Hospital REVIEW - April 2019 - nzrda
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Hospi tal
NZRDA
REVIEW
April 2019
© 2019 New Zealand Resident Doctors’ Association
CONTENTS
Hospital Review 2019
Introduction �������������������������������������������������������������������������������������������������������������� 4
Trainee Interns ���������������������������������������������������������������������������������������������������������� 5
Northland������������������������������������������������������������������������������������������������������������������ 6
Whangarei Hospital
Auckland�������������������������������������������������������������������������������������������������������������������� 7
Auckland Hospital & Starship
Counties Manukau ���������������������������������������������������������������������������������������������������� 8
Middlemore Hospital
Waitemata ���������������������������������������������������������������������������������������������������������������� 9
North Shore & Waitakere Hospitals
Waikato�������������������������������������������������������������������������������������������������������������������� 10
Waikato Hospital
Bay of Plenty ����������������������������������������������������������������������������������������������������������� 11
Tauranga & Whakatane Hospitals
Tairawhiti �����������������������������������������������������������������������������������������������������������������12
Gisborne Hospital
Lakes������������������������������������������������������������������������������������������������������������������������ 13
Rotorua & Beyond
Hawke’s Bay������������������������������������������������������������������������������������������������������������ 14
Hawke’s Bay Hospital
Taranaki ������������������������������������������������������������������������������������������������������������������ 15
Taranaki Base Hospital
Whanganui���������������������������������������������������������������������������������������������������������������16
Whanganui Hospital
Midcentral�����������������������������������������������������������������������������������������������������������������17
Palmerston North Hospital
Wairarapa���������������������������������������������������������������������������������������������������������������� 18
Wairarapa Hospital
Hutt Valley ���������������������������������������������������������������������������������������������������������������19
Hutt Hospital
Capital & Coast ������������������������������������������������������������������������������������������������������ 20
Wellington Hospital & Kenepuru
Nelson Marlborough�������������������������������������������������������������������������������������������������21
Nelson & Wairau Hospitals
West Coast�������������������������������������������������������������������������������������������������������������� 22
Grey Base Hospital
Canterbury�������������������������������������������������������������������������������������������������������������� 23
Christchurch Hospital
South Canterbury���������������������������������������������������������������������������������������������������� 24
Timaru Hospital
Southern������������������������������������������������������������������������������������������������������������������ 25
Dunedin & Invercargill Hospitals
3
INTRODUCTION
The RMO Viewpoint
Dear Colleagues, particular hospital, the best first points of call are
your delegates (your RDA representatives working
Welcome to NZRDA’s annual Hospital Review. This
across NZ). You can find out who your delegates
is a subjective and unofficial assessment of the
are by heading to our website (www.nzrda.org.nz).
hospitals distributed across our beloved country. It's
Alternatively, get in touch with us here at the RDA
written by RMOs for RMOs.
office and we will assist you!
We hope that this publication will give you
In producing this document, RMOs were asked to
an insight into what you might expect before
comment on 10 categories, but also to contribute
commencing work. It might also help you choose
any other thoughts and comments they considered
where to work – given that you will shortly choose
relevant.
your allocations.
To all those RDA delegates and RMOs who
To all you Trainee Interns out there, please see
contributed their time and effort to the production
the information on the facing page about RDA
of this review – a big thank you. If you have any
membership and indemnity insurance. We are here
feedback on or questions about the content of this
to help, so let us know if you have any questions.
review, we'd be happy to discuss. In the meantime,
If you have further queries about working at a happy reading!
Review criteria
RMO Unit MECA Compliance
The helpfulness, friendliness and Frequency and severity of non-
supportiveness (or otherwise) of RMO compliance; ease of solving disputes, etc.
Unit staff.
Daily Workload
RMO Lounge
How reasonable for a first year?
General comfort and proximity to key
work areas; kitchen facilities, lounge Rosters
area, natural light; status of phone lines
Never get to see your children (or make
to enable responsiveness.
any). . .?
Cafeteria
Acute Demand
General comments, including cleanliness,
accessibility; meals, including options, Long day work volume, work quality and
quality, availability, restrictions. experience.
Car Parking SMO Support
Space availability, safety and security, Educational opportunities/academic
proximity to main entrance for nights, support; industrial support.
alternative arrangements if appropriate.
City Living
Things to do (night life etc.), cost,
transport, proximity to other places etc.
4
TRAINEE INTERNS
Written by RMOs for RMOs
RDA Membership is Free individual members who get into difficulty, and
promote good change.
Beginning your first year as a house officer is
always daunting. As well as coming to grips with Indemnity Insurance
being a doctor, you also need to understand what it
means to be an employee. The RDA offers indemnity insurance through NZMPI,
a wholly New Zealand-owned insurance company.
The RDA is here to help you deal with “all that This is indemnity insurance: a guaranteed contract
contract stuff” and more. Membership for TIs is free! of cover for you if you get into difficulty, which
Just visit the Membership page on our website at (without trying to gloom you up) you probably will -
www.nzrda.org.nz, fill in the form, and it’s done... despite all the training, you are human after all!
But there is a catch! To remain a member once
you start work as an RMO, you will need to pay This is free for TIs: just tick the box usually called
a subscription fee - but not until your first pay “RDA insurance” or “NZMPI” when filling in the
cheque! After this, it’s $40 per month. form for DHB employment. This insurance remains
available to house officers and registrars, and
We do encourage TIs to join; we produce regular continues into SMO and GP land when you get to
updates dedicated to TIs, which provide “things you that stage.
need to know” especially as the time approaches
when you will start your working life as a doctor. To sum up
What is the NZRDA? We actively lobby for our members’ interests,
comment publicly when appropriate, and
The NZRDA (New Zealand Resident Doctors’ communicate with other medical organisations
Association) – or the RDA for short – is by far the in New Zealand and overseas. We work with
largest organisation in New Zealand representing politicians, government, and the private sector.
RMOs (Resident Medical Officers, which includes
house surgeons, senior house officers and Through the RDA you have the opportunity to have
registrars). your say and influence decisions that affect your
future and the future of healthcare in NZ!
