it!has!been!very!manageable!overall.!I!would!recommend!
Email:!pip.smith@nmdhb.govt.nz!
Wellington!as!a!solid!place!to!start!your!early!years!as!a!doctor.!
Web:!www.nmdhb.govt.nz!
!
Cante rbury DHB

(
Christchurch(Hospital(
Contact:!
Dr.!ShengBHui!Wong!
Karen!Schaab!
!
Private!Bag!4710,!Christchurch!
Christchurch!Public!is!a!large!busy!teaching!hospital!with!600+!beds.!
Ph:!+64!3!364!1585!
!
Fax:!+64!3!364!0897!
The!Good:!
Email:!karen.schaab@cdhb.govt.nz!
B Large!hospital,!plenty!of!cases!and!advanced!cases!to!be!seen!that!may!be!
Web:!www.cdhb.govt.nz!
transferred!away!from!smaller!hospitals.!
!
B Multiple!subspecialties!to!try,!great!if!youre!interested!in!getting!into!
Christchurch(Hospital(
that!specialty!to!try!and!get!your!face!known!to!the!crowd.!
B Large!patient!load,!youre!busy!but!you!learn!plenty!on!the!job!and!how!
to!manage!your!job!efficiently.!Once!you!can!manage!a!busy!team,!you!
can!manage!anything.!
B Most!specialties!have!registrars!or!other!senior!house!surgeons!floating!around!so!you!have!someone!to!turn!to!if!
you!have!questions.!This!is!also!great!if!youre!on!call.!


B Ease!of!access!to!investigations.!Many!which!can!easily!be!requested!by!house!surgeons!rather!than!having!to!go!
through!someone!more!senior.!
B Weekly!Wednesday!teachings.!Dr!John!Thwaites!is!the!RMO!coBordinator!and!is!hugely!supportive!of!nurturing!
RMOs.!
B Great!if!you!already!know!the!place.!Its!always!a!steep!learning!curve!to!understand!a!new!system,!new!
4
guidelines,!new!geography!and!new!people!from!a!hospital.!Staying!in!Christchurch!if!youre!from!here!will!take!
that!stress!factor!away!and!let!you!focus!on!getting!used!to!your!new!job.!
B RMO!activities,!there!are!weekly!sport!groups!e.g.!netballs,!touch!and!annual!talent!shows!and!even!joining!in!
good!old!NZMSA/CMSA!student!events!e.g.!the!MASdebate!which!is!always!good!fun.!
B TIs.!In!a!teaching!hospital,!often!you!get!paired!up!with!one.!If!you!happen!to!get!a!good!one,!not!only!do!you!half!
your!workload!but!theyre!also!a!great!coffee!buddy.!
B Coffee.!Boatshed!cafe!outside!the!hospital!is!fantastic.!You!also!have!2!other!options!inside!the!hospital!if!youre!
short!of!time.!
B Advanced!computer!system,!Concerto.!Only!when!you!dont!have!it!do!
you!realise!how!nice!it!is!to!have!everything!on!one!log!in!and!to!have!
So uth Cante rbury DHB
the!ability!to!access!old!clinical!notes!in!one!click.!
Contact:!
B Extra!duties.!There!are!plenty!of!opportunities!floating!around!if!you!
Maree!Mackenzie!
want!some!extra!moolah!for!that!nice!ski!trip!!
Private!Bag!911,!Timaru!
B Parking!facilities.!Parking!buidlings!were!taken!down!during!the!big!
Ph:!+64!3!687!2389!
event.!However,!they!made!a!new!one!which!is!free!to!all!and!only!
Fax:!+64!3!687!2369!
about!5B10mins!walk!away.!
Email:!mmackenzie@scdhb.health.nz!
B Based!in!a!large!city!with!a!number!of!activities,!restaurants,!cafes!and!
Web:!www.scdhb.co.nz!!
shopping!opportunities.!Westfield!Riccarton!mall!is!one!of!the!biggest!
(
and!best!malls!that!all!the!big!brands!city!goers!love.!
Timaru(Hospital(
B Close!to!surrounding!outdoor!activities.!City!close!to!the!beach,!the!
mountains!for!skiing!and!Hanmer!for!the!hot!springs.!Flights!to!other!
cities!and!countries!are!also!very!reasonable.!
!
The!Bad:!
B No!one!can!deny!Christchurch!is!affected!by!the!big!event.!Some!specialties!are!more!affected!than!others!e.g.!
general!medicine!which!is!split!into!two!sites.!Some!people!may!find!this!difficult!to!work!with.!!
B The!central!city!is!also!affected!so!surrounding!traffic!can!be!congested!but!there!are!enough!activities!around!the!
city!to!keep!you!interested.!
B RMO!unit!is!a!busy!place!managing!a!large!number!of!doctors.!Hence!often!timetables!and!paychecks!can!be!
incorrect!or!less!than!ideal.!As!with!most!places,!know!your!RDA!rights!and!be!sure!to!make!sure!youre!treated!
right.!
B Large!hospitals!have!registrars!and!other!senior!colleagues!around.!However,!on!the!downside,!this!means!less!
hands!on!experience!for!you.!You!will!need!to!work!twice!as!hard!if!you!want!some!theatre!time.!
B Paperwork!is!something!you!have!to!put!up!with!everywhere.!However,!large!busy!hospitals!also!mean!an!
especially!large!amount!of!paperwork.!!!
B It!also!means!its!hard!to!finish!on!time!especially!in!general!surgery!and!medicine.!!Id!see!it!has!a!huge!bonus!if!
you!ever!finish!on!time.!
B 3rd!quarter.!Already!short!staffed!in!most!places,!being!in!a!tertiary!hospital!such!as!Chch!will!definitely!make!you!
work!for!you!money.!
B Food:!reasonably!large!selection,!however!most!people!dont!rave!about!it.!Still,!free!food!is!better!than!no!food.!
B You!will!inevitably!need!to!put!up!with!the!good!ol!shakes!!But!theyre!not!too!bad!once!you!get!used!to!them.!
Christchurch!could!always!do!with!more!help!from!those!who!are!keen.!
!
!
!
!
16
So uthe rn DHB
(
Dunedin(Hospital(
Dunedin(Hospital(
Contact:!
Dr!Jane!Yeojeong!So!
Nina!Giles!
!
5
Private!Bag!1921,!Dunedin!
The!good!
B Teaching!hospital:!all!about!evidence!based!medicine!and!teaching!
Ph:!+64!3!474!0999!ext!8405!
ward!rounds!and!weekly!medical!rounds!and!journal!clubs!etc.!!
Fax:!+64!3!474!7715!
B Centre!of!RACP!exam!training!programme:!you!get!a!glimpse!at!what!
Email:!nina.giles@southerndhb.govt.nz!
is!it!like!to!prepare!for!physicians'!exams.!
Web:!www.southerndhb.govt.nz!
B From!what!I!heard,!all!our!surgeons!are!nicer!and!more!approachable!
compared!to!other!cities.!
!
B Everything!is!within!walking!distance!from!the!hospital,!you!can!go!to!
Invercargill(Hospital(
the!bank!on!your!lunch!break!!
Contact:!
B Cheapish!accommodation!but!you!may!have!to!fight!with!the!
Jen!Allen!
students!if!you!want!to!live!in!town!!
PO!Box!828,!Invercargill!
B Close!to!beaches!and!Queenstown/Wanaka.!
Ph:!+64!3!218!1949!ext!8338!
B Reasonably!easy!to!get!leave.!
Fax:!+64!3!214!7242!
B The!RMO!Office!is!quite!good!at!following!MECA!but!it!may!soon!
Email:!jen.allen@southerndhb.govt.nz!
change!as!we!have!had!a!big!turnover!in!RMO!office!recently.!
Web:!www.southerndhb.govt.nz!!
B RMO!office!is!really!good!in!financially!supporting!you!if!you!want!to!
take!ObsGyn!diploma,!ophthalmology!course!etc.!
!!
The!bad!
B No!room!for!house!surgeon!to!admit!patients!except!on!nights.!
B Like!many!tertiary!hospitals,!lots!of!paper!work!(from!chest!pain!pathways!to!stroke!pathways...).!
B Limited!resources!in!RMO!room,!we!only!have!couple!of!couches,!dusty!stereo,!TV/SKY!and!computer/printer!at!
end!of!their!lives.!No!locker,!shower!or!bed.!Theoretically!there!is!a!room!on!each!floor!for!House!Surgeons!to!drop!
off!their!bags!but!it's!about!the!size!of!a!disabled!toilet!at!its!best,!there!is!no!computer!or!desk!(and!it's!too!noisy!
with!all!the!computer!cables!going!through!anyway!).!
B Parking!gets!difficult!once!uni!starts!in!full!swing.!
B RMO!will!try!to!ask!female!house!officers!about!their!family!planning.!
B Micromanagement!from!consultants!BB!can!be!good!or!bad;!they!really!like!to!know!everything,!and!I!mean!
everything,!and!want!to!be!called!at!night.!
!
!
!


