REVIEW OF NZRDA

www.nzrda.org.nz May 2015

before and after

566968 Review of Hospitals.indd 1 14/05/15 11:26 AM Welcome to NZRDA’s annual Review of Hospitals, a subjective and unofficial assessment of our experiences, written by doctors, for doctors. Dunedin Hospital’s clinical services building, on this year’s front cover, has recently had it’s bandages removed and, while still dated, is looking rather spruced up. But, metaphorically speaking, the repairs are only skin deep. Without wanting to pick on Dunedin, seeing a major edifice in one of our major cities crumbling and leaking like that is a wake up call for us all. If we do not attend to our public health system’s chronic ailments, we risk losing it.

Our resident doctors tell us all is not well behind the outer facades of our hospitals. Alongside their SMO colleagues and fellow health professionals they are making the most of a system that in some ways is crumbling and leaking, and that in a few places seems to be actively working against their ability to do their jobs.

For the past two years we have noted the trend towards service at the expense of training, the squeeze on the apprenticeship model on which our training is based. The push for doctors to do more for less is limiting the time available for teaching in many of our hospitals . That has not improved. But the common theme in this year’s review is a lack of support many resident doctors feel from their RMO units, that is, from their employers, the DHBs themselves.

It’s not all bad news. We would like to congratulate the unit coordinator at Tairawhiti, who provides excellent RMO unit support for our colleagues. She “... is competent and very agreeable, always available for a friendly chat, and keeps a jar of lollies in her office for us!” West Coast’s RMO unit staff are also “very friendly, helpful and supportive”. We are sure that most do their best and most resident doctors report positive overall experiences, but many hospitals struggle at times to provide the supportive environment essential for the provision of a top notch training and service institution. We understand that all staff - RMO units included - are constrained by the austerity mode our public health sytem is currently enduring. Responses to those constraints vary, from going that extra mile to support resident doctors through to “a culture of MECA breaches” (Waitemata). Here is the worst news: there is an unhealthy, unprofessional culture in one region, where unacceptable behaviour is commonpla ce, even encouraged, and conditions are ripe for bullying and harassment. (See page 10, Waikato DHB).

Once again we are prompted to say that RMO lounges and other facilities are contractual entitlements, not optional extras. NZRDA members have worked hard for them, to ensure a level of support that enables us to do our job. Yet many DHBs continue to treat these entitlements as unimportant trivia , or worse, as an expense to try to avoid. Instead, a small amount of attention – office staff knowing these 1

566968 Review of Hospitals.indd 2 14/05/15 11:26 AM entitlements, a comfy bed with regularly cleaned linen for on-call, a printer that actually works - would help turn doctors’ work experience into a positive story to pass on to their colleagues.

A quote from an ADHB resident doctor reflects some of the frustration out there, but also the hope that, at ADHB at least, we can see the way to a vastly improved doctor experience:

“ADHB is an interesting place to work – highly supported clinically and (generally) appropriately staffed, keeping the workload manageable (in contrast to the other DHBs). Yet it fails in much simpler issues: MECA breaches, leave, parking, the RMO lounge and rostering/relieving. If these simple and seemingly inexpensive issues were solved, the many other more difficult successes (teaching/learning /support/workload) would be even more apparent. There is lots of potential here – enough to be hopeful that they can turn these issues around.” To the doctors who toook the time to answerr the questionnaire fromm w hich this review was commpiled – thank you. And to new doctorrs coming into our hospitals – Happy reviewing!

(NB: No reviews were received this year from Wairau,Wairarapa or Whanganui)

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566968 Review of Hospitals.indd 3 14/05/15 11:26 AM Our RMONorthland unit staff are friendly DHB and - doWhangarei nice for lunch. Dinners,Hospital especially at try to help, but they lack enough power weekends, have fewer options. to be very helpful. Getting leave is a big problem. We also have trouble with It’s hard to find a parking space for 4pm relief rosters. shifts. They have now changed to paid car parking. The RMO lounge is on the roof, which we share with some very noisy pigeons. Our daily workload is generally fine, You would be hard pressed to get further although relief rosters can be bad. O&G away from ED, where we’re needed most has 12 nights and the on-call surgical of the time. The kitchen doesn’t have registrar has 24 hours on call. mugs but the couches are good and there’s plenty of light. The single phone Medical SMO teaching has improved at is a little redundant, since we have cell Whangarei but registrar teaching is still phones rather than pagers, and the not generally protected. single round table for studying doesn’t seem like enough. And while our two Whangarei is a more laid back lifestyle computers can access everything we than in the bigger cities. You will have need the printer hardly ever works. great access to the beach, excellent surf There are two beds. Be in quick. There and beautiful countryside. are no changing, shower or toilet facilities but lockers are availabl e. On the whole, Whangarei is a good place to work with a supportive culture, Our cafeteria is generally fine; but the current difficulty with getting staff are friendly and the salads are leave lets it down.