We are a union: a group of employees who come
together to achieve strength and safety in numbers. Disclaimer
We are run by resident doctors for resident doctors. This review is intended to provide an honest,
Our main purpose is to look after and promote the provocative and irreverent commentary on the state
interests of our members. This includes taking care of New Zealand hospitals from the points of view of
of doctors’ rights and interests at work, within the RMOs. All commentary is opinion only, and we have
health sector and in the wider community. been careful not to overly edit or dilute the voices
of our members in their assessments. Even when
The philosophy of the NZRDA is based on
the commentary seems to be stated as fact, it isn’t;
community, support and union principles such as a
it is opinion – but educated opinion, informed by
democratic structure and service delivery.
the real life experiences of doctors working within
What do we do? our District Health Boards.
The RDA negotiates and enforces RMO terms and The NZRDA is always happy to discuss the opinions
conditions of employment, and we work to ensure that appear in our Hospital Review; if you have
your employment contract is honoured. thoughts or comments, feel free to contact us at
ask@nzrda.org.nz
We also work to protect and enhance RMO training,
work-life balance and wellness. We represent
5
NORTHLAND
Whangarei Hospital
Ah, the beautiful North. Only two (and a bit) months in advance. Leave for the month opens on
hours north of Auckland, this area is known for it’s the first day of the month. This means people set
coastline and relaxed atmosphere. Northland DHB alarms for midnight to book a week of leave in six
has a brand new RMO Unit. Time will tell to see months time. It’s very difficult to get more than one
how they do navigate the MECA. This DHB has an week of leave at a time.
engaged CMO and SMOs are generally supportive
of our union and have supported our industrial
action to date.
A short out to Northland: the first DHB to introduce
Schedule 10 rates before the MECA made them!
Most rosters are compliant with Schedule 10,
they provide good clinical governance, and RMOs
gain good experience. They support community-
based attachments, and have increased their CBA
component recently with some runs available in
rural hospitals. Car parking is down a hill, 5-10 minutes walk from
the main hospital building. It’s pay and display,
The RMO unit is friendly and happy to chat. but only $1 day for doctors. There’s no charge
There’s a slight sense that it has its own agenda for evening or night shift parking. Alternative
in terms of job allocations, and often people get arrangements are available at the top of the hill if
offers that don’t align with their preferences. This you’re on long days. Plus, we should be cycling or
can be frustrating especially for PGY2 where six walking to work, shouldn’t we?
month allocations are limited (ENT, Paeds, O&G,
Opthalm and ED). Swapping amongst RMOs to get RMO Lounge: no nonsense. It’s on the roof between
their preferred jobs isn’t supported. Everyone here the wings of the hospital, and quite private. The
does relief for three months and doing a quality pros include food, lockers, two single beds, two
improvement project during this time is encouraged. computers, Sky TV, couches, and free food. The cons
are that it’s sometimes dirty, no air conditioning,
MECA compliance is good. Rosters and work volume and the nearby resident pigeons are loud.
are manageable. Workload is fair for most runs.
Long days are 0730 to 2300 for surgery and 0800 The cafe is clean and has upped its game recently.
to 2300 for medicine. Cross cover is rife. Pro tip: There’s usually a good mix of food within hours.
if you haven’t been asked to cross cover someone After hours and on weekends the food is pretty
before handover, your phone is off or MIA. Short bad, with limited options for vegetarians and
day medicine weekends are acknowledged as being vegans.
the worst. Paediatrics and O&G rosters are quite
antisocial with after hours shifts and swing shifts, Whangarei cost of living is fair with recent
but overall it’s better than working in Auckland. increases in rent prices, but the city is more of a
small town with limited night life.
Acute demand is fine; you’re rarely overwhelmed,
but the handover process needs to be formalised. The selling point of Whangarei is in daytime
SMO support is great among the permanent staff. activities. Surf beaches are forty minutes from
They’re strong advocates of RMO education, keen the town, there are multiple mountain bike routes,
to get you independent in seeing sick patients, and ready access to Poor Knights diving (some of
managing acute and chronic issues and doing the best in the world) and fishing. Closer to town,
procedures autonomously. There’s opportunity Mount Parihaka is a great bush walk. You can walk
for hands-on and clinical practice, especially in the loop to explore the town. The Quarry Gardens
Paeds/O&G (especially in O&G!), ENT and ED. are lovely and the town centre has some quaint
stores. Overall, Northland DHB and Whangarei
The leave system for house officers is frustrating Hospital is a great choice.
and confusing. You can’t book leave more than six
6
AUCKLAND
Auckland Hospital, Starship & NRA
The RMO unit is very poor. You never know who another HO but never listen.
to contact with the NRA, especially if you need to
escalate something. Emails and claims regularly It’s hard to get leave for courses. You’re too busy
disappear and it’s up to you to keep track of several with ward work to get to teaching or theatre.
email chains or they might easily get “lost”. Then, Auckland is a great city - there are lots of cool
after many moons, you might get a response saying cafes, bars and things to do. However, cost of living
that they never received the claim at all! There is a is high and public transport is unreliable.
lot of push-back, declines without good reason, and
Starship
inconsistency as to what will be reimbursed. They
make everything seem like a battle; nothing is ever
straight forward.
The chief resident system creates goodwill and is
The RMO lounge is far away - a good 10 minute more human than many RMO units, but may tend
walk to the surgical wards. to bias those planning to do paediatrics long term.
Sleeping facilities consist of a large room with Regs and locums will often cover HO shifts to help
five bunk beds. It’s difficult to sleep here because out, and cross cover out of hours in uncommon but
people are constantly coming in or out or snoring. not unheard of.
Put bluntly, it’s a token gesture to fatigue and sleep A small room with two couches and three
health. computers serves the Starship RMOs. There’s a
microwave and small fridge but the room gets hot
and is often busy. The adult hospital RMO lounge is
open with full facilities but is far from the wards.
For napping, there are two adequate couches and
two proper beds at the adult RMO lounge.
The cafe is shared with the public on the adult side,
which is detrimental to discussing RMO issues over
meals. The food good, but lacks variety.