!
Finances
One!of!the!best!things!about!starting!work!is!the!freedom!you!gain!from!earning!your!own!money.!!
Its!easy!to!feel!overwhelmed!by!the!financial!decisions!you!need!to!make!as!you!embark!on!a!busy!
!year,!so!here!are!our!top!tips!for!new!graduates.!
!
A LITTLE TIME NOW MEANS A BIG PAY OFF IN

THE FUTURE
Spend!some!time!reviewing!your!finances!or!discussing!with!a!MAS!adviser!!
the!earlier!you!set!up!a!plan,!the!easier!it!will!be!to!stay!on!track.!
!
DEBT MANAGEMENT
More!than!75%!of!medical!students!graduate!with!over!$50,000!of!debt,!so!
dont!stress!!Build!a!plan.!Pay!off!your!high!interest!debt!first.!Talk!to!your!
MAS!adviser!about!consolidating!your!debt!or!helping!you!design!a!payment!
plan!that!is!within!your!budget.!
!
Remember:!not!all!debt!is!bad.!Smart!debt!builds!on!your!assets,!for!example!
your!education!or!a!home.!Sometimes!it!is!necessary!to!borrow!money!!but!if!
you!set!up!a!realistic!payment!term!and!stick!to!it,!you!are!building!your!
future!credit!history.!Make!sure!you!understand!the!terms!and!conditions!of!
any!loan,!including!the!interest!charged,!related!fees,!and!the!consequences!if!
you!are!unable!to!make!payments.!
!
Student loan
Step 1 Financial
assessment: Where am I
now?
Find!out!your!starting!salary!and!what!
other!entitlements!your!employment!
terms!include!such!as!holidays,!sick!
leave,!bonuses!and!commission.!Your!
employment!contract!will!contain!this!
and!other!important!information!!take!
the!time!to!read!it.!
!
Step 2 Goal setting:

Where do I want to be?
Before!you!spend!all!of!your!first!pay,!it!
is!worth!thinking!about!what!you!want!
to!achieve.!!
!
If!you!earn!more!than!the!repayment!threshold!of!$19,084!(about!$367!per!
Step 3 Financial plan:
week)!for!the!tax!year!(1!April!to!31!March),!you!are!required!to!start!making!
repayments!toward!your!loan.!If!you!pay!via!your!employer,!10!cents!of!every!
How do I get there?
dollar!you!earn!over!the!repayment!threshold!will!be!deducted!from!your!
A!good!financial!plan!will!cover!three!
salary!or!wages.!
main!areas.!
!
B Debt!Management!
If!you!go!overseas,!you!will!need!to!keep!IRD!informed!of!your!contact!details.!!
B Savings!&!Investment!
Interest!applies!on!your!loan!while!you!are!away!(if!you!are!overseas!for!184!
B Risk!Management!
days!or!more!in!total!in!the!year),!although!you!may!be!entitled!to!a!student!
loan!repayment!holiday!for!up!to!three!years.!More!information!can!be!found!at!http://www.ird.govt.nz.!
!
Credit cards
When!managed!well,!credit!cards!can!be!a!convenient!way!to!pay:!theyre!useful!if!you!dont!have!enough!savings,!want!
to!pay!online,!or!in!an!emergency.!But!if!you!fail!to!pay!them!off!in!full!each!month!!or!you!spend!more!than!you!can!
afford!!you!can!get!into!trouble.!The!longer!you!leave!an!unpaid!credit!card!balance,!the!more!expensive!it!gets.!
!
18

!
Make!sure!you!check!the!fees,!interest!rates!and!reward!schemes!
included!in!any!credit!card!agreement.!!If!you!think!you!might!have!
trouble!controlling!your!credit!card!spending,!you!may!find!that!a!
debit!card!is!a!better!solution,!in!that!there!is!less!chance!of!spending!
more!than!you!can!afford.!
!
SAVINGS & INVESTMENTS
Voluntary repayment bonus

If!you!pay!off!your!student!loan!faster!than!
required,!you!might!be!eligible!for!a!10%!
repayment!bonus.!
!
Voluntary!repayments!are!made!on!top!of!what!
7
you!are!required!to!repay!to!Inland!Revenue!
over!a!tax!year.!To!qualify!for!the!repayment!
bonus,!a!surplus!lump!sum!(or!smaller!
payments)!must!total!$500!or!more!in!a!given!
tax!year!(1!April!to!31!March).!The!bonus!only!
applies!to!repayments!made!to!IRD!!not!if!you!
repay!with!StudyLink!prior!to!the!end!of!your!
course.!
Make!sure!your!money!is!working!as!hard!as!possible!for!you.!Rather!
than!leaving!any!spare!cash!in!an!everyday!cheque!or!savings!account,!
set!up!a!high!interest!earning!account.!!Check!out!options!that!allow!
for!tax!savings!where!possible.!An!account!or!investment!set!up!as!a!
Portfolio!Investment!Entity!(PIE)!is!a!great!option!because!you!pay!tax!
on!investment!income!based!on!your!prescribed!investor!rate!(PIR),!
rather!than!your!standard!tax!rate.!Savers!who!benefit!the!most!are!those!on!a!30%!or!33%!income!tax!rate,!because!a!
PIE!caps!your!tax!rate!at!28%.!For!new!graduates!the!PIR!is!based!on!either!of!your!last!two!years!of!taxable!income.!As!
your!Trainee!Intern!taxBfree!grant!does!not!count!as!taxable!income,!your!PGY1!and!PGY2!years!PIR!could!be!as!low!as!
10.5%.!If!you!have!money!that!you!are!prepared!to!lock!away!for!a!period!of!time,!you!can!get!even!higher!interest!rates!
in!a!debenture!or!term!deposit.!
!
Make!the!most!of!your!spending.!Some!credit!cards!can!be!linked!to!reward!schemes!like!FlyBuys!!investigate!the!
options!available!to!you.!You!should!also!think!about!retirement!savings!now.!Starting!early!is!the!best!way!to!save!
money!in!the!long!run.!As!a!doctor!working!for!a!DHB,!you!may!be!entitled!to!subsidised!superannuation.!The!2012!
MECA!agreement!allows!for!up!to!6%!of!your!salary!to!be!matched!by!a!given!DHB.!You!have!the!option!of!a!standard!
superannuation!plan!(subsidised!by!your!DHB)!or!KiwiSaver,!which!is!
subsidised!by!your!employer!and!by!the!Government.!Your!superannuation!
Tax refund
funds!are!invested!in!your!choice!of!portfolio!and!managed!by!a!team!of!
experts.!This!is!a!simple!way!to!invest!in!your!retirement!over!the!long!term.! At!the!end!of!the!financial!year!(31!
March)!of!your!first!House!Officer!year,!
Splitting!your!contributions!between!standard!superannuation!and!
you!will!have!worked!since!November!of!
KiwiSaver!is!a!good!way!to!get!the!most!from!both!schemes.!
the!previous!year.!You!may!be!entitled!
!
to!a!tax!refund!as!you!only!worked!for!
Because!superannuation!is!a!longBterm!investment,!you!should!consider!the!
part!of!that!year.!To!find!out!how!to!
benefits!and!restrictions!of!each!type!of!product.!Talk!to!a!MAS!adviser!
apply!for!this!refund,!contact!an!IRD!
before!you!sign!up.!!
representative!by!phone!or!look!online!
!
at!http://www.ird.govt.nz.!
RISK MANAGEMENT
Make!a!plan!to!protect!what!you!already!have.!Start!by!doing!a!risk!assessment.!When!you!consider!your!assets,!you!
may!think!of!your!car,!your!possessions!and!your!savings!!but!once!you!graduate,!you!instantly!have!a!new!one.!Your!
ability!to!earn!income!as!a!doctor!is!your!most!valuable!asset,!and!it!is!important!that!you!protect!it.!Your!job!pays!an!
income!that!allows!you!to!maintain!a!certain!lifestyle.!Your!income!gives!you!choices!!to!buy,!to!save!and!to!borrow.!
!
Ask yourself these five questions:

What are your potential risks?
These!risks!could!include!a!fire!in!your!home,!your!car!getting!stolen,!you!falling!ill!and!not!being!able!to!work,!or!even!
death.!
!
!!
!

What are the chances of these risks occurring?

There!is!probably!only!a!small!risk!of!a!fire!in!your!home,!but!it!will!cost!a!lot!if!it!happens.!The!chances!of!your!car!
getting!damaged!or!stolen!are!much!higher,!but!the!costs!will!not!be!as!great!as!losing!your!home.!Your!risk!of!getting!
sick!and!not!being!able!to!work!are!also!quite!low!!but!it!might!not!take!much!to!render!you!unable!to!work!as!a!doctor,!
as!opposed!to!someone!in!lower!skilled!work.!Your!risk!of!death!is!quite!low!if!you!are!young!and!healthy.!8
What would happen?

If!there!was!a!fire!in!your!home,!you!could!lose!the!house!(if!you!own!it),!and!all!of!your!possessions!inside!it,!similar!to!
your!car.!If!you!got!sick!and!could!not!work,!your!family!might!have!to!support!you,!and!you!might!not!be!able!to!
continue!saving!for!the!things!you!planned.!Would!your!family!have!to!give!up!work!to!look!after!you?!!If!you!died,!your!
family!would!have!to!arrange!a!funeral!and!tend!to!your!affairs.!
!
How much would it cost?!!