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566968 Review of Hospitals.indd 4 14/05/15 11:26 AM RMO Waitemata unit staff at North DHB Shore - areNorth North ShoreShore has Hospital enough beds for all; borderline supportive. That’s not their Waitakere has two beds and two couches personality, that’s just how they work; of dubious sanitati on. Changing, shower friendly and apparently helpful but and toilet facilities are present but largely incompetent. They process cramped. The shower is piss-poor. No claim forms well, but seem to have no towels. There aren’t enough lockers so idea how to cover leave or nights as if it it’s first-in-first-served. Bring your own was the first time they ever did it. The lock. mind boggles. They seem unclear of the MECA. The general medical NRA Waitemata’s cafeterias are both very adviser is very unfriendly and tends to good but Waitakere’s options keep brush people aside. Gaps in the rosters disappearing. Coffee is no longer don’t get filled until attention is brought included on the RMO card. Vegetarian to the unit by other RMOs, and even options can be inedible. They once then RMOs’ assistance is needed to fill attempted to remove all beverage and the roster (not the other way around, as coffee from the meal list but brought it is supposed to work. Grrr). it back at the RMO ’s protest. The food menu is still barely palatable. The RMO lounge at North Shore is centrally located close to ED, theatre Waitakere has good car parking but it’s and ICU. It has a small kitchen with not safe at night. North Shore has good all the necessary facilities as well as a parking; just across from the hospital coffee machine. This part of it is close to and well lit. perfect, really. Waitakere’s lounge is not so conveniently placed. Public transport to is a no-goer, so – poor public transport, Of the other facilities, we could do with expensive living but hey – Auckland! more phone lines, one of which at North Great nightlife, food and other activities. Shore is always broken and impossible to get fixed. We’d also appreciate a MECA breaches are very frequent, study area. The space is inefficient for varied, severe and hard to resolve. A an RMO to achieve any meaningful MECA breach will affect you directly amount of study. It’s too nois y anyway. at least every fortnight. Some of these The computers are outdated and it’s include: STIL day applications being only a matter of time before they break/ “declined”; leave requests automatically die. Internet speed is glacial, perhaps declined because of a shortage of slower in these times of global warming. relievers; RMOs being forced to cross- The printer works every other day on cover (not asked – forced). If warnings average. North Shore’s printer is broken are given they do attempt to resolve the permanently and as with the phone line, issue but otherwise will plead complete impossible to get fixed. ignorance.

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566968 Review of Hospitals.indd 5 14/05/15 11:26 AM There is a culture of MECA breaches Surgical SMO support ranges from here, reinforced by the management fantastic to poor. If you can hack it team, the charge nurses and the it’s an awesome run for learning and operations manager. It includes cross experience. Watch out for the clu eless cover after hours, and enormous RMO unit smiling assassin types. And difficulty raising issues (and being watch out for irritating nurse paging taken with any sincerity by at least one behaviour. operations manager). Even SMOs are struggling. And it is reinforced by the The on-call medical shift is doubly large power difference evident in the insane – see above, but worse. hierarchical management structure at As for SMO support here: read Nil. To Waite mata. be fair, SMOs experience similar issues as the RMOs and many appear visibly Our workload is reasonable within a upset but powerless to prevent them. large normal variation. The C- category The medical ward is named as the “soul roster has been good but others not. destroyer”. You’re busy enough dealing Ward calls can be insane and medico- with sick patients but nurse paging legally dubious. Rosters don’t reflect the behaviour has been an issue for the actual number of hours worked – not last few years and there appears to be even close. Registrars have to attend no improvement in sight (for example, Saturday un-rostered ward rounds being asked to chart laxatives at 3 a.m. (most house officers are exempt). We etc). SMOs do try to teach despite the still have seven nights in a row rosters. busy work schedule, and industrial The RMO unit tries to delete post-acute support from consultants is variable but days on Saturdays so that the roster generally supportive. doesn’t “breach” and the RMO is told we don’t ”need” to come to post-acute days To sum up, Waitemata DHB is a great on Saturday, which is impractical and place to work during ordinary hours. frankly ridiculous. The chall enge is the skeletal staffing out of hours and a complex managerial The on-call surgical shift is insane. structure that makes finding an answer, You choose between quality care and and getting a result, no easy task. documentation, or doing the majority of the jobs, but not both. The work volume is not as bad as medical but is still high and sometimes gets to unsafe levels, for example, 82 tasks completed in a 15 hour shift. It’s hardly a quality learning environment. The wards are very large, each patient has two sets of notes and you spend most of your time looking for them (the notes, not the patients).