Since introduction of Schedule 10, there’s been a
good work/life balance, and reliever numbers have
The cafe is decent. Hot meals are greasy, but the
increased for both HO and regs.
salad bar is good, although it runs out fast. The
cafe closes too early (7pm daily) and doesn’t open The acute demand on a long day is less than at
early enough on the weekend (11:30 am). other busy hospitals for a HO.
There’s always a fight to get a park in the morning
and it’s a long walk at night. It’s too expensive in Northern Regional Alliance
general, and a taxi chit for long days would be The NRA (Northern Regional Alliance) acts as
appreciated. an agent for the Northland, Auckland, Counties
With MECA compliance, it’s hard to tell whether Manukau and Waitemata DHBs. The NRA is a
they are purposely deceptive when they respond to middle man between you and the DHBs. It’s
a dispute or are ignorant. responsible for assisting with (amongst other
things) leave requests and run allocations. In the
Daily workload is variable by department. Some past we have received mostly negative feedback
people are busy all day every day while others have regarding the NRA and its processes, whilst there is
nothing to do after 10am! nothing to suggest the NRA has become any worse,
General surgery long day workload is ridiculous. unfortunately there has yet to be a significant
It’s impossible to get all the tasks done. They need improvement and many RMOs are left frustrated
after their NRA encounters.
7
COUNTIES MANUKAU
Middlemore Hospital
The RMO lounge is in another building down a long on long day when your consultant is not on take,
corridor. It’s impractical to reach on a long day or which means a frenzied, post-acute ward round the
nights because it’s so far away. For sleeping, only following day when no-one in the team knows the
the RMO lounge is available. patients. The house officer rosters are sometimes
organised by the junior registrars rather than the
RMO unit. This means that while they’re on the
ground and better connected with need for service
delivery, there’s more work for the junior regs.
Long days are brutal here. For some rotations,
there’s one house officer assigned to ward jobs and
another assigned to ED, while others have to cover
both ED and the ward. Our ED has the highest
turnover in Australasia so it’s no surprise that
long days are pretty rough. The acute workload is
borderline insane, They really need to employ more
HOs on long days. It’s a work in progress.
The cafeteria is very good, although vegetarian
options are mediocre but there are at least SMOs are generally strongly supportive in
two meat hot food options, a salad bar, and a Middlemore for academia and are highly collegial.
sandwich/wrap making station, and a hot soup. There are plenty who are affiliated with the
Lots of fruit, yoghurt, and other instant meal university and do a lot of teaching through there,
options, and sometimes they give out free ice but also lots of SMOs are who are invested in your
cream! career. There’s no prominent hierarchy that would
prevent one from even calling their consultant
The car park is notorious for being dangerous. directly. Support for industrial action varies from
Earlier this year, two of staff members were specialty to specialty.
attacked in the car park. They have upped the
security since, but lighting is poor and CCTV Middlemore has one of the best reputations for
doesn’t capture all areas. being super collegial. Especially in PGY1, we often
have a group chat that fosters a non-judgmental
City living is very good in Auckland - there’s environment so you can ask anything you like if you
something for everyone! It’s a bustling city full of feel out of your depth. You can often call virtually
vibrance. The only issue is that public transport is any registrar in any specialty for help and people
practically decorative and traffic will become your are generally very understanding and won’t jump
best friend (or worst enemy) so getting to places down your throat for a silly request.
will be a hassle.
Daily workload for a first year is above average Infrastructure
- Middlemore is well known for being one of the Any RMO considering Counties Manukau needs
busiest hospitals in the country. to be aware of the problems with the physical
buildings at Middlemore. Most buildings have
Most house officer runs are compliant with serious problems with rot/fungus, earthquake
Schedule 10, with the exception of psychogeriatrics stability, or asbestos, and many have the full
and psychiatry rotations. The RMO unit will try to trifecta. No matter what, Middlemore is set to be
resolve your dispute, but emails are few and far a building site for many years to come as the DHB
between. You can often elicit a quicker response by either fixes existing buildings or constructs entirely
calling or showing up in person, where they’re much new facilities.
more reasonable and approachable.
Rostering can be counterintuitive. Often, you’re
8WAITEMATA
North Shore & Waitakere Hospitals
North Shore
Hospital
The RMO unit is friendly and they are
reasonable most of the time. However,
they can be slow at responding to
enquiries.
The RMO lounge is well stocked with
food, (generally microwavable meals).
It has three computers, one phone, a
TV, and a coffee machine that tends to
break down a lot. There’s a little side
room with two beds, but the door isn’t
sound proof so you do get woken up.
Clean sheets, blankets and pillow cases DHB and the quality of teaching is great especially
are available. for PGY1s and PGY2s.
The best thing about the cafe is that it’s only open
to staff, so you feel safe to discuss work related
things over lunch. Meals can vary in quality, with a Waitakere
lot of curries. Otherwise there’s a good selection of
healthy food.
Hospital
Doctors usually have no problem finding a car park.
The RMO unit are friendly, but it can take a
Parking is $3 per day even if you leave the premise
while for them to respond. They aren’t always
and come back. They also don’t charge you double
knowledgeable about local systems.
if you go between NSH and Waitakere hospital. It’s
very secure/safe. The RMO lounge is secluded and difficult to find at
first. Allegedly, the Waitakere RMO room is based
Auckland is a big, developing city with lots to do.
in the old morgue. There’s not much natural light
Great beaches nearby and public transport is good
and somewhat suspect kitchen facilities.
if you live near bus lines. The hospital itself is close
to a bus station (Smales Farm). The cafe is in a handy location with indoor and
outdoor seating. There’s a good range of snacks
Daily workload is very reasonable with lots of
and food, and staff are happy to modify items but
support. First and second quarter are well staffed.
there are limited vegan options.
There are some teams that are busier than others,
but generally you leave on time. It’s difficult to get to Waitakere through public
transport unless you live in West Auckland. The
House officers across all departments are on
traffic on the North Western continues to worsen
Schedule 10 but it hasn’t been rolled out for
but it’s free flowing travelling central out west. Car
registrars.
parking is good - spaces are usually available.