Would!you!have!enough!money!saved!to!cover!these!costs?!Would!you!want!to!dip!into!your!retirement!savings!to!
cover!them?!If!you!are!unable!or!do!not!want!to!afford!the!consequences!of!these!risks,!you!should!consider!insurance!
cover.!For!instance,!you!would!most!likely!insure!a!car!if!you!already!own!one.!However!if!you!do!not!own!your!home!or!
have!minimal!belongings,!you!may!be!tempted!to!not!purchase!house!and!contents!insurance.!
!
What!many!people!do!not!consider!is!what!happens!if!your!landlord's!property!is!accidentally!damaged!by!you!or!your!
flatmates.!If!you!cause!a!fire,!you!could!be!charged!tens,!or!hundreds!of!thousands!of!dollars!for!the!repair.!You!should!
consider!taking!out!a!small!contents!insurance!policy!with!a!personal!liability!component.!If!your!parents!are!insuring!
you,!make!sure!the!insurance!company!is!aware!!otherwise!you!might!not!be!covered!in!the!event!of!a!claim.!
!
Income!security!or!income!protection!insurance!will!pay!you!an!income!if!you!cannot!work!due!to!illness!or!injury.!It!is!
easier!to!set!up!when!you!are!young,!as!your!application!is!based!on!your!health!now.!The!same!goes!for!your!insuring!
your!life.!Life!insurance!is!a!lump!sum!payment!made!when!you!die.!It!is!used!to!ensure!that!your!debt!is!paid!off!and!
your!dependents!are!provided!for.!You!might!not!think!you!need!to!worry!about!it!at!this!stage!in!your!life,!but!it!is!a!
good!idea!to!set!a!policy!up!early!so!that!you!do!not!have!to!face!exclusions!later!down!the!track.!!
What will you do if you need surgery or you make a mistake at work?
Finally!do!not!forget!general!health!insurance!and!your!professional!indemnity!cover.!!
!
IN SUMMARY
Set!aside!some!time!to!complete!a!financial!assessment.!!
Think!about!your!short!and!long!term!goals.!
Investigate!your!entitlements,!work!on!a!realistic!monthly!budget!and!make!a!long!term!financial!plan.!
Pay!off!any!high!interest!debt.!
Set!up!regular!savings!as!well!as!longBterm!savings.!
Think!about!your!assets!and!make!a!plan!to!protect!them.!
!
You!can!also!find!some!useful!savings!and!budgeting!tools!at!www.sorted.org.nz.!!
!
If!you!need!help!or!have!questions,!contact!a!MAS!financial!adviser!today!by!phoning!0800!800!627!or!
email!info@mas.co.nz.!
!

!
20

!
!
!
!
Your degree will

take you places.
The MAS New
Professionals
Pack will help
you get there.
Graduation is a perfect time to start planning your financial future. The MAS
New Professionals Pack delivers trimmed down costs and free advice.
Life insurance. A premium discount for up to five years after you graduate.1
Finance. Enjoy finance at a reduced interest rate with no fees for up to five
years after you graduate.2
Income Security insurance. A premium discount for up to three years after
you graduate.1
And, your future could look even better with Medical Assurance Society
KiwiSaver Plan and Retirement Savings Plan investment options, which qualify
for employer superannuation contributions.3 MAS. With you every step of the way.
Call us today
Theinfo@mas.co.nz
New Zealand Medical Students Association Incorporated
Email
C/- PO
156,at
Wellington
6140, New Zealand!
!
Visit
us Box
online
www.mas.co.nz
Legal stuff
10
Medical liability
All!doctors!require!medical!practice!indemnity!which!can!be!obtained!through!the!
Medical!Protection!Society,!the!New!Zealand!Medical!Professionals!Medical!
Indemnity!Insurance,!or!the!New!Zealand!Resident!Doctors!Associations!
professional!liability!insurance!programme.!The!costs!of!practice!indemnity!for!
hospital!doctors!will!be!met!by!the!employing!DHB.!
!
The MECA contract

All!District!Health!Boards!use!the!Resident!Doctors!Association!and!District!Health!Boards!Multi!Employer!Collective!
Agreement!(RDA!MECA).!This!agreement!contains!the!terms!and!conditions!of!employment!for!house!surgeons!
employed!at!DHBs!in!New!Zealand.!!!
!
Under!New!Zealand!employment!law,!if!a!workplace!uses!a!MECA,!all!new!employees!must!be!employed!under!that!
MECA!for!the!first!thirty!days!of!their!employment.!All!new!house!surgeons!must!be!employed!under!the!RDA!MECA!for!
their!first!30!days!of!employment.!!Therefore,!when!you!are!offered!a!position!at!a!DHB,!the!contract!you!will!be!
presented!with!will!be!a!copy!of!the!RDA!MECA.!You!will!be!automatically!signed!up!to!this!MECA!and!your!employment!
will!be!covered!by!the!terms!and!conditions!outlined!in!the!document.!!
!
The!purpose!of!this!30!day!window!is!to!give!new!employees!time!to!make!the!decision!whether!or!not!to!join!the!RDA!
(the!union).!If!you!choose!to!join!the!RDA!within!the!first!30!days,!your!employment!will!continue!under!the!MECA.!If!
you!have!not!joined!the!RDA!within!the!30!days,!you!will!be!required!to!sign!an!individual!employment!agreement!(IEA).!!
The!DHB!will!supply!you!with!a!copy!of!this!IEA.!The!IEA!is!based!on!the!MECA,!so!the!same!terms!and!conditions!will!
apply.!!!
!
You!can!also!choose!to!join!the!RDA!at!any!time!outside!the!30!days,!even!if!you!have!signed!an!IEA.!In!this!situation,!as!
soon!as!you!join!the!RDA,!you!will!automatically!be!covered!by!the!MECA!and!your!IEA!will!no!longer!be!in!place.!
One!of!the!roles!of!any!union!is!employee!representation.!If!you!become!a!union!member,!the!union!will!represent!you!
if!you!have!any!employment!issues!or!need!employment!advice.!The!New!Zealand!Medical!Association!will!also!provide!
their!members!with!employment!advice,!but!they!do!not!offer!a!representation!service!for!employment!issues.!
!
Medico-legal matters
Dr!Alan!Doris!of!the!Medical!Protection!Society!explains!why!Medico9legal!matters!are!so!important,!and!how!to!avoid!
common!traps!for!young!players.!
!
MedicoBlegal!principles!underpin!clinical!practice.!It!is!often!cases!where!there!are!ethical!or!legal!dilemmas!which!are!
the!most!challenging!and!interesting.!However,!in!all!cases!it!is!important!that!doctors!apply!clinical!knowledge!in!a!way!
that!is!legally!and!ethically!appropriate;!to!consult!senior!colleagues!and!avoid!working!in!a!vacuum.!Simple!things!like!
writing!concise!and!accurate!records,!getting!valid!consent!from!patients!and!knowing!when!to!seek!advice!can!help!you!
practise!safely.!
!
22

!
All!health!providers!need!to!be!familiar!with!the!Code!of!Health!and!
Disability!Consumers!Rights.!The!Code!sets!the!standards!of!service!
that!a!consumer!has!the!legal!right!to!receive,!and!a!doctor!has!a!duty!
to!provide.!When!something!goes!wrong!with!the!care!of!a!patient!it!
is!these!rights!and!duties!which!will!be!referred!to!if!there!is!a!review!
by!an!authority!such!as!the!Health!and!Disability!Commissioner.!
!
The!Medical!Council!of!New!Zealand!is!responsible!for!ensuring!that!
doctors!are!fit!to!practice!and!sets!standards!of!conduct!and!
competence!which!must!be!adhered!to.!If!a!doctor!does!not!meet!the!
standards!set!by!the!Medical!Council!then!there!is!a!risk!of!restrictions!
being!placed!on!the!doctors!scope!of!practice,!or!even!losing!
registration!completely.!This!is!a!very!high!price!to!pay!given!the!many!
years!of!dedication!and!work!required!to!gain!registration!as!a!doctor!
in!the!first!place.!
!
!
Useful(links(
Medical!Council!of!New!Zealand!B!
http://www.mcnz.org.nz/.!
The!Resources!tab!leads!to!a!number!of!
11
standards!and!guidelines!published!by!the!
Council.!
!
Health!and!Disability!Commissioner!B!
http://www.hdc.org.nz/.!
The!Code!of!Health!and!Disability!Consumers!
Rights!can!be!found!here!as!well!as!a!range!of!
information!about!the!Commissioners!office!
and!copies!of!investigations!carried!out.!
Avoiding traps for young players

Doctors!at!the!start!of!their!career!face!some!particular!medicoBlegal!hazards!and!so!you!may!find!some!tips!to!avoid!the!
five!most!common!ones!helpful.!
!
Consent
You!should!not!feel!pressured!to!do!anything!beyond!your!knowledge,!experience!and!competence,!this!includes!
obtaining!consent!for!a!procedure!that!you!are!not!familiar!with.!Always!get!a!senior!to!explain!or!demonstrate!it!as!part!
of!training.!
!
Failure!to!take!consent!properly!can!lead!to!medicoBlegal!problems!including!complaints!and!disciplinary!proceedings.!If!
your!actions!are!scrutinised!youll!need!more!than!a!signature!on!
Useful(links(
a!consent!form!to!fight!your!corner.!Consent!is!a!process,!rather!
The!Medical!Councils!statement!on!Information!and!
than!a!formBfilling!exercise.!!
Consent:!!
!
http://www.mcnz.org.nz/portals/0/publications/20
Survival!tips!
11BInformation!and!Consent.pdf.!
B Always!act!in!your!patients!best!interests.!
B Record!in!the!notes!what!a!patient!has!been!told.Use!your!
common!sense!!consent!is!patientBspecific!and!depends!on!the!individuals!circumstances,!including!age,!
lifestyle,!occupation,!sporting!interests,!expectations!etc.!!
B It!may!well!be!that!you!are!not!in!a!position!to!advise!fully,!for!example!with!professional!sports!people.!
B Ensure!that!information!given!to!patients!is!in!a!form!which!they!can!understand.!
B Patients!are!presumed!competent!to!consent!unless!proved!otherwise.!
B A!competent!adult!can!refuse!treatment.!
B The!law!concerning!incompetent!adults,!who!are!unable!to!give!valid!consent,!is!more!complicated.!If!you!are!in!
doubt!consult!senior!colleagues.!
B Remember!there!are!circumstances!where!a!child!can!give!consent!without!reference!to!a!parent!!if!in!doubt!
consult!a!senior!colleague.!
!
Prescribing
If!you!are!unsure!about!a!prescription,!or!mishear!on!a!ward!round,!always!seek!clarification,!never!guess.!
23