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566968 Review of Hospitals.indd 6 14/05/15 11:26 AM OurAuckland RMO Unit’s DHB functions - areStarship run Starship Children’s is the children’s Hospital trauma and largely through a ‘chief resident’. One of regional/national surgical centre their core responsibilities is to act as the for some specialties so you get great middle person between management exposure and good SMO support. and the residents. It can vary. The Consultants will actively teach during most recent two chief residents were the ward rounds, and schedule teaching. extremely well regarded by the RMOs. SMO industrial support is largely We don’t fare too badly with MECA untested and unknown. breaches because the chief residents are usually able to solve or avoid them. During winter the on-call medical shift can be particularly heavy. On-call We have excellent access to the Starship registrars can get called into HDU and RMO lounge on level 3. It looks out not be seen for some time. You get a towards a foyer, and you would be brave good variety of subspecialties, covering to try the ‘kitchen facilities’. The two them all after hours. Medical SMOs’ phones may or may not work – but that’s teaching can be a bit hit-and-miss with not such a problem because most of our few teaching sessions Starship-wide, communication is by on-call mobile but they are generally supportive of our phone anyway. We have two desks. Few industrial rights. people study here; two - oddly enough. The computers come from the last City living is the best - there’s a reason millennium and function accordingly. the house prices go up, up and up – The printers don’t work. The sofas, Auckland living is sought after. The donated by the RDA, are so plush they downside is - being in downtown are almost are beds. We have no shower Auckland, carparking is a problem. You facilities, and changing in an undivided can park your car in the building, but if room could be awkward for all involved, you don’t get a select park you are locked and unfortunately theatre have been in until 7 or pay $20 a day, or $50/week. upset at non-theatre people using their toilets. No such thing as secure lockers; we just place our bags down and hope for the best.

Our cafeteria is clean and shared with . The food, of good quality and availability, is well regarded in the region.

Rosters can also be busy with two long days a week in winter. Weekends on call tend to be split.

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566968 Review of Hospitals.indd 7 14/05/15 11:26 AM There’s Aucklanda high turnover DHB of staff - within Auckland The daily workload Hospital for such a big hospital the regional RMO unit “North” and is reasonable and quite academically each face only seems to stick around for stimulating. There are lots of patients a few months. This rapid changeover but lots of doctors too. Rosters are means they appear sometimes unclear frequently non-compliant with excess about their individual responsibilities. hours. You won’t leave on time but that Leave is difficult to get and any kind is just life in the big city. There’s usually of interaction can be impersonal at only one long day per week. times. Much of the time they spout a lot of BS, perhaps unintentionally, The on-call surgical shift is very busy perhaps through ignorance. Some are for house officers on the wards. The simply unhelpful; others bureaucratic, admitting house officer helps out the manipulative and bullying, making it admitting registrar. Don’t expect to see abundantly clear that neither you nor any actual surgery as a house officer, but the MECA matters to them. SMO surgical support is pretty decent and many enjoy teaching. Actually it’s MECA breaches are endemic; we get a great place to learn. Some SMOs have them every damn day. RMO unit staff coffee with RMOs for a team-based chat manage this problem by pretending about life outside of work. they’re new and claiming they don’t know the rules – which, due to the staff Our industrial issues are of little concern turnover, is likely to be true much of the to most bosses, however. The younger time, but does not wash with us. SMOs are supportive overall, but some old-fashioned attitudes still prevail. Some departments are downright hostile.

Industrial support from the medical SMOs is generally better than surgical, and their academic support is also excellent. There are many opportunities to do oral presentations within the department as well as research opportunities.