Waitemata is the only DHB we know of that has
Waitakere is very colleagial and there’s a
eprescribing AND smartpage. This is a huge help in
supportive paediatrics team (but paeds is a reg
managing workload during on-call.
rotation only at Waitakere). Adult medical teams
Overall, SMOs are supportive. Most of them are also seem supportive. Most RMOs prefer working at
interested in teaching and helping RMOs reach Waitakere over North Shore.
their career goals. Teaching is a big part of this
9WAIKATO
Waikato Hospital
In the face of losing house officer accreditation, We strongly recommend you read the MECA before
there’s a newly branded RMO unit. It appears working here. Breaches occur everywhere and it’s
friendly and proactive in it’s approach to filling up to the RMOs to point them out. The departments
in vacancies and providing leave. They created say “but this is how we have always done it”,
new positions of pathology, rheumatology and but if you show them the MECA clause, they’ll
extra medical house officers during the “high” generally change it. Don’t rely on the RMO unit for
quarters (1&2) in anticipation of change over for advice about the MECA. Cross cover after hours is
the second half of the year. The newly developed common (and illegal).
RMO council, a forum to connect hospital admin,
SMOs and RMOs is helping. New positions of Chief
Medical HO and Chief Surgical HO allow for more
leadership and advocacy developments, and are
paid positions here reflecting the valuable role they
play. It’s helping get the RMOs more engaged and
vocal, which is encouraging.
The RMO lounge has Sky TV, computers, phones,
kitchenette and frozen meals. Next to the RMO A new PFM system has been rolled out as a way
lounge, there are four sleep rooms, showers and of managing acute jobs after hours. We’re in the
lockers. awkward phase where the old technology hasn’t
been booted out yet. You carry the hospital iphone,
The cafe is good, often cheesy hot meals, leading your pager, your own phone, possibly a second
some RMOs to suspect the cafe must have shares pager such the arrest pager, plus your usual amount
in the local dairy collective. Nonetheless, there’s a of paper. Most runs are Cs or Ds and you don’t start
healthy selection of salads and sandwiches. Bakery nights until six months in. Night HOs are generally
items, yoghurt, choc milk, cheese, pot noodles and well staffed.
cookies are available to RMOs, but everything else
you need to pay for. The cafe is shared with the Waikato has been slowly introducing Schedule 10
public and is the only place with poor wifi. rosters.
Taxi chits are available in the RMO lounge for RMOs cover large portions of the hospital after
anyone who is too tired after a night shift to drive hours and the teaching isn’t great - there’s almost
home. Staff parking is either by subscription of no chance of going to acute theatre after hours or
$11/week (docked from your pay) or $3/entry. doing any procedures other than replacing lines or
There were a handful of car break ins and assaults putting in catheters.
on staff last year, so the security presence has
supposedly increased. It isn’t safe to walk to your SMO support has been strong when they aren’t
car alone at night if you’ve parked it a few streets stretched themselves. As Waikato clinical school
away for free. is here, there’s an academic or teaching aspect to
most SMO lives. Audits are abundant if you want
We don’t live to work, we work to live. Like the to do them. Waikato is a place where you could
hospital, we must look towards the future. A once potentially stay for most of your training and a lot
dilapidated main street, Victoria has come back of the SMOs have been through the same as you.
to life with new trendy tapas restaurants, cocktail
bars and brunch spots. Hamilton, as the joke Waikato is embroiled in scandal such as a
always has been and always will be, is a fantastic questionable past CEO, a fake psychiatrist, shaky
base for travelling to near by exciting areas. Spend house officer re-accreditation - the reputation isn’t
your weekends mountain biking, or climb 1000m to flash. Changes have occurred and there’s a faint
the top of Mt Pirongia. light in the distance. If you’ve bothered to read this
far, we want you.
10BAY OF PLENTY
Tauranga & Whakatane Hospitals
We like this DHB. They provide good runs, We have little complaints about the roster - most
favourable hours, and are generally progressive in days you’ll leave at reasonable time (before 5pm).
their approach. They seem to like RMOs.
The RMOs at Tauranga are a tight knit bunch, often
staying from house officer to reg years. It’s a nice
place to work and a great place to live.
Whakatane
Whakatane hospital has a small team but a
good one. If you’re after a good small hospital
experience, then Whakatane is a strong choice.
The RMO unit is excellent. They’re very friendly,
with an extremely supportive RMO manager who
is accommodating with regards to leave and who
cares about the wellbeing of RMOs.
It’s important to note that Bay of Plenty is a MECA compliance is generally good, with few
provincial DHB, so offering exposure to tertiary breaches. Disputes are resolved expediently.
specialties and training are limited.
Long days and nights can be initially daunting,
Bear in mind that (and assuming we settle the given that you are covering all the hospital and
MECA) in Bay of Plenty DHB, there is no rotation all of specialties. It’s a steep learning curve, daily
between Whakatane and Tauranga for HOs and workload is quite manageable, rosters are great in
registrars – you will be only at one or the other. general and there is ready access to annual leave.
Outside of work, both areas have great beaches
There are no registrars at the hospital, so you get
and a huge range of outdoor activities.
a great deal of direct support from SMOs, who are
approachable and always keen to share knowledge
Tauranga and skills.
The RMO lounge has all the essentials: couches,
The RMO unit seem to take the industrial action bed, shower/toilet, computer, kitchenette, heat
as a personal slight rather than understanding pump/AC, freezer with frozen meals for long days
that RMOs are standing up for national issues. if the cafeteria is closed. However, it is slightly
This can mean they don’t always represent RMOs’ distant from the main clinical areas.
best interests. It can also make some of the house
officers uncomfortable, especially in the surgical Whakatane has ample parking and an after-hours
services, where the DHB has requested business as carpark close to the entrance. Security is always
usual rather than reduced workloads. The medical available to escort you at anytime and car parks
unit are very good, although there’s been a change are well lit.
in the management so yet to be seen if they are
City living is variable. Whakatane is a rural town
good or not. The surgical side is diabolical; it’s
and there is not much night-life, but a plus side is
difficult to get leave.
that you’ve got the beach on your doorstep! There
The RMO lounge is fairly run down, with no natural are a wide range of outdoor activities, and Rotorua
light and poor meal provisions for night staff. and Tauranga are nearby.