When!prescribing,!the!hazard!warning!lights!in!your!brain!should!be!flashing!persistently.!This!is!one!of!the!most!
dangerous!areas!for!all!clinicians.!From!overBprescribing,!transferring!incorrectly!to!new!charts!and!prescribing!for!the!
wrong!patient,!to!forged!prescriptions!and!overdoses,!incorrect!dosages,!interactions,!and!allergies,!prescribing!is!
fraught!with!complications.!It!is!imperative!that!you!have!a!good!knowledge!of!the!pharmacology!and!the!legislation!
surrounding!drugs,!and!the!hospital!protocols!and!controlled!drug!routines!!if!unsure,!ask.!
12
!
Always!document!allergies!and!double!check!names,!doses,!frequency!and,!in!some!cases,!(like!anticonvulsants),!brand!
names.!You!should!not!feel!pressured!to!do!anything!beyond!your!competence!B!always!ask!a!senior!for!advice.!If!a!
patient!is!admitted!and!there!is!any!doubt!regarding!their!current!medication!then!consult!the!ward!pharmacists!or!the!
GP.!
Useful(links(
!
The!Medical!Councils!statement!on!prescribing:!!!
Handovers!are!another!tricky!area.!Teams!must!work!together!in!
http://www.mcnz.org.nz/portals/0/publications/
the!allotted!time!to!ensure!that!the!clinically!unstable!patients!are!
good%20prescribing%20practice%20april%20201
identified,!plans!for!further!care!are!put!in!place!and!tasks!not!yet!
0.pdf.!
completed!are!clearly!understood!by!seniors!and!juniors.!Make!sure!
A!guide!to!safe!prescribing!in!children!from!Best!
that!the!patient!information!is!written!clearly!for!the!handover!
Practice!Journal:!!
team.!
http://www.bpac.org.nz/magazine/2010/july/me
!
derrors.asp.!
Survival!tips!
And!at!the!other!end!of!the!age!spectrum:!!
B Prescriptions!should!clearly!identify!the!patient,!the!drug,!the!
http://www.bpac.org.nz/magazine/2008/februar
dose,!frequency!and!start/finish!dates,!be!written!or!typed,!
y/prescribing.asp.!
and!be!signed!by!the!prescriber.!
B Be!aware!of!a!patients!drug!allergies.!
B Good!handovers!require!good!leadership!and!communication.!
B If!you!seek!and!receive!advice!from!a!senior!about!a!prescription,!write!that!advice!in!the!notes.!!
B Refer!to!the!British!National!Formulary!or!similar!reference!manual.!
B Verbal!prescriptions!are!only!acceptable!in!emergency!situations!and!should!be!written!up!at!the!first!available!
opportunity.!Particular!care!should!be!taken!that!the!correct!drug!is!used.!
!
Confidentiality
Doctors!who!break!a!patients!confidence!undermine!trust!in!the!medical!profession.!As!well!as!the!common!law!duty!of!
confidentiality,!doctors!need!to!abide!by!the!privacy!legislation!and!the!Health!Information!Privacy!Code!(HIPC).!Privacy!
issues!often!cause!difficulties!for!doctors!who!can!easily!be!caught!in!the!middle!between!their!patient,!families!and!
third!parties!such!as!employers,!insurance!companies!or!the!Police.!The!Privacy!Commissioner!has!helpfully!summarised!
the!HIPC!Code!for!health!providers!as!follows.
1. Only!collect!health!information!if!you!really!need!it.!
2. Get!it!straight!from!the!people!concerned!where!possible.!
3. Tell!them!what!you're!going!to!do!with!it.!
Useful(links(
The!Privacy!Commissioner!has!
4. Be!considerate!when!you're!getting!it.!
published!a!toolkit!for!health!
5. Take!care!of!it!once!you've!got!it.!
providers:!!
6. People!can!see!their!health!information!if!they!want!to.!!
http://privacy.org.nz/healthBprivacyB
7. They!can!correct!it!if!it's!wrong.!
toolkit/.!
8. Make!sure!health!information!is!correct!before!you!use!it.!
9. Get!rid!of!it!when!you're!done!with!it.!
10. Use!it!for!the!purpose!you!got!it.!!
11. Only!disclose!it!if!you!have!a!good!reason.!
12. Only!assign!unique!identifiers!where!permitted.!

!
24

The!starting!point!should!be!that!information!you!receive!about!a!patients!health!should!not!be!disclosed!to!anyone!not!
directly!involved!with!that!persons!health!care!without!the!patients!consent.!If!you!disclose!information!without!the!
patients!consent!you!must!have!a!clear!justification!for!this.!
!
Survival!tips!
13
B Before!breaching!confidentiality,!always!consider!obtaining!consent.!
B Take!advice!from!senior!colleagues.!
B If!considering!passing!a!patients!health!information!to!another!party!without!the!patients!consent,!have!a!clear!
understanding!of!your!justification!for!doing!so!first!with!reference!to!the!Health!Information!Privacy!Code.!
B Doctors!are!required!to!report!to!various!authorities!a!range!of!issues,!including!notifiable!diseases!(e.g.!TB).!!
B The!courts!can!require!doctors!to!disclose!information,!although!it!would!be!a!good!idea!to!contact!MPS!if!you!
find!yourself!presented!with!a!court!order!or!a!police!request!for!patient!information.!
B HighBrisk!areas!where!inadvertent!breaches!of!confidentiality!can!occur!are!lifts,!canteens,!computers,!printers,!
wards,!clinic!reception!areas,!patient!waiting!areas,!A&E!departments,!pubs,!and!restaurants.!
B Be!careful!not!to!leave!memory!sticks!or!handover!sheets!lying!around.!
B Be!sure!not!to!disclose!any!patient!identifiable!health!information!on!social!media,!Facebook,!Twitter!etc!
!
Record keeping
Keeping!good!notes!provides!you!with!the!best!backup!should!your!care!be!called!into!question!at!some!point!in!the!
future,!though!legible!notes!must!be!kept!primarily!to!assist!the!patient!when!receiving!treatment.!Notes!are!a!reflection!
of!the!quality!of!care!given!so!get!into!the!habit!of!writing!comprehensive!and!contemporaneous!notes.!
Useful(links(
Survival!tips!
Medical!Council!statement!on!maintenance!and!
B Always!date!and!sign!your!notes,!whether!written!or!
retention!of!patient!records:!
on!computer.!Dont!change!them.!If!you!realise!later!
http://www.mcnz.org.nz/portals/0/publications/Maint
that!they!are!factually!inaccurate,!add!a!correction,!
enance%20and%20retention%20of%20records.pdf.!
but!do!not!delete!the!original!entry.!
A!useful!article!on!managing!requests!for!the!health!
B Any!correction!must!be!clearly!shown!as!an!
information!of!a!child:!
alteration,!complete!with!the!date!the!amendment!
http://www.medicalprotection.org/newzealand/caseb
was!made,!and!your!name.!
ookBjanuaryB2010/childsBplay.!
B Making!good!notes!should!become!habitual.!
B Document!any!decisions!made,!any!discussions,!
information!given,!relevant!history,!clinical!findings,!patient!progress,!investigations,!results,!consent!and!
referrals.!
B Do!not!write!anything!in!the!notes!that!you!would!not!be!comfortable!saying!directly!to!the!patient.!!
B Remember!that!email!communications!between!colleagues!about!a!patient!may!be!made!available!to!the!patient!
if!an!information!request!is!made!by!them!or!their!family.!
B Only!include!things!that!are!relevant!to!the!health!record.!
B Be!wary!of!including!third!party!information!in!the!health!record!(for!example,!information!about!a!relative!of!
the!patient).!
B Patients!have!a!right!to!access!their!own!medical!records,!and!many!exercise!this!right.!
!
Probity
The!public!expects!doctors!to!have!the!highest!standards!of!honesty,!integrity!and!ethical!behaviour,!and!the!Medical!
Council!requires!this.!Remember!also!that!there!can!be!professional!accountability!for!behaviour!in!your!private!life,!
such!as!any!criminal!conviction.!
!
Doctors!must!be!honest!and!trustworthy!when!signing!forms,!reports!and!other!documents!and!any!documents!they!
write!or!sign!must!not!be!false!or!misleading.!This!means!that!doctors!must!take!reasonable!steps!to!verify!the!
25