General medical can be busy if you’re on ward call, especially overnight as you need to cover , which is in another building. The nurses can be needy. Registrars are always available to be consulted. 7

566968 Review of Hospitals.indd 8 14/05/15 11:26 AM You have to go outside and a long way Space restrictions are timed for nurses from the wards to get to the RMO room; (7 a.m. to 7 p.m.) and expensive. We’ve you’d wake up by the time you got there been refused taxi chits for 4+ nights. if on nights. It’s underground, replete with fleas and has no lock on the door. Besides the crap traffic issues, you can’t The kitchen is not stocked and the main beat the big city. It’s the main reason heat pump is not working. There are to work in Auckland. As the only two phones, but many of us ‘bestmate’ international sized city Auckland has the hospital numbers to reply to pagers. everything to offer with many good There are tables – underneath a huge restaurants to choose from for a start. pile of chairs. The lighting’s inadequate A ten out of ten for city living. And for study anyway. We have four or five as for the traffic – public transport is computers and lots of RMOs - so could improving all the time. Electric trains do with more. The printer doesn’t work will start se rving Auckland hospital’s but it never has any paper or ink anyway. Grafton station in mid-2015. Bring them on Len Brown! There are no beds, no changing, shower or toilet facilities. As for secure lockers Auckland offers a huge variety of clinical – does building a pillow fort around runs and subspecialties to learn from. your bag count? There’s a white board It has large patient flows but is also for writing up how many patients are very protected with multiple layers of waiting in ED. If you thou ght your seniority. You’re never alone here, but on employer cared, come and join us in the the flip side there is less room to spread RMO room and see for yourself! your wings.

The cafeteria has a great salad bar, and ADHB is an interesting place to work is clean and central. We don’t have any – highly supported clinically and restrictions on meals and the choices (generally) appropriately staffed, keeping are good. We’d even go so far as to say the workload manageable (in contrast to Auckland has the best meals of the three the other Auckland DHBs). Yet it fails in Auckland DHBs with a good variety much simpler issues: MECA breaches, and good vegetarian options. Weekend leave, parking, the RMO lounge and options are limited, however. rostering/relieving.

As for parking - take the bus! Or the If these simple (and seemingly train (500m to the nearest station). inexpensive) issues were solved, Car parks are only really available for the many other (and more difficult) nightshift and you will be away from the successes (teaching/learning/support/ entrance. There’s no guarantee of a park workload) would be even more apparent. on normal days. There is the option to There is lots of potential here – enough park in the staff carpark if you’re on a to be hopeful that they can turn these long day but arrangements aren’t great. issues around.

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566968 Review of Hospitals.indd 9 14/05/15 11:26 AM Counties Manukau DHB - Our RMO unit staff appear to be friendly It’s a massively busy place so MMH and helpful to a degree, but is it slyness? doctors have learned to take busy, awful Is it a game? There are plenty of mistakes rosters in their stride, but not without and not enough support, for example for struggl e. You can find yourself working relievers. Helpfulness depends on the on every second weekend on a 1 in 3 specialty, and we’re still having problems run. The team expect us with rostering, for example, rostered to work Saturdays despite already doing plastics and medical nights back-to- 12 days. The on-call surgical shift barely back. MECA breaches occur but they are leaves you free to attend house officer usually solved without too much drama. teaching, but the quality of the work is You can get reimbursed for extra time. good and the team is supportive.

The RMO room is one km away from The on-call medical shift is busy. In the hospital main entrance! Is it a game? winter now we have three house officers Kitchen facilities are old and the fridge working, which has helped a lot. SMOs is stocked with stale cafeteria food. The are very approachable and good to study area is not bad but the computers talk to about college and training, but are antiques and there’s only one phone. industrial support is not so forthcoming. There are two beds; we do wonder if the Medical SMOs provide 24/7 support for sheets have ever been changed. You are ED and gastro. Medical registrars are unabl e to make the room completely supportive. dark. Changing, shower and toilet facilities are old but ok - but the ones in For city living you can’t beat the biggest theatre are way better and closer. We’ve city! got secure lockers though. But the really cool thing about MMH Our cafeteria is in the middle of the is that it’s like a rural hospital, but in hospital, clean, accessible and with lots Auckland. The collegiality, enthusiasm of options - which are mostly crappy. and community vibe is exceptional. But the staff make up for it; they’re From the cleaners to the consultants - always friendly. Some changes are being definitely the most supportive DHB in made, for example, improvement to the Auckland. salad bar to include more options.

Car parking is across the train track. It’s too far away and not safe, but there are security escorts available. There’s no parking machine by the parks so if you forget to top up your card you’ll need to walk back to the main building.