For sleeping, the beds are comfortable and clean. Overall, the working environment is fabulous. The
However, there generally aren’t enough beds, and bosses are friendly, the work is interesting, you’ll
the air con blows into the room which can be noisy. get heaps of hands-on experience and the RMO
unit is amazing.
11TAIRAWHITI
Gisborne Hospital
Our RMO coordinator is very nice, approachable, being nearly three hours away.
and she does her best to give us the best rosters
possible. Annual leave is also pretty easy to come There is not much of a town scene but we are often
by. MECA compliance is very good and she has a having flat parties, potlucks or movie nights. Cost
good understanding of our contract. of living is low compared to larger centres.
We are not on Schedule 10 but still follow a 10:4 The workload is reasonable. Once you get into
roster without getting deductions. We also do not the swing of things, most of us finish on time and
work nights in our first year. get to have a good work-life balance. You get
great experience in Gisborne especially when you
Our RMO lounge has two computers, a phone and compare to the larger centres. You will see patients
couches to nap on. The lounge has an adjoining in ED and manage patients in ICU.
shower and toilet.
You are often liaising directly with the SMOs who
are usually approachable and supportive. We
recently got four medical registrars which has
helped ease the workload and increase the support
for the house officers in the hospital.
“Once you get into the swing
of things, most of us finish on
time and get to have a good
work-life balance.”
There seem to be a lot of small business popping
up, and there are ample places to drink great
coffee. There's also the Sunshine Brewery, and
seemingly endless wineries to visit.
Auckland and Wellington are one hour flights away
“MECA compliance is if you need to escape (which we all do at some
very good and the RMO point!).
coordinator has a good
understanding of our
contract.”
Food at the cafe is above average and you get to
know the staff well. They also get to know your
dietary preferences. Tairawhiti DHB recently started
a “Plastic Free Policy” which is great to see.
We have ample car parking space. It is free and
close to the hospital so it is safe to walk to your
car at night.
Gisborne is a great place to live especially in the
summer. Most people surf after work and the
access to beaches is amazing here. It can however
get isolated at times with the closest large town
12LAKES
Rotorua & Beyond
Some of the most senior people in the RDA have pathology, and less of the worried well and neurotic
said that Lakes DHB probably has the best RMO overly-demanding patients (although they’re still
unit in the country. Of course things can change, out there). This makes work and learning more
but the RMO unit still seems pretty good. interesting.
Lakes was the first DHB to implement the safer Services are general medicine, general surgery,
rosters in 2017 and one of the earliest to adopt the orthopaedics, ENT, ICU/HDU, paediatrics,
community based attachments for PGY1s (e.g. GP O&G, and psychiatry. There’s also a visiting
runs). ophthalmology reg and an elusive dentistry service.
There aren’t any medical subspecialist teams, but
many physicians are dual trained so we still have
respiratory physicians, gastroenterologists, an
endocrinologist, geriatricians, and cardiologists.
There is a CCU but no cath lab.
“You will see a lot of
The staff in the RMO unit (called the medical
interesting pathology here.”
management unit here at Lakes, or MMU) are Most registrars are fairly junior but we still have
almost always friendly and welcoming. Sometimes training/senior registrars in most specialities except
they’re frustrating, but in terms of things like orthopaedics. Junior registrars can mean there’s
approving leave, they’re pretty reasonable as long more of a consultant presence on the ward which
as you try to give as much notice as you can. But, is good for learning and reassurance, especially
this means there are a lot of shifts that need to once you become a registrar. The majority of the
be covered when people have their leave granted, consultants are approachable and nice people.
and smaller centres like Rotorua don’t have many
(or really any) locums ready to pick up work last The cafeteria is not the DHB’s strength, but it’s
minute, so there’s a lot of extra work to be done to improving. The food is sometimes underwhelming
make up for that which can get a bit tough. and often not a health extravaganza. If you’re late
to lunch or dinner the options can get very slim, but
The pre-vocational educators at Lakes are really they have lovely staff who get to know you.
supportive too. These are the 4 consultants who
pretty much guide you through your first 2 years as Parking is free and on site - can’t complain.
a doctor and make sure you’re going ok. They meet The rental market is challenging as many landlords
with all PGY1s every week and you meet with them use their properties for temporary tourist
individually 2-3 times per quarter. They care about accommodation, but you’ll find something. Getting
their roles and put a surprising amount of effort in early is helpful - hospital staff accommodation
into trying to make the PGY1 year as smooth as is almost always full. Traffic is generally fine so the
possible. At the start of every year they invite all outskirts of town are only 15 mins or so drive from
the PGY1s and PGY2s to one of their houses for a the hospital.
BBQ - it’s quite cute.
If you like the outdoors, it’s likely that you’ll love
Rotorua Hospital has 223 beds making it a small Rotorua! It’s a tourist hub for a good reason and
hospital, but not too small. Taupo Hospital (also the people are awesome. Don’t just pick a DHB for
Lakes DHB - but takes no house officers) send the hospital, think about what you’ll be doing for
their more complicated or sick patients to Rotorua, the rest of your leisure time as well. If you don’t like
and Rotorua sends patients needing tertiary the outdoors, your entertainment options are more
level care to Waikato Hospital. Because there is limited. Night life is pretty basic. Overall, the RMOs
a truck load of poverty around the Lakes region, at Lakes are pretty happy here.
you see a lot of quite sick people with interesting
13HAWKE’S BAY
Hawke’s Bay Hospital
Officially called Hawke’s Bay Fallen Soldiers’
Memorial Hospital, this facility is clinically
excellent, providing strong medical and surgical
experience, and has a well integrated medical
community and infrastructure.
The RMO unit in Hawke’s Bay is under new
management and has a new structure within the
organisation. This has increased the distance
from those with power to make the decisions
that matter. The RMO unit manager either hasn’t
read the MECA or willfully disregards it’s contents
despite warnings against doing so by the local
delegates.