information!in!the!documents,!and!must!not!deliberately!leave!out!anything!relevant.!You!may!encounter!families!who!
dont!want!certain!information!visible!on!the!death!certificate,!but!doctors!have!a!legal!and!professional!obligation!to!
complete!the!certificate!truthfully.!
Useful(links(
!
The!Medical!Councils!foundation!document!
Survival!tips!
on!standards!for!doctors!is!at:!!14
B If!you!are!uncertain!double!check!your!work!with!a!senior.!
http://www.mcnz.org.nz/portals/0/guidanc
B Take!steps!to!verify!what!you!are!saying.!Never!sign!a!form!
e/goodmedpractice.pdf.!
unless!you!have!read!it!and!you!are!absolutely!sure!that!what!
you!are!saying!is!true.!
B Probity!means!being!honest!and!trustworthy!and!acting!with!integrity.!
B Be!honest!about!your!experiences,!qualifications!and!position.!
B Be!honest!in!all!your!written!and!spoken!statements,!whether!you!are!giving!evidence!or!acting!as!a!witness!in!
some!legal!process.!
B You!must!be!open!and!honest!with!any!financial!arrangements!with!patients!and!employers,!insurers,!and!other!
organisations!or!individuals.!
B Assume!that!all!records!will!be!seen!by!the!patient!and/or!others,!e.g.!coroner,!Health!and!Disability!
Commissioner.!
!
There!are!medicoBlegal!aspects!to!all!cases,!and!these!should!be!viewed!as!interesting!and!challenging,!though!very!
important!to!get!right.!If!uncertain!consult!with!a!senior!colleague!or!get!expert!advice!from!one!of!the!medicoBlegal!
advisers!at!MPS!(0800!22!55!677).!
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Getting registered
!
If!you!expect!to!work!as!a!doctor!in!New!Zealand!after!you!finish!your!medical!degree,!you!must!!
apply!for!registration!with!Medical!Council!of!New!Zealand!(MCNZ).!You!can!find!the!registration!!
application!form!on!the!MCNZ!website!at!the!following!link:!!
!
http://www.mcnz.org.nz/Registration/Formspoliciesandfees/Registrationapplicationforms!
/tabid/100/Default.aspx.!
!
You!must!fully!complete!your!application!form!and!send!it!with!the!required!fee!as!stated!on!the!application!form!to!
MCNZ!so!that!it!all!reaches!the!MCNZ!office!in!Wellington!early!in!October!2012.!
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If!MCNZ!requires!further!information!at!any!stage!during!the!processing!of!your!application!they!will!contact!you!
directly.!It!is!important!to!provide!MCNZ!with!a!current!and!reliable!email!address.!The!required!fee!entails!the!
processing!of!your!application!and!a!three!month!practising!certificate!(until!28!February!2013).!The!receipt!for!this!fee!
will!be!sent!to!you!with!your!first!practising!certificate.!
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Practicing Certificate
When!MCNZ!has!been!advised!directly!by!your!conferring!university!that!you!have!completed!your!degree,!a!practising!
certificate!will!be!sent!directly!to!the!DHB!where!you!will!be!
Registration(number(
working.!Your!university!usually!confirms!your!qualification!
Your!first!practising!certificate!will!contain!your!
about!a!week!before!you!start!work.!Your!practising!
registration!number!which!you!can!use!(in!addition!to!
certificate!will!be!made!available!to!you!on!your!first!day!of!
your!name)!on!prescription!forms,!ACC!forms!etc.!Your!
registration!number!will!be!clearly!stated!on!your!
work.!Your!practising!certificate!will!specify!the!name!of!the!
practising!certificate!and!you!will!be!asked!to!quote!it!on!
DHB!at!which!you!work.!If!you!change!employment,!you!
all!future!correspondence!with!the!Medical!Council.!
must(notify!the!Council!so!that!your!practising!certificate!
can!be!amended.!
In!December!2012,!you!will!be!sent!another!application!from!MCNZ!for!a!practising!certificate!which!will!put!you!onto!
your!practising!certificate!cycle!(from!1!March!2013!onwards).!Your!cycle!will!be!based!on!your!date!of!birth.!There!are!
four!possible!renewal!dates!every!year.!Once!youre!on!your!practising!certificate!cycle!you!will!be!charged!a!yearly!fee!
at!the!same!time!every!year.!!
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Online medical register

Your!registration!number,!name,!registered!address,!qualifications,!registration!status!and!registration!dates,!as!well!as!
any!conditions!imposed!on!your!registration!or!annual!practising!certificate!will!be!listed!in!the!medical!register,!which!is!
available!to!the!public.!This!information!will!be!made!available!to!the!Ministry!of!Health!under!a!data!provision!
agreement!for!the!purposes!of!the!Health!Practitioners!Index.!Under!this!agreement!your!date!of!birth!and!gender!will!
also!be!made!available!for!identification!purposes!only.!

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28

You!will!be!able!to!check!your!register!entry!(once!you!start!work)!on!Councils!online!register.!You!can!find!the!online!
register!by!going!to!the!Councils!homepage:!www.mcnz.org.nz.!
!
Your registered addresses
The!Health!Practitioners!Competence!Assurance!Act!(HPCAA)!requires!doctors!to!notify!Council!of!three!addresses:!
17
B residential!address!
B work!address!
B postal!address.!
You!must!choose!one!of!these!addresses!to!be!your!registered!address.!Your!registered!address!is!publicly!available!
information.!For!privacy!reasons!you!may!choose!to!use!your!work!address!as!your!registered!address.!Please!clearly!
indicate!which!address!is!your!chosen!registered!address!on!the!enclosed!application!form.!
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Your!postal!address!may!be!the!same!as!either!your!work!or!residential!address.!Whichever!address!you!choose!as!your!
postal!address!must!be!reliable!and!accurate!at!your!November!start!date!(if!you!do!not!know!where!you!will!be!living!
select!your!work!address!as!your!postal!address).!Once!you!are!registered!you!have!a!statutory!obligation!to!notify!
MCNZ!promptly!of!any!change!to!your!residential,!work!and!postal!addresses.!You!must!do!this!in!writing,!and!can!do!it!
online!at:!www.mcnz.org.nz.!!
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New!Zealands!health!system!is!undergoing!change!and!constantly!evolving!!with!many!issues!!
on!the!horizon!that!directly!affect!doctors!in!training.!Who!is!representing!your!interests!and!!
advocating!on!your!behalf?!The!New!Zealand!Medical!Association!(NZMA)!is!the!largest!medical!!
professional!organisation!in!New!Zealand!with!approximately!5,000!members.!It!is!panBprofessional!!
in!that!it!represents!member!doctors!from!all!disciplines!within!medicine,!at!every!stage!of!their!!
careers,!including!medical!students.!!!
!
The!NZMA!DoctorsBinBTraining!Council!(DiTC)!is!made!up!of!elected!representatives!that!work!on!behalf!of!trainee!
intern,!RMO!and!medical!student!members.!The!Council!has!a!busy!time!ahead!as!it!seeks!to!influence!and!provide!input!
into!issues!such!as:!
B the!proposed!revamp!of!the!prevocational!years!
Below(are(examples(of(some(of(the(
B the!Careers!Intention!Plan!for!PGY1s!
DiTCs(recent(work.(
B collegeBspecific!issues!that!may!affect!those!looking!to!apply!to!
!
training!programmes!
Submissions!
B the!move!towards!generalist!type!training!
Prevocational!training!requirements!
B potential!impact!of!physician!assistants!on!doctors!work!
for!doctors!in!New!Zealand!
environments.!
!
!
Position!statements!
The!underlying!goal!behind!these!issues!is!the!need!to!improve!the!
Limited!prescribing!rights!for!trainee!
recruitment!and!retention!of!doctors!to!ensure!our!country!has!a!sustainable,!
interns!
high!performing!healthcare!system.!To!retain!doctors!in!New!Zealand,!they!
The!RMO!working!environment!
need!to!feel!valued!by!our!health!system!and!for!doctorsBinBtraining!it!is!
!
particularly!important!that!service!provision!does!not!compromise!training.!
Resources!
The!quality!of!the!training!experience!must!remain!the!number!one!priority!
Bullying!and!harassment!resource!
with!adequate!training!time,!mentoring,!support!and!supervision.!
Social!media!guide:!maintaining!
!
professionalism!while!using!social!
The!DiTCs!members!(which!include!the!President!of!the!NZMSA!and!a!PGY1!
media!
representative)!contribute!towards!developing!submissions!and!position!
statements!in!response!to!policy!proposals!and!other!health!sector!initiatives.!!
!
Professional
representation
Why belong to the NZMA?