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566968 Review of Hospitals.indd 10 14/05/15 11:26 AM NothingWaikato has improved DHB in the - Waikato Waikato RMO unit Hospital, since last year orHamilton the year before or the year before that. It costs nothing to be helpful, it may even improve productivity, and it certainly improves job satisfaction. Yet year after year we receive negative reports about this department. Deliberate obstruction may not amount to bullying but it creates the environment where bullying and harrassment flourish. It needs to stop. We expect Waikato DHB top management to take responsibility for this dysfunctional behaviour, make the necessary staff changes, and join us in the twenty-first century where bullying and harrassment, in the words of Professor Michael Grigg, President of the Royal Australasian College of Surgeons, becomes “a scourge of the past.” Waikato’s RMO unit staff appear showers in theatre are better. deliberately obstructive and inflammatory as a whole. They are It would be nice if the cafeteria was not very helpful, especially for leave open earlier and later. It’s clean but with at Christmas. We get heaps of MECA limited stuff for RMOs to eat – healthy breaches – deliberate, malicious calci-yum is the only drink allowed, in and difficult to deal with. They’ll try fact heaps of the food is restricted - “Not anything. for RMO’s”. We do like the burgers and toasted sandwiches. Rosters and workload vary a lot. Surgical on-call is busy but usually manageable The car park is in a multi-storey building with plenty of interesting a long way from the entrance. There’s from midland region referrals. The lots of crime. Taxis are a good option. SMOs are supportive but frequently not in attendance. They had to make an Hamilton has a good, small downtown official hospital policy to ensure they see with some night life, especially if you their patients twice weekly! Registrars like the uni student-type scene. Anyway, are kept very busy. we’re close to the main attraction; the Auckland bar scene is not far away. The work volume is manageable for medical on-call with enough staff on and has a huge catchment supportive SMOs. Two of our favourite area so collects a fascinating assortment runs are renal and haematology. of pathology. It is easy to get lost both physically and emotionally in such a big While it’s a long way from the medical/ complex but if you can find your niche, surgical wards the RMO room has good, with great bosses and registrars, then but basic, kitchen facilities. The furniture you’ll have a lot of fun and learn heaps. is broken, there’s only one phone, one Get savvy quickly with your MECA and computer, no printer and no study area. take care of your own health and your We do have secure lockers though. There friends otherwise you will risk burning are three beds and one bathroom – the out. 10

566968 Review of Hospitals.indd 11 14/05/15 11:26 AM We like ourTairawhiti RMO unit person DHB a lot. She - Gisborneindustrial support Hospital and they’re higher is competent and very agreeable. The up in the hierarchy. Again, we get great occasional leave request denial is always support from the intern supervisor. accompanied by profuse apologies and explanations. She’s always available for a Our RMO lounge, close to the wards, friendly chat, and keeps a jar of lollies in is furnished with slightly ratty couches her office for us! and a TV. There’s no temperature control and the sun blazes into the We don’t really get MECA breaches. shared kitchen (shared with quality Workload is usually manageable – with control nurses) – that’s usually positive late days so infrequent that we get tetchy but sometimes unmanageable in after half an hour over! We do a 10:4 summer. A single phone line is usually roster in our first year with no nights more than enough. We have two desks, and a long day Saturday and Sunday – usually well-cluttered – our bad… only that adds up to 29 hours. There is a lot one computer is able to view of cross-cover. images, at least until IT sorts it out… eventually. We can use the printer in the The surgical on-call covers surgery, quality control hub. Changing, shower O&G, ortho and ENT. It’s usually and toilet facilities are next door and are manageable, often relaxed. There’s tiny but usually sufficient. Secure lockers no registrar to assist in theatre so are right outside. house officers get plenty of hands on experience. Consultants encourage The cafeteria is clean with somewhat learning in theatre and out. Industrial limited options. It closes at seven support is good from the intern on weekdays and obscenely early on supervisor, and the consultant is usually weekends. If you’re organised pick up very approachable and reasonable. your dinner from the kitchen. The cook will remember your order and look after The on-call medical shift is more you. The food’s usually good; we’ve got consistent work-wise than surgical few complaints except that cold meal and we can get support from the day is always a disappointment. surgical house officer if needed. Again, it’s hands-on admitting and doing You get plenty of free, close car parks, procedures. There’s good support and separate from public parking (which encouragement to learn. We have is also free), minimal security but few regular journal club where we present, issues. and a medical grand round. Day- to-day opportunities and support Want some city living in Gizzy? The vary with the SMO, but a new Lone Star can rage on weekends and rotating roster means exposure to it live music is easy enough to find, but all. Some consultants give excellent honestly, don’t come for the nightlife,