In recent times, leave has become a negotiable Parking is so-so. It is not the main issue with the
commodity, i.e. you can only have your leave if you hospital although it can be difficult to find parking
pick up out of hours shifts for no extra pay. They some mornings. There is free parking on roads
appear to believe that lieu leave is also negotiable surrounding the hospital. It’s worth noting that cars
and at their discretion - the RDA is on to this. are frequently broken into in these areas. Onsite
parking is $1 per day and free on weekends and
The RMO lounge occupies the fifth floor of the nights. There are also DHB-led initiatives that allow
tower block. It is the only area on that level so it is for excellent secure bicycle parking, subsidised bus
generally free from other MDT staff. The room itself fares and free designated parking for those who
is tired and needs work but it does the job. There is carpool. The onsite parking is well lit at night and
a TV, computers, phone, kitchen, shower, bathroom, security patrol the area regularly.
and laundry facilities.
The region boasts excellent weather, wine and
“The food is generally good, activities. During the summer there is always
something on whether it be concerts, wine or food
although the cafe seems events. It’s easy to get away for weekends and
flights are increasingly cheap and frequent. Cost of
to be immune to the global living is pretty good and housing is affordable.
movement away from single For a first year, workload varies for different teams
and specialties. You will tend to spend more hours
use plastics.” at work on surgical teams.
The Registrars have bedrooms for nights, the Overall, rosters are good and the unit has been
House Officer gets their choice of four (!!) couches. good at rectifying non-compliant rosters without
Nights are variably busy so you may not have an any issues.
opportunity to make use of the area.
The clinical staff are excellent and are committed to
The food is generally good, although the cafe high quality training and educational opportunities.
seems to be immune to the global movement The hospital’s RMO teaching leaves a lot to be
away from single use plastics. They will take any desired and is often pitched well below level. You
opportunity to put food in a plastic container. The will rarely have an RMO teaching session with
cafe is a mix of staff, patient and visitors and is another clinician as a house officer. The registrar
usually busy at meal times. There is an outdoor teaching is superior in that respect although it is
courtyard which is very pleasant during the summer arranged by the individual departments.
months.
14TARANAKI
Taranaki Base Hospital
We have had some turmoil in our RMO unit with There are cafes and places to go out for dinner/
a high volume of turnover in the past couple of drinks, but if you’re a nightclub fiend, it’s not the
years. Thankfully, we’ve had a couple of wonderful place for you.
people working there this year who are kind and
RMO focused. Sadly we are losing one of them in The number of patients is slowly but surely
a couple of weeks, but our supportive manager is increasing here. Generally people are well
staying with us for now. supported and not overworked. Med and rehab
HO run is a D. surg and ortho are a C, however
med generally have a more consistent workload
throughout the day and surg often are variable and
may just need to stay for the afternoon ward round.
Most bosses are supportive.
MECA is normally well complied with. If any issues
arise, the RMO unit are generally well receptive to
any concerns (now).
The rosters at baseline are pretty good but we do
find there are calls for “additionals” to cover roster
gaps a little too frequently with pressure to pick
Our RMO room is a bit out of the way, so is mostly these up. Generally you’ll work one long day every
used at night. Theres plenty of natural light during week, but some without, and usually one or two
the day. The kitchen is simple. Theres a fridge, weekends per quarter. Split nights will start after
microwave, and simple drink making facilities. The three months and only if you’ve done a medical/
couches are comfortable and the TV is small with rehab run.
freeview. There are beds for every on duty RMO.
There are lots of opportunities to learn and gain
The cafeteria is the main hub for socialising in experience as there is only one night house surgeon
the hospital. The food is generally good as far as for medicine and surgery. On long days, there’s one
hospital cafes go and there’s a large juice selection. surgical and one medical.
There’s also a small salad bar and sushi available.
Despite what the RMO office might say, we have no Teaching for first years is generally well done. Semi-
restriction on amount or type of food. regular practical teaching sessions in addition to
the weekly HO tutorials.
Sleeping facilities have recently been renovated
with comfortable, single rooms. There are showers At Taranaki, we currently have six RDA delegates.
and toilet near by. There’s amazing collegiality between our friendly
group of RMOs that is fostered year on year as
There are plenty of free car parks available at people often stay for two/three years in Taranaki.
Taranaki, although it’s let down by not having well
lit parking for those leaving late at night. There’s
usually a security guard in the carpark at night near
hometime, but they sometimes finish before RMOs
if you have to stay a little later.
We live on the coast, on the way to nowhere. We
are around 4-5 hrs drive from both Wellington
and Auckland, and there are frequent flights out.
Taranaki itself has a lot to offer, from beaches to
the mountain. WOMAD is the event of the year, and
concerts happen throughout summer in the park.
There’s lots to do if you’re into tramping, surfing etc.
15WHANGANUI
Whanganui Hospital
The RMO unit is certainly more friendly and more
responsive since the meeting with RMOs/RDA/
senior management at the end of 2018. Generally
supportive and facilitate leave for training courses,
including all associated costs. Annual leave
requests are mostly approved but as Whanganui
has a large cohort of UK trained RMOs, leave can
be harder to obtain during the NHS changeover
period. If leave is declined, there’s no counter offer
for alternative dates despite RMOs asking.
The RMO lounge is within easy walking distance
to wards and close to the cafe. Small room but
well equipped for the number of RMOs - couches,
Since the last hospital review, Whanganui has
TV, foosball table, computer, phone for pages,
implemented Schedule 10 for all applicable
kitchenette.
runs except psychiatry which is in progress.
The on-call room is adjacent to the RMO lounge MECA compliance has improved since meeting
so reasonably close to main clinical areas but also with management at the end of 2018. Disputes
quiet so conducive to napping/sleeping. Equipped are mostly straightforward to resolve - usually
with a bed, TV, phone, sheets, blanket, en-suite between the RMO involved and the RMO unit but
bathroom and shower. occasionally reps or the RDA get involved.
Both cafes are shared with the public. They’re Workload is generally manageable and RMOs
clean and have plenty of seating with natural mostly leave on time. This, in combination with the
sunlight. Phone to answer pagers but we are in the strong collegial culture amongst RMOs, means that
process of transitioning to an app-based clinical RMOs who are available during the day are willing
task manager system. There’s a variety of quality to assist other colleagues with heavy workloads.
food options including vegetarian. Hot meals are As it’s a small hospital, there’s more clinical
usually readily available and you can phone ahead responsibility, closer working relationships with
to request a cooked meal be packed and sent to a SMOs, and greater procedural opportunities which
ward if you’re unable to make it before the end of are invaluable for developing an RMOs competence
serving time. There are no restrictions to meals as and clinical practice, so the RMO experience is
long as they’re within reasonable cost. much more than completing paperwork.