Surveys!have!shown!that!the!majority!of!NZMA!members!join!to!demonstrate!their!commitment!to!the!profession.!A!
strong!membership!base!enables!the!Association!to!be!an!influential!advocate!for!the!profession!and!to!help!advance!
the!medical!profession!and!the!health!of!all!New!Zealanders.!We!encourage!you!to!have!influence!in!shaping!your!future!
and!our!health!system!by!keeping!up!to!date!with!what!the!DiTC!is!doing.!We!are!also!keen!to!hear!your!views!and!to!
know!what!issues!concern!you!most.!The!DiTC!recognises!that!to!be!effective,!ongoing!dialogue!with!its!members!is!
essential.!We!undertake!online!surveys!to!improve!our!understanding!of!the!issues!that!affect!you!and!to!ensure!our!
advocacy!is!representative!of!your!views.!Last!year!we!ran!a!survey!on!prevocational!training!which!proved!very!
valuable,!as!it!provided!a!clearer!idea!of!what!our!members!think!of!Health!Workforce!New!Zealands!(HWNZs)!
proposed!changes!in!this!area.!
!
30
ADVOCACY - WHY DO IT?
This kid
wouldnt be sick
if his home was
warm.
What can I do?
19
<
Moving!from!medical!school!to!vocational!training!brings!with!it!new!
opportunities!and!challenges.!The!DiTC!hosts!a(national!Trainee!Forum,!
attended!by!representatives!of!the!medical!colleges,!which!enables!
trainee!reps!to!share!information!and!have!input!into!shaping!their!
training!experience.!Dialogue!is!crucial!B!the!trainee's!voice!is!often!
hidden!because!of!clinical!commitments!and!lack!of!access.!At!the!
Forum!reps!have!the!opportunity!to!discuss!the!issues!with!HWNZ!and!
the!Medical!Council!of!New!Zealand!and!to!hear!from!senior!colleagues.!
It!all!adds!up!to!meaningful!input!into!issues!that!will!affect!careers!into!
the!future.!!
!
My loan is so huge!
I will have to locum in
Australia to get in the
black. Why isnt the
Government
concerned?
Workforce
shortages are
impacting on
patient care.
<
Doctors-in-Training Council annual

Trainee Forum(
<

!
Aaargh!
Career Planning?
CM
HWNZ?
<
ADVOCACY
MY
<
CY
<
Political representation matters(
<
<
Is anyone else
concerned about the
huge number of Aussie
med students needing
jobs? Will they take
my job?
<
CMY
Should medical
students be allowed
to prescribe?
I am discharging
all these patients
and I know theyll
come back because
they cant afford
to fill the
prescription.
I just want to
feel more valued.
Dr!Anna!Choi,!a!former!PGY1!representative!on!the!DiTC,!articulated!very!well!why!
political!representation!matters:!!(
Caring!for!the!patient!sitting!
across!from!us!isn't!limited!to!
those!15!minutes!of!interaction;!it!
is!linked!to!much!broader!issues!of!
training,!workforce!capacity,!and!
public!policy.!As!individual!
clinicians!we!have!a!responsibility!
to!partake!in!these!issues,!
whether!by!awareness,!voting!for!
representation,!and/or!being!a!
voice!in!the!debate.!
!
Find out more(

Read!more!about!the!DiTCs!
activities!and!meet!your!
representatives!at!
www.nzma.org.nz/DoctorsBinB
Training.!We!also!encourage!you!to!connect!with!your!peers!on!our!Facebook!page!(search!for!NZMA!DoctorsBinBTraining!
Council).!DiTC!representatives!are!always!interested!in!hearing!about!your!experiences!and!point!of!view!to!better!
represent!your!interests,!so!contact!us!at!ditc@nzma.org.nz.!Also,!dont!forget!to!read!Tinnitus!!a!succinct!and!
informative!newsletter!that!we!email!to!all!our!doctorsBinBtraining!members!throughout!the!year.!
!
A message from the Residents Doctors Association

Welcome!to!the!profession!!
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The!New!Zealand!Resident!Doctors!Association!(NZRDA!or!the!RDA)!is!the!representative!organisation!that!was!set!up!
by!Resident!Doctors!(also!known!as!Resident!Medical!Officers!!i.e.!House!Surgeons!and!Registrars)!over!25!years!ago!to!
provide!support,!advocacy!and!industrial!power!to!our!group!of!doctors.!It!is!governed!by!a!National!Executive!made!up!
of!resident!doctors!from!around!the!country!assisted!by!a!network!of!delegates!from!the!range!of!hospitals!and!other!
work!environments!(e.g.!GP)!and!training!specialties!within!which!we!work.!!