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566968 Review of Hospitals.indd 12 14/05/15 11:26 AM it’s mostly house parties. You could pick training in Gisborne, but clinically up a beachside mansion for less than experienced house officers are always an Auckland apartment. Top beaches! in demand elsewhere. We do all the We’re pretty isolated by car but you can admitting in ED, heaps of procedures, get fairly regular flights to Auckland and are always first (only) assistant in or Wellington for your occasional theatre. We don’t work nights in first metropolitan fix. year and are guaranteed a maximum of one weekend in three (2.5 weekends Your old friends may not be here but per quarter). It can be a big step up in there’s great collegiality and a great social responsibility and independence, which environment outside of work (and plenty can be scary, and is a great opportunity of new friends in Gisborne). Not having for learning. registrars means you can’t do vocational

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566968 Review of Hospitals.indd 13 14/05/15 11:26 AM DHB - Hospital RMO unit staff are friendly but can make You can get a park if you arrive before life difficult at times. MECA breaches are 7:45 a.m. frequent but generally of low severity. The daily work load is very reasonabl e; The RMO lounge is easily accessible it’s uncommon to finish after 4pm. with recently added lazyboys. Kitchen facilities have been recently upgraded. The medical ward call is hard work, We have three phone lines, two otherwise workload is reasonable. At computers and a recently replaced night house officers cover medical, printer. There are two comfortable beds surgical, psych, cardio, ICU and rehab in their own rooms. Changi ng, shower – which can make it very busy. Work is and toilet facilities are good but there are dominated by minor jobs, for example no secure lockers. med recharting. We get at least two hours teaching time per week - but it’s The cafeteria food is nothing to write not protected. home about – poor quality and limited healthy options. But the beaches are Overall Tauranga is a fantastic place to great. Most of us live at the Mount, work with a very reasonable workload. 15 minutes from Tauranga, with a The lifestyle is as good as it gets in New great beach, active lifestyle and good Zealand. A great group of colleagues restaurants and cafes. and friends.

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566968 Review of Hospitals.indd 14 14/05/15 11:26 AM Lakes DHB - Rotorua Hospital RMO unit staff are generally friendly, There’s a good amount of parking helpful and receptive to suggestions and available, although it’s becoming tight requests. However, take their advice re as the student numbers increase. The MECA rights and entitlements with dedicated p.m. car park is available if caution – they are not always right. Read you’re on nights or long day s (display your contract and ask your delegate! your sticker or prepare to be harassed). MECA breaches are reasonably common and often not sorted without Rotorua’s a very cool place to live. Ten involvement of the RDA. Again - know minutes to multiple lakes after work for your contract and know your delegate. dips in the summer. There’s a redwood forest on hand for avid runners and The MOR lounge is a little dated but a mountain bikers. And you’re close big space that does the trick. The table enough to the mountain for day trips in tennis table, purchased by the social winter. club fund, is available to fill the gaps in the day and encourage some healthy Daily workload here is variable competition. Kitchen facilities are basic; depending on the run. You will learn a the kitchen is equipped with inedible lot because you will do a lot. Rosters on frozen meals. Occasionally there will most runs expect one long day per week be tea, coffee and in-date milk if you’re and about three weekends, including lucky. There is one phone line and one two long days, per quarter. And at least computer and only one desk. IT facilities one set of seven nights per quarter once include standard access to CIS, x-ray etc you are allowed to do them. but no conveniently located printer. On- call bedrooms are adequate but seldom Work volume is variable. You cover able to be used – you’ll be too busy for ward calls and clerking and ED – and sleeping. Changing, shower and toilet on weekends have help from an ortho facilities are not great; there’s one very house officer, 8 to 4, who will cover ED. old and poorly kept shower close by. After four you’re on your own – with a Secure lockers are available. registrar – to cover surgical, ortho and ED admissions. It’s good experience - The cafeteria is shared with all staff, again you will learn a lot because you visitors and patients – careful with will do a lot. “cafeteria chat”. Food has been appalling in the past. This improved with a change We get one hour of weekly dedicated in chef and now there’s an okay selection surgical teaching and variable amounts of a hot meal, cabinet food, sandwiches of on ward teaching – registrars are or salad. We are allowed one drink but better at this. no coffee.