Hospital parking is free with plenty of spaces Work volume on long day is variable but usually
available. Being a small city, the hospital is close to manageable. After hours provides opportunity for
everywhere. Commute time is generally less than RMOs covering surgical or O&G/paediatrics to go
10 minutes by car without traffic jams, so there’s to theatre for various acute cases.
no need to get up early to get a park! It’s well lit
SMOs are generally friendly, approachable, and
for nights, and there’s a security guard available
readily hold teaching sessions twice per week.
to escort you to your car if needed, but RMOs
SMOs are also supportive in relation to procedures
generally feel safe to walk to their car without
and often encourage RMOs to perform the
security.
procedure under their supervision, especially in ED.
Whanganui is a beautiful place. There are beaches
Whanganui provides a wide range of learning
nearby, the river runs through the city, weekly
opportunities to develop your clinical practice with
pub quizzes that RMOs attend together, a lively
good support from fellow RMOs, SMOs, registrars
Saturday riverside market, and plenty of cafes.
(where applicable) and other hospital staff, in
Cost of living is very affordable. Whanganui is
addition to a good work-life balance with a variety
conveniently located to other areas of the north
of activities to keep one busy outside of work.
island for outdoor activities.
16MIDCENTRAL
Palmerston North Hospital
The RMO unit staff are friendly. There have been
multiple times where they’ve gone above and
beyond to provide support to RMOs. They’ve
responded positively to implementing safer rosters
in other areas of the hospital not required under
Schedule 10. They’re hamstrung by understaffing at
times, but they do their best with what they’ve got.
We’ve recently got a new smart TV and couches.
The RMO room is close to the library, lecture
theatre and not too far from the wards. We have
a couple of phones and one computer - another
wouldn’t go amiss. Kitchen facilities include boiling
water, fridge, toastie machine and microwave. The
RMO room is adequately sized for after hours staff.
We have a separate room with a sliding door
friendly bunch, and we meet up for after work for
for sleeping, it has a set of bunk beds. Not the
drinks or “gatherings” at flats.
greatest of sleeping arrangements, and they’re in
the same room as the computer. There is often a lot of cross cover going, with
General Medicine worst affected. Out of hours
The cafe has good sandwiches if you get there
cross cover (which should never happen due to
before they sell out. The quality of hot meals varies
significant safety risks) does happen on occasion.
- generally the food is acceptable, but at weekends
Disputes are usually fairly easily resolved with a
it’s poor. Nights food is generally unpalatable. The
discussion with the RMO unit, failing that, bringing
cafe is large, has adequate seating, and there’s free
your RDA rep along usually sorts things.
drip coffee and tea.
New systems in General Medicine are making
For nights staff there is a dedicated car park close
workloads more manageable. Sometimes in General
to some of the hospital main entrances. If you’re on
Surgery patient takes can be overwhelmingly busy.
long day/day duty, the car parks are far away and
in poorly lit areas. There are closer, more expensive Rosters are compliant with Schedule 10, although
options. Price ranges from $2.50 daily upwards. some RDOs are taken through the week and not
Security will walk you to your car if you ask. attached to weekends.
“The RMO unit are very Teaching time is “protected”, but dependent on
your registrar and workload, so it can be difficult
friendly. There are multiple at times.
times when they’ve gone On call can be soul destroying some days - other
days it can be a breeze. During the day job
above and beyond to support there’s lots of paperwork and some systems in the
RMOs.” hospital are complicated and take a long time, so
sometimes you miss out on patient contact and
Palmerston North has a number of places to eat learning. However, there are some times where
and drink, but after a year or two you can exhaust there are good opportunities for this.
your options. It’s two hours from everywhere,
SMOs are generally approachable and some will
so good for weekends away to Hawke’s Bay or
take time to teach you. They’re supportive of RMOs
Wellington. Rent is well priced, with nice houses
securing good working conditions.
around if you are willing to drive 10 minutes to
work. Traffic is always good. Public transport/bus
system is confusing. The RMOs are a sociable and
17WAIRARAPA
Wairarapa Hospital
The RMO manager does try her best in getting you The daily workload for a first year is very good.
leave. Pro tip: get your leave in early as it’s the best The day job is pretty easy - ward round and jobs.
chance of her getting locums to cover you. It’s easily managed and there’s no stress for the
general medicine runs as there are five house
The RMO room is a small office with a computer, surgeons that help one another out.
phone, small set of cupboards, sink and mini fridge.
There is a lazy boy and 2-3 chairs. On long day it’s just you, the nurses and the
patients on the ward. The SMO is always available
on the phone.
Whenever you say “I’m going to Masterton” to
anyone they always shudder and pity you. However,
the experience there is worth the increased
confidence and experience (and maybe stress).
You get to initiate vasopressors, NIV, assist in
theatre, and do a lot of invasive procedures like
taps and drains. Talking to SMOs directly on the
phone effectively prepares you for the registrar
years.
“The lack of onsite senior
“Whenever you say ‘I’m going
oversight at night is
to Masterton’ to anyone, they
terrifying, but they’re always
shudder.”
accessible.”
Sleeping and napping facilities are very poor. If
you’re gonna sleep, it’s in the AOU (ED don’t like The only negative thing would be nights - just two
using this term) as you need to be near ED. house surgeons manning ED and the ward. You
need to know the basics of subspecs like psych,
Car parking spaces are often available, however paeds, obs and gynae as heaps come into ED. The
there is the occasional security breach. There are lack of onsite senior oversight at night is terrifying,
hospital guards in the car park who are able to but they’re always accessible. `
walk you to your car if you want them to.
“The daily workload
for a first year is
very good, it’s easily
managed.”
There is not much to do in Masterton
itself and it is not known for its
city living. Most RMOs tend to
head back to Wellington for the
weekend, which is only 1.5 hours
drive away. Surrounding areas such
as Martinborough and Castlepoint
are nice to visit.