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The!RDA!negotiates!our!terms!and!conditions!of!employment!which!are!contained!
within!the!MECA!(Multi!Employer!Collective!Agreement).!Everything!above!the!
minimum!wage!and!statutory!obligations!are!held!in!here.!This!includes!a!meal!
provided!for!lunch!(breakfast!on!nights!and!dinner!on!a!long!day),!limits!on!the!hours!
20
worked;!e.g.!a!maximum!16!hours!a!day!and!72!in!the!week,!guaranteed!every!other!
weekend!free!from!duty.!!
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Protection!from!working!night!duty!for!the!first!three!!six!months!as!a!doctor!
(improved!from!the!Medical!Councils!rule!of!six!weeks).!Cost!of!the!Annual!Practicing!
Certificate!and!indemnity!insurance!being!reimbursed,!along!with!costs!of!training!
(which!can!certainly!mount!up,!especially!in!registrar!training!programs)!as!well!as!
salary!and!other!provisions!such!as!leave!entitlements!etc.!
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When!you!move!from!your!place!of!residence!as!a!TI!to!your!first!job,!up!to!50%!of!the!
cost!of!moving!is!reimbursed.!Our!provisions!are!some!of!the!best!in!the!world!for!
resident!doctors!however!they!do!demand!onBgoing!work!(and!sometimes!a!battle)!to!
maintain!what!those!doctors!who!have!gone!before!us!have!fought!hard!to!achieve.!
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When!you!first!start!working,!you!will!automatically!be!covered!by!the!RDA!MECA!for!the!first!month!and!within!that!
time!you!have!to!choose!if!you!want!to!continue!to!be!covered!or!not.!By!joining!the!RDA!you!will!ensure!continuation!
under!our!MECA!and!you!will!get!the!advice,!back!up!and!protection!afforded!by!our!organisation.!With!any!problems!
that!may!be!encountered!we!have!levels!of!support!starting!with!a!friendly!chat!from!one!of!our!local!hospital!delegates!
or!delegate!support!officers!in!the!office!ranging!up!to!our!in!house!solicitors!or!even!our!barrister.!You!will!also!be!
supporting!your!colleagues,!past,!present!and!future,!in!improving!and!maintaining!our!lot!in!life.!
!
Obviously!we!dont!just!negotiate!a!MECA.!NZRDA!is!involved!in!working!with!the!wide!range!of!health!and!government!
organisations!to!improve!the!world!within!which!we!live!and!work.!Our!presence!reminds!the!system!that!resident!
doctors!exist!and!are!important!not!only!to!the!current!delivery!of!quality!medical!care,!but!the!future!as!SMOs!and!GPs.!!
!
Other!services!offered!by!NZRDA!include!superannuation!through!Tower,!indemnity!insurance!and!income!protection!
insurance.!We!strongly!recommend!joining!up!with!superannuation!as!this!is!effectively!an!automatic!6%!pay!rise!!Talk!
to!a!financial!advisor!for!specifics,!but!you!will!be!better!off!with!the!extra!money,!however!you!arrange!the!details.!
According!to!law,!you!will!automatically!be!enrolled!in!KiwiSaver!when!you!start!work,!and!every!time!you!change!DHBs.!
If!you!dont!want!to!be!in!KiwiSaver,!you!need!to!opt!out!early!on.!You!can!split!your!contributions,!e.g.!2%!KiwiSaver,!
4%!superannuation,!and!the!DHBs!will!match!you.!
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Once!you!become!an!RMO!if!you!are!interested!in!becoming!involved!as!a!delegate!or!finding!out!more!about!the!union,!
a!delegate!training!fourBday!weekend!takes!place!every!March.!Leave!for!the!four!days!is!provided!for!under!MECA!as!
employment!relations!education!leave!(EREL)!and!must!in!all!but!exceptional!circumstances!be!granted!by!your!DHB.!
Your!accommodation,!flights!etc!are!fully!funded!from!our!Education!Trust!for!this.!To!find!out!more!email!us!and!come!
along!!
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You!can!join!the!RDA!by!visiting!www.nzrda.org.nz!and!filling!in!the!forms!online,!for!students!it!will!cost!$10!per!year.!
You!will!also!need!to!choose!one!of!the!payment!options.!We!recommend!the!easiest!option!of!a!monthly!automatic!
payment!that!you!can!set!up!with!internet!banking.!Any!problems,!either!talk!to!a!local!delegate,!call!0800!803!993!or!
email!membership@nzrda.org.nz.!!
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21
Looking after
yourself
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In!many!aspects,!doctors!enjoy!better!health!compared!to!the!general!population.!However,!!
medics!are!often!poor!at!seeking!appropriate!help!when!health!problems!develop1.!Some!take!!
the!saying!physician!heal!thyself!too!literally!and!do!not!participate!in!health!screening;!do!!
not!have!their!own!general!practitioner,!selfBprescribe!or!selfBrefer!to!specialists.!As!well!as!being!!
contrary!to!the!Medical!Council!of!New!Zealands!Statement!on!providing!care!to!yourself!or!those!!
close!to!you2!there!is!a!significant!risk!that!a!doctors!health!care!is!subBstandard!by!not!having!
!their!own!GP!and!accessing!services!appropriately.!A!doctor!with!an!unrecognised!or!untreated!health!problem!may!
unknowingly!be!impaired!and!be!providing!less!than!ideal!care!to!his!or!her!patients!as!a!result.!It!is!very!important!that!
every!doctor!has!their!own!GP!and!they!consult!appropriately!and!in!a!timely!fashion.!!
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An!area!where!doctors!appear!to!have!worse!health!than!the!general!population!is!in!mental!health!and!substance!
abuse.!The!step!from!being!a!student!to!becoming!a!junior!doctor!brings!significantly!increased!stress!and!is!a!time!when!
it!is!important!to!be!aware!of!your!health!and!how!to!keep!well.!Occupational!health!statistics!from!the!UK!suggest!that!
the!highest!rates!of!workBrelated!mental!ill!health!occur!in!medical!practitioners!and!members!of!the!armed!forces3.!
These!findings!apply!to!doctors!early!in!their!career!as!well!as!those!towards!the!end.!It!is!not!clear!whether!this!higher!
rate!of!mental!angst!and!illBhealth!is!attributable!to!the!dominant!personality!characteristics!of!individuals!who!become!
doctors,!the!nature!of!working!in!the!health!business!or!a!combination!of!these!factors.!Identified!sources!of!stress!
which!may!lead!to!mental!health!problems!are:!!!
B work!pressure!!workload,!inadequacy!of!resources!and!poor!support!
B nature!of!work!!high!demand!and!low!control,!in!conjunction!with!the!inherent!trauma!of!dealing!with!
suffering!
B poor!relationships!with!colleagues!!particularly!poor!team!working!
B service!pressures!!investigations,!complaints!and!court!cases,!including!inquests.!
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Easy!access!to!prescription!and!nonBprescription!drugs,!and!the!ubiquitous!presence!of!alcohol!in!New!Zealand!culture,!
adds!to!the!challenges!of!mental!wellBbeing!of!doctors.!!
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Throughout!medical!school,!youve!no!doubt!been!inundated!with!messages!about!the!importance!of!your!own!
wellbeing.!Hopefully,!by!the!time!you!graduate,!youll!have!your!own!coping!mechanisms!in!place!for!times!of!stress.!
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The!transition!from!student!to!doctor!is!a!time!when!you!will!no!doubt!need!these!strategies!to!help!keep!you!a!
functioning!human!being,!but!it!is!also!a!period!where!it!can!seem!like!there!is!no!time!for!anything!other!than!work.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
1
!Kay!MP,!Mitchell!GK,!Del!Mar!CB.!Doctors!do!not!adequately!look!after!their!own!physical!health.!Med!J!Aust!2004:!
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2
!Medical!Council!of!New!Zealand!Statement!on!providing!care!to!yourself!or!those!close!to!you!
http://www.mcnz.org.nz/portals/0/Guidance/Statement%20on%20providing%20care%20to%20yourself%20and%20tho
se%20close%20to%20you.pdf!
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3
!Mental!health!and!ill!health!in!doctors,!UK!Department!of!Health,!February!2008!
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_083090.pdf!
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Here,!we!look!at!some!(hopefully)!familiar!techniques!for!looking!after!yourself,!along!with!some!practical!ways!to!
integrate!them!into!hospital!life.!The!following!also!include!insights!from!Dr.!Anna!Chois!the!first!year!blog!which!can!
be!found!in!full!at!http://www.nzmsa.org.nz/news/theBfirstByear/.!
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23
Dont forget your relationships
Your!family,!friends!and!partners!are!so!important!and!all!too!easy!to!take!for!granted.!!Although!they!no!doubt!
understand!how!time!consuming!medicine!is,!thats!not!a!free!pass!to!let!your!nonBmedical!relationships!whither.!!!
!
These!people!know!you;!even!though!you!may!spend!what!feels!like!23!and!a!half!hours!every!day!with!your!medical!
team,!and!they!know!exactly!how!you!like!your!coffee,!they!may!not!know!that!the!day!you!put!two!sugars!in!that!coffee!
is!not!shaping!up!to!be!a!good!day.!!Your!family!and!friends!do!know!these!things!about!you,!so!they!are!well!placed!to!
recognise!when!your!stress!has!turned!to!distress.!
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Not!to!mention,!even!though!it!may!be!wonderful!to!have!someone!
enthuse!with!you!over!how!fantastic!the!actual!medicine!is,!you!also!
If!the!thought!of!5:30am!gym!sessions!
need!conversations!with!people!who!dont!know!the!difference!
makes!you!shudder,!try!getting!your!daily!
between!a!CABG!and!a!cabbage.!
quota!of!exercise!by!walking/cycling!to!work,!
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joining!a!social!sports!team,!or!investing!in!a!
So!make!time!for!them,!it!doesnt!need!to!be!a!huge!chunk!of!your!
console!like!Wii!or!Sony!Kinect.!!!
day,!or!a!late!night!out;!meet!at!a!cafe!near!the!hospital,!go!around!to!
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their!place!with!a!movie,!or!even!chat!over!Skype!!!!
Remember!that!youre!getting!plenty!of!
!
exercise!running!around!the!hospital,!so!
whatever!form!of!activity!you!choose,!it!
should!be!fun!and!relaxing.!
(After!finally!making!use!of!a!GP,!Anna!Choi!writes)!It!wasnt!just!
because!of!what!he!(the!GP)!offered!for!my!problem!in!that!moment,!
but,!rather,!a!sense!that!I!was!now!no!longer!alone!in!holding!responsibility!for!my!health,!and!that!there!was!some!sort!
of!accountability,!documentation,!and!safety!net!I!could!rely!on!over!time.!A!fresh,!objective!set!of!eyes,!working!in!
conjunction!with!an!experienced!medical!brain.!If!Joe!Bloggs!down!the!street!is!entitled!to!this!(also!known!as!
healthcare),!are!we!not!also?!
!
A!GP!is!an!objective!set!of!eyes,!with!their!main!agenda!being!your!health.!A!good!GP!is!worth!their!weight!in!gold,!and!
deserves!some!scouting!out.!!Dont!lose!touch!with!the!
family!GP!or,!if!youve!moved!cities,!scout!out!the!local!
practice!at!the!same!time!youre!finding!the!nearest!
supermarket!and!cafe.!!!
Theres!nothing!you!can!do!about!your!long!days,!but!
!
you!can!optimise!the!time!you!have!to!sleep.!If!you!need!
An!important!part!of!growing!into!this!new!role!of!being!a!
a!period!of!time!for!your!brain!to!switch!off!before!you!
doctor!is!knowing!when!we!need!to!relinquish!it!to!some!
can!fall!asleep,!put!away!your!computer!(Facebook!and!
degree.!This!is!easier!said!than!done!because!like!I!
Twitter!updates!are!not!more!important!than!your!
mentioned!earlier,!being!a!doctor!is!not!like!a!coat!we!can!
pillow)!and!try!reading!a!nonBmedical!book,!listening!to!
take!on!and!off,!but!rather,!a!new!skin!we!grow!into.!With!
music,!or!even!trying!some!meditation!exercises.!
that,!well!never!be!able!to!fully!separate!ourselves!from!our!
!
identity!as!a!doctor.!But!in!those!moments!when!it!comes!to!
And,!of!course,!cut!out!the!late!night!caffeine!and!
our!own!health!and!wellBbeing,!and!of!those!we!love,!its!
alcohol.!
important!that!we!recognise!that!we!are!only!human.!
!
!
Stay active
Have your own GP
Dont forget to sleep

35
You only get out what you put in

NutriBGrain!has!got!a!point!here,!and!the!food!you!put!into!your!body!has!consequences!on!your!ability!to!work!and!
provide!the!best!care!for!your!patients.!However,!when!youve!got!patients!to!see,!and!youre!run!off!your!feet,!it!can!be!
hard!to!find!the!time!to!eat!a!banana,!let!alone!sit!down!for!lunch!!!
!
24
However,!if!you!want!to!be!at!the!top!of!your!game,!hypoglycaemia!and!dehydration!are!not!your!friends!!If!you!dont!
have!time!for!lunch,!carry!around!some!trail!mix!or!muesli!bars,!and!try!to!sit!down!and!enjoy!your!snack,!even!if!its!
only!for!two!minutes.!!!
!
Theres!nothing!better!than!a!home!cooked!meal!at!the!end!of!a!day,!so!try!making!use!of!a!slow!cooker;!everything!can!
go!in!the!pot!in!the!morning,!ready!for!you!to!enjoy!later.!Or!cook!en!masse!when!you!have!an!empty!afternoon,!and!
freeze!the!meals!for!the!coming!week.!And!if!all!this!is!just!too!much!work!and!youre!craving!the!fast!fix!of!takeaways,!
search!for!a!sushi!or!salad!bar,!there!are!more!healthy!takeaway!stores!emerging,!its!just!a!matter!of!finding!your!
favourite!!
!
You have spiritual needs too