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566968 Review of Hospitals.indd 15 14/05/15 11:26 AM The on-call medical shift is too again these are variable workload-wise; much work. Full stop. It is frequently you will have a medical registrar on site borderline unsafe after hours due to and a surgical registrar on call at home. a huge volume load on both yourself Currently we’re on a 7 x 10 hour night and your medical registrar (who will be shift roster – which starts after working stuck in ED) – especially in winter. This for four days on the ward. You will be is something we are trying to work on. shattered by Friday morning. Again, you will learn heaps because you will do heaps. The hospital was recently renovated so is a nice modern site to work in. Its The SMOs are a collectively supportive provincial setting means RMOs are a bunch, with variable enthusiasm for tight unit group who are supportive teaching on the ward, but we have steady of each other, with lots of out of work dedicated medical teaching time in place socialising. with both house officer teaching and handover teaching time. Consultants Rotorua is a great place to live and play. have been supportive of industrial issues You will be more hands on than your for RMOs over the past year. big city counterparts and will need to figure it out for yourselves more often, We do a 12:2 roster. On nights you will but your skills will reflect this by the end cover both medicine and surgery – of your first and second years.

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566968 Review of Hospitals.indd 16 14/05/15 11:26 AM Hawkes Hawkes Bay’s RMO Bay unit DHB staff are - Hastingstennis table. We Hospital have enough phone friendly, depending on who you get. lines and two computers with internet Put your leave requests in early and be and you can print to the floor below. prepared to push a bit. MECA breaches But we don’t have a desk for study. The are relatively infrequent but you need beds are from the 80s – hopefully to to keep your eye out. Daily workload be replaced this year. The house officer and rosters are usually reasonable. gets the couch. We keep hoping for The number of house officers is slowly an upgrade of bathroom and shower increasing. facilities – they need it. There are lockers but bring your own lock. Depending on the day the on-call surgical shift can be really busy. The You can get some good food options in consultant on-call system has just the cafeteria - like sushi – the problem is changed so we’re waiting to see how this getting there in time for dinner. works out. There are good opportunities to get to theatre in Ortho. The surgical The car park’s a bit small so you become registrars are good. On-call medical an expert at squeezing into illegal spaces. shift and medical SMO support are There are five long day parks. reasonable. The registrar roster has just changed so there is now more support Most house officers live in Napier – in the evenings. there’s lots more happening there, on the waterfront. It’s a good group of RMOs The RMO lounge on the top floor gives a with plenty of social events or sports great view of the sunsets - and sunrise s. teams to join. Overall a pretty damn There’s a new dishwasher and a table good place to be!

The frontlineTaranaki Taranaki DHB RMO - unitNew staff rundown.Plymouth We’ve Hospital been promised a are approachable, friendly and available revamp due to a recent trust monetary at most times. Unfortunately there are donation – watch this space. There’s no frequent communication delays and tea/coffee/milk, plates, cups, bowls or some MECA breaches that are difficult any cutlery. We have one phone and to resolve, the main issues being a desk in each of the two bedrooms reimbursement of costs of training, (for night medical registrar and house study leave, covering shifts and teaching officer) and one in the lounge. There’s - which when you think about it covers one computer with good inter/intra net almost everything! access and a printer. Changing, shower and toilet facilities and secure lockers Our RMO lounge is large with plenty are adequate. of natural light, but old, dated and cont... 16

566968 Review of Hospitals.indd 17 14/05/15 11:26 AM New Plymouth’s cafeteria has a good officer helps the reg admit to ED which variety and quality of food but the hours relieves pressure on the evening house are limited. The vegetarian choice can be officer. kindly described as average. There’s been a recent push for healthier options and Medical consultants have a variety of we’re looking forward to these. special interests and specialties and are generally supportive. The HOD is Parking is close and available for nights. friendly and approachable. Security’s available to walk to your car if needed. New Plymouth Hospital is new! It has lots of computers. The medical ward has Daily workload here is very reasonable. lap tops for ward rounds but still paper The medical service has an extra post notes. The Electronic Prescribing Centre take house surgeon and also an extra and task manager for on-call is electronic house surgeon on weekends. First year which reduces pages – it’s very good! rosters are good but the ED roster needs attention. Medical registrars New Plymouth is an awesome place to are understaffed and surgical/ortho live; beautiful city, lovely beaches and registrars have ‘on-call’ 24 hour rosters. walks – and the mountain!! Even the dining options are great. You generally The on-call surgical shift is usually get home on time so it’s a good work/ manageable but it comes and goes. life balance over here in the Naki. You get good exposure to a variety of problems. You’ll be required to admit The overall package in Taranaki is sub spec patients (e.g. ENT, opthal, uro). excellent, taking into account hospital, Surgical and ortho registrars can be off- staff, colleagues, rent, beaches, town site but are always on the phone. etc. Did you know New Plymouth had the most number of sunshine hours per The new three-month teaching program year, two years running! by an enthusiastic SMO is widely enjoyed and appreciated. We get one to two hours departmental teaching a week but house officers only get one hour of protected teaching time (medical/ surgical/ortho). Industrial support is minimal.