18HUTT VALLEY
Hutt Hospital
As a house surgeon, the RMO unit is good - the
RMO coordinators try their best. As a registrar, it
is difficult to get leave; it can be a stressful and
frustrating process at times. Most of the time RMOs
have to swap long days to get leave approved.
However, they’re usually supportive in approving
leave to attend educational events.
Since the new menu change, food in the cafe
has improved, but the range of choices and
options after hours (for example on long days and
weekends) are still very limited and the menu is So far our roster seems compliant and is fully
fairly repetitive. There are very few options for staffed.
those with specific dietary requirements.
“It’s not the best roster here
“As a registrar it is difficult to at Hutt but by no means is it
get leave; it can be stressful the worst.”
and frustrating.” There’s a good work-life balance at Hutt. It’s not
Space availability in the car park is very good. It’s the best roster but by no means is it the worst.
well light and very secure. Paid parking is pretty Night shifts are bunched up and not overly frequent
cheap. which is nice.
City living is excellent - Wellington is a great place SMO support is fantastic - they are friendly,
to live. approachable and supportive.
“Hutt is an
excellent working
and learning
environment with
a great SMO base
who really care.”
Overall, Hutt is a very friendly, well
run hospital. We would suggest
that you ignore less important
things such as RMO lounges and
the canteen and instead focus on
the fact that Hutt is an excellent
working and learning environment
with supportive interdepartmental
relationships and a great SMO
base who really care.
19CAPITAL & COAST
Wellington Hospital & Kenepuru
Capital & Coast has a great RMO unit and RMO in the MECA, but it’s the best you're going to get in
unit manager, with real energy and drive to improve New Zealand.
the RMO experience. They take bullying seriously
and are willing to tackle any instances as they The HO experience is the same as that in other big
arise. hospitals: you get less hands-on experience, you do
more paperwork, but you’re exposed to a lot more
RMOs in this DHB also experience good support medicine across sub-specialties.
at senior management level through to CMO level.
From an RDA point of view, this DHB is keen to Claiming expense reimbursement is unnecessarily
address whatever issues come along and work with cumbersome. It seems that with the expense
us on resolutions. reimbursement department there’s an aversion to
electronic technologies. A cynic would say this is
designed to minimise uptake of expense claims.
Wellington Within some departments eg orthopaedics there’s
a culture of not paying additional duties or cross
Hospital cover.
All in all, it’s a good hospital with a vibrant social
The RMO unit is generally helpful. They will scene, the city is great, staff are friendly and the
help suggest alternative leave periods if leave workforce is happy.
applications are initially denied. Reasonably smooth
transition process to this DHB, albeit with irrelevant
orientation (i.e. earthquake focused rather than
useful clinical/hospital related orientation).
Kenepuru
As reported in the 2018 review, the main problem
The RMO lounge has recently been done up. It’s
with Kenepuru is that surgical HOs are not well
tidy, clean and comfortable with around eight beds.
supported by the surgical team. Furthermore,
A downside of the cafe is that they still use a lot the fact that they’re first-years means there is
of plastic, however they provide a wide variety of additional pressure on them. Whilst there’s nothing
good, hearty meals and the staff are friendly. to suggest things have got any worse, there’s also
nothing to suggest much improvement.
The SMO support is good, especially in gen med,
sometimes less so in sub-specialties. Like other
larger hospitals, there is a tendency for people not
to work so well outside their silos.
Parking onsite is minimal - there are very limited
spaces available and can often be far away from
the hospital itself.
Daily workload for first years is mixed - for some
runs you’re very well supported but less so on
others.
Acute demand on a long day generally comes with
The lifestyle
a manageable workload now that we have three You can’t beat Wellington on a good day! If you
house officers on for medical and surgery. can forgive the average weather, Wellington
has a vibrant cultural and arts scene. There’s
Wellington is a good place to go to do exams nowhere else in New Zealand can you enjoy the
because they have strong teaching programmes. same opportunities to buy over-thought beer for
Unfortunately, the time allocation doesn’t come extortionate prices. Or, you could take a stroll and
close to the quantity of protected teaching outlined bracing swim in beautiful Oriental Bay.
20NELSON MARLBOROUGH
Nelson & Wairau Hospitals
Nelson-Marlborough was once a great place to The cafeteria has just undergone a massive
work, and this remains true. However, things took a overhaul and the food is great, making it now
turn for the worse at this DHB in 2017. perhaps one of the best in the country. Car parking
is never an issue.
The region is beautiful, with endless outdoor
activities to enjoy. Mountain biking, tramping,
beaches, lakes, skiing... to name a few!
There’s fantastic collegiality at Nelson; it’s an
incredibly supportive environment. It’s a great
option for first-years.
Wairau
Though our RMO unit is quite small, they bend over
backwards to support leave requests. Admittedly
this does mean gaps can often crop up in the roster.
This DHB has traditionally given medical registrars
a tough time, and this continued last year. Further, The RMO lounge is fairly simple; one room with
there were some difficulties with third-quarter relief. small kitchen (often piled with dishes). There’s a
The RMO unit, however, is receiving extra staff to large TV and one single bed for napping, and the
help combat their problems. sheets are changed sporadically.
The cafe boasts barista coffee and decent meals -
Nelson Hospital one of the best parts about this hospital!
As with most regional hospitals, there’s parking
Nelson remains a great place to work, for house everywhere. There are also dedicated long day
officers especially. The hospital now has a working parks right outside the ED entrance.
10-4 and 8-4pm working day roster. The quality of
SMOs and registrars is brilliant, and the support The lifestyle is second to none. It’s not known for
they offer is outstanding. city living, but the range of outdoor activities are
excellent, with endless breweries and wineries
The RMO unit are incredible helpful. They’re very around.
flexible with leave and always happy to help with
roster changes to work for you. Daily workload for a first year is pretty run
dependent - generally it’s fairly good with lots of
Registrars are only in place for gen med, gen surg, hands-on experience and little paperwork.
ortho, ED and anaesthetics. Nelson has only had
registrars forYou can also read