Finding!a!higher!meaning!in!life!can!make!dealing!with!hardships,!such!as!the!inevitability!of!a!dying!patient,!easier!to!
bear.!
!
Take!comfort!in!your!religion!or!if!you!are!not!religious,!spirituality!can!mean!finding!beauty!in!nature,!faith!in!humanity,!
or!a!myriad!of!other!simple!pleasures.!Take!time!to!focus!
on!the!positive,!because!even!though!you!are!surrounded!
by!death!and!dying!in!a!hospital,!you!are!also!surrounded!
Everyone!has!different!warning!signs,!and!its!important!
by!hope,!and!love,!and!small!miracles!every!day.!
to!take!heed!of!yours.!Whether!its!withdrawal!from!
!
those!around!you,!an!increase!in!your!alcohol!intake,!a!
Be self aware
Have faith in yourself
shorter!temper,!or!stopping!those!activities!you!normally!
enjoy!!be!aware!of!your!body!and!minds!plea!to!take!a!
breather.!!!
!
It!can!feel!like!theres!no!time!left!for!you!to!just!breathe!
in!the!hospital,!but!theres!always!a!bathroom!where!
you!can!take!a!few!deep!breaths!and!relax!for!a!
moment.!!
!
After!recognising!your!warning!signs,!address!the!way!
you!deal!with!stress!and!hardships!by!increasing!your!
mental!resilience.!!
Being!responsible!for!someones!health!is!a!big!deal.!
There!will!be!times!that!you!feel!out!of!your!depth,!and!
down!right!scared,!but!dont!lose!faith!in!yourself!and!
your!abilities.!You!survived!six!years!of!medical!school;!
those!around!you!clearly!believe!that!youre!capable!and!
worthy!of!the!responsibility!of!the!Dr!preface!to!your!
name,!so!dont!let!your!self!doubt!hamper!you.!
!
With!time!and!experience!you!start!to!notice!yourself!
becoming!more!confident!in!your!clinical!judgement!and!
skills.!That!wonder!you!once!had!as!a!fourth!year!medical!
student!watching!the!house!officer!get!a!patients!consent!
or!take!that!arterial!blood!gas!ohBso!slickly!is!replaced!by!!unconscious!competence.!Clinical!acumen!develops!only!
with!experience;!experience!is!only!possible!by!logging!in!the!hours,!by!spending!all!day!every!day!seeing!patients.!You!
learn!by!watching,!by!doing,!by!asking,!and,!most!of!all,!by!learning!from!your!mistakes!all!day!every!day.!!
Take care of each other

Even!though!it!can!look!like!everyone!around!you!is!impossibly!confident!and!accomplished,!in!truth,!everyone!struggles!
at!some!point.!Noticing!someone!who!is!struggling,!and!just!stopping!to!ask!How!are!you!coping?!can!be!one!of!the!
most!important!things!you!can!ever!do!for!that!person.!When!Anna!Choi!struggled,!someone!recognised!it,!and!helped.!!!
!!
!
36

All!I!wanted!was!a!breather.!A!moment!to!myself!to!collect!my!thoughts.!And!as!my!thoughts!were!collected!it!dawned!
on!me!that!I!was!completely!shattered.!At!that!moment!one!of!the!medical!registrars!happened!to!walk!by.!Ive!never!
been!good!at!hiding!my!emotions!and!he!must!have!noticed!something!was!wrong!because!he!asked!me!how!I!was!
doing.!With!that,!I!couldnt!stop!myself!from!crying!right!there!and!then.![Yes,!again!with!the!tears!]!This!lovely!registrar!
forced!me!to!leave!the!ward!for!twenty!minutes,!but!not!before!taking!my!pager!and!half!of!the!onBcall!house!surgeon!
25
job!list.!He!was!still!helping!me!with!jobs!at!six!in!the!evening!(despite!his!shift!technically!finishing!at!four).No!amount!of!
baked!goods!could!ever!convey!my!gratitude.!All!my!life,!I!will!never!forget!his!kindness.!
!
We!lavish!compassion,!kindness!and!care!onto!our!patients,!so!dont!forget!that!every!once!and!awhile,!a!fellow!doctor!
may!need!it!too.!
!
What to do if youre fast approaching rock bottom

More!often!than!not,!rock!bottom!sneaks!up!on!us.!It!is!a!gradual!buildBup!of!seemingly!insignificant!little!lows!which!
we!keep!hidden!to!ourselves.!Your!little!lows!may!be!different!from!mine.!They!may!build!up!faster!or!slower;!maybe!
your!week!six!will!be!pretty!darn!sweet.!But!the!one!message!I!want!to!leave!you!with!as!you!head!into!your!first!year!as!
a!doctor!is!this:!we!all!struggle.!It!is!not!just!you.!Those!second!years!around!you,!those!registrars,!your!consultants,!each!
of!them!have!gone!through!what!you!are!going!through!now,!no!matter!how!onBtoBit!they!may!seem.!We!each!of!us!
have!had!those!lows.!Were!just!not!good!at!talking!about!it.!Us!Kiwis!are!so!good!at!being!nice,!but!were!not!very!good!
at!asking!the!tough!questions.!ARE!YOU!OKAY??!ARE!YOU!COPING??!YOUR!ANSWER!DOES!NOT!HAVE!TO!BE!A!NOD!
AND!A!SMILE.!
!
Never!forget,!you!are!not!alone!in!your!struggles.!It!does!not!make!you!any!less!of!a!doctor.!No!matter!how!hopeless!it!
may!feel,!it!is!never!hopeless.!And!there!is!always!someone!you!can!talk!to.!
!
Rock!bottom!is!a!place!none!of!us!want!to!head,!but,!inevitably,!some!of!us!will!find!ourselves!there.!If!you!do!find!
yourself!there,!its!important!to!get!help.!Ask!for!leave!from!the!RMO!office!(the!worst!they!can!do!is!say!no),!tell!
someone!you!trust,!at!work!and!at!home,!that!youre!not!coping!so!well,!and!remember!that!there!is!a!light!at!the!end!of!
the!tunnel!and!things!will!start!looking!up.!!!
!
Professional!help!is!available,!both!privately!and!through!your!GP,!who!is!able!to!refer!you!for!four!sessions!of!
psychotherapy!and!counselling!(another!great!reason!to!get!a!GP).!!Similarly,!MPS!has!a!counselling!service!they!provide!
on!0800!225!5677!via!the!option!medicoBlegal!advice.!
!
Alternately,!there!is!a!wealth!of!great!helpBlines!and!websites!available!for!you:!
!
www.thelowdown.co.nz!
www.depression.org.nz!
www.mentalhealth.org.nz!!
0800!543!354!Lifeline!
0800!111!757!Depression!Helpline!
!
There!are!lots!of!other!great!resources!available!for!your!use,!in!particular!the!NZMSA!and!AMSA!Keep(Your(Grass(
Greener(Wellbeing(Guide(for(Medical(Students.!Its!filled!with!great!ideas!to!keep!you!healthy,!from!brilliant!minds,!and!
anecdotes!that!remind!you!that!you!are!not!alone.!
The!electronic!version!can!be!found!here:!!
!
http://www.nzmsa.org.nz/wpBcontent/uploads/2009/11/KeepingYourGrassGreener.pdf.!!
!
!
37
About the NZMSA Guide to Graduation

While!every!effort!is!made!to!ensure!that!the!information!contained!in!the!NZMSA!Guide!to!Graduation!is!accurate,!the!
time!course!of!publication!means!that!information!provided!here!may!be!out!of!date!and!so!we!recommend!that!senior!
medical!students!consult!other!resources.!Please!also!note!that!many!sections!of!this!publication!are!the!opinion!of!
individuals!and!do!not!necessarily!represent!the!opinions!of!the!NZMSA.!
26
!
List of contributors
Editor:!Carissa!Herbert!
!
Format!and!design:!Ryan!Barber!
!
Contributors:!
NZMSA!Executive!!Michael!ChenBXu,!Sigourney!Taylor!
ACE!and!NoRTH!!Rebecca!Dyke,!Peter!Hargraves!
MAS!!Rebecca!Ameriks!
MPS!!Dr.!Alan!Doris,!Rebecca!Imrie!
NZMA!!Anna!Phipps,!Daphne!Atkinson,!Falyn!Edlin,!Sokmanea!Foo,!Dr.!Yeri!Ahn!
NZRDA!!Melissa!Dobbyn!
Dr.!Anna!Choi,!Dr.!Thalib!Mowjood,!Dr.!Vikash!Patel,!Dr.!Yanan!Hu,!Dr.!Emily!Gill,!Dr.!Matt!Rowe,!Dr.!Ryan!Tatnell,!Dr.!Jun!
Kwon,!Dr.!Ravi!Mistry,!Dr.!Elizabeth!Carr,!Dr.!Jane!Yeojeong!So,!Dr.!ShengBHui!Wong!
Some final words from Anna Choi

I!survived!my!first!year.!It!was!truly!touch!and!go!there!for!a!while,!but!I!made!it.!
!
And!so!will!you.!
!
It!is!the!ultimate!Rite!of!Passage!for!us!doctors,!and!at!the!end!of!your!first!year!you!too!will!have!a!repository!of!
memories!!funny,!intense,!heartbreaking,!breathBtaking!memories!!that!you!will!replay!in!your!mind!like!scenes!from!a!
movie!and!think!back!to!with!fondness.!Even!the!s**tiest!of!moments.!Because!they!all!played!a!part!in!making!you!the!
doctor!you!are.!
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Top ten tips for House Officers

The Ace Scheme

Your future employer

Bay of Plenty DHB

Hawkes Bay DHB

Wider Wellington Region

Nelson Malborough DHB

South Canterbury DHB

The MECA contract

Avoiding traps for young players

A message from the Residents Doctors Association

Looking after yourself

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Top ten tips for

Know your rights.!!

Know your responsibilities.!!

Know where to find out.

Know that it's all worth it.!!

Know that you are not alone.

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Know that being nice takes you a long way. !!

Know that you are entitled to a ginormous tax refund3 at the

Know that everyone will make mistakes, including you.

Know that vital signs are vital.

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Key dates for ACE 2012

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Key contact for ACE

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Making your application easier for you and the

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RMO units at a glance

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Auc kland re gion

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Bay o f Ple nty DHB

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Hawke s Bay DHB

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Capital and Co as t, Hutt Valle y and W airarapa DHB

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Cante rbury DHB

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