The on-call medical shift is also usually manageabl e, but if you’re overrun the medical registrar will occasionally assist with jobs. The med reg is always available when needed. An extra house

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566968 Review of Hospitals.indd 18 14/05/15 11:26 AM MidCentral DHB - Palmerston North Hospital RMO unit staff are approachable and from rosters, and they’re reasonably very friendly until you realise they have easy to settle. Some of our rosters are messed up your roster. worse than others. General surgery and ortho do 24-hour calls. House officer The RMO room is close enough to most call frequency is not too bad but most wards and ED but kitchen facilities are registrar rosters get frequent calls. poor and there are no separate sleeping areas. There are no beds and not enough Palmy is a very good hospital if you couches for the night staff. Besides, it want surgical training. Surgical SMOs can be hard to sleep with someone else are approachable, supportive and watching a DVD. Sometime s people go encouraging. Protected teaching time to the library next door to sleep but there is not very good though. Nurses are is a risk of being kicked out by security. becoming better at cannulas and bloods At least you can go to the library to - but only if they like you. study. There are no phones, except in the corridor, and only one computer for Medicine is busier than surgical, but all RMOs to share. There are no nearby it’s manageable and you get lots of shower facilities but secure lockers are pathology with pretty good support and available for most areas except paeds teachings from the SMOs. You usually and O&G. get a chance to sleep for an hou r or so because there are two house officers on The cafeteria is reasonably clean and nights – but only if the O&G team are accessible with good meal options. They not watching DVDs! finally got a sound shell around the phone in the cafe but it still difficult to Palmy’s a better place than most people hear calls. The food is of average quality think. We have a very good social but just before the Spotless contract network and everyone keeps in touch comes up for renewal we get really nice regarding social activities through a food. Parking is available but you need Facebook page. There’s usually some to pay. Palmy’s geography is flat so it’s social function for RMOs most weeks. easy to bike. Being a good-sized hospital you are Palmy’s a student town. Massey has very exposed to a great range of medical good cafes and restaurants but you need and surgical problems with several personal tr ansport. We’re close enough subspecialties, for example ENT, to better cities to visit for the weekend. , , haematology, renal, cardio and neuro. But it’s small Daily workload is reasonable. We don’t enough so that it’s easy to get to know get a lot of MECA breaches, apart everyone.

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566968 Review of Hospitals.indd 19 14/05/15 11:26 AM Hutt Valley DHB - Hutt Hospital Hutt’s RMO unit staff, whilst generally We’ve been well supported to attend the friendly, at times lack common sense Wellington RACP teaching program. and a reliable system. Reciprocal While senior industrial support hasn’t backscratching seems to be the way really been tested we’re pleased to say to go. Hutt is not a major player in the that the SMOs work to maintain happy MECA breach world but rostering employees and a good work life balance. requires frequent vigilance, oversight and negotiation. The RMO lounge is comfortable and generally all yours – that’s probably The daily workload here is quite because the others haven’t found it! The reasonable. You get excellent support sleeping quarters are also hard to find from SMOs and other teams, for – they’re even further away but worth example, the “ED busy” page if more hunting for. Each sleep room (there are than four patients are waiting. Rosters eight!) has a bedside light and phone are improving with split nights with shower and toilet facilities. The introduced into some. RMO lounge has Sky TV, one study desk, two computers and one printer – The on-call surgical shift has a variable, we’re not sure if it works. There are no but normally manageable, workload. secure lockers but you can get yourself Work volume and experience is mostly one in the ED/MAPU change room if more manageable and enjoyable than you take your own lock. Wellington. There is a high level of plastics teaching. Cafeteria food at Hutt is variably edible! They generally do a good sushi and The amount of work on the medical on- sandwich selection but hot food leaves call shift varies from outrageously low to a lot to be desired. Good home-made outrageously high, as is typical in smaller baking though, including lolly cake! The hospitals. Daytime in-service support is cafe is clean and the staff helpful. Some great but evenings and nights leave one nutritional focus, however, would do more exposed – the work continues wonders. while everyone else goes home. If you can get a parking card, parking is You get excellent experience. The medical great but otherwise it’s a wander down SMOs are supportive and interested Pil muir Street late at night. It’s not too and give plenty of scheduled teaching, bad as the only entrance in use is at ED/ M+M, audit and clinical rounds, all MAPU, well-lit