Mark's First Work Impressions

I’ve just finished up my first full week so I now know (sort of ) what my job is here. As everything is organized a tad differently, just knowing what to call myself turned out to be a challenge. My official title is “Consultant Physician.” The term physician, however, means the same as Attending in Medicine back in the States, (so no self-respecting surgeon would allow themselves to be called a physician). There are two main aspects to the job: outpatient and inpatient (certainly the term “hospitalist” doesn’t mean much here) and I'm involved in both for a general population of about 60 to 70,000.

On the outpatient side, it turns out internists here really don’t do any primary care as we understand it in the U.S.; they consult for the GP’s (general practitioners) who do the the bulk of primary care. Since there are very few subspecialty medicine folks here (a cardiologist comes to our hospital just once a month, for example), that means I end up being the first line of consultation and we send far fewer patients on to subspecialists. So … lots of cardiology and neurology at levels I wouldn’t normally end up treating at home, like pretty intense, quasi-unstable cardiology. Also, since we do all the stress tests (and they do lots of them here), I’m seeing lots of chest pain. I have three outpatient sessions per week along with a half day of stress tests (no nuclear tests here … have to go an hour away for that, and all the way to Wellington - 2 ½ hours - for a cath). On the inpatient side, I have one intense day of call per week (which includes consulting frequently for the ER which is staffed only by RMO’s – intern types, see below – at night) and about every fourth weekend. Much of the inpatient medicine is similar to the States but, once again, no subspecialists and many different protocols and medications.

As for my partners in the hospital, there’s one Kiwi, and the others hail from Pakistan, India, South Africa and Romania. As we had heard, there really are not enough docs here and many leave for more money elsewhere (especially Australia). Folks seem to really like working with and seeing an American doc (and seem to tolerate my crazy accent). Needless to say, they’ve already worked me over pretty hard to stick around longer than six months. Probably the biggest differences on the inpatient side is (a) you don’t really need to do much documentation, just what you feel is necessary (there’s really no malpractice here), and (b) the educational hierarchy is quite different. As some of you may know, in the English system students can enter into medical school right after high school (it’s somewhat combined with undergrad). Then after that, they typically do a couple of years as a “resident medical officer” (RMO), rotating between medicine and surgery. After all that, they can become a registrar, where they focus on “GP” work, or Internal Medicine, etc.

The RMO’s I’m working with also come from around the world: NZ, England, Wales, Bahrain, China, India. At least a few have started hinting that they’d love to come to the States for residency and hitting me up for tips on how to make that happen. As you can see from the photos, the hospital is under renovation with a really nice new addition that houses the ED, surgical “theatres”, obstetrics and the CCU (kind of like FAHC …. There is even a similarity in the sunny logo, although the signage is all in English and Maori, unlike at home). All my colleagues here have been very welcoming -- from the manager of the hospital offering us a weekend at her summer home on the other coast of the North Island, to my boss having us over to dinner, to the husband of the stress test technician inviting Melissa to watch him slaughter a lamb. Now that’s hospitality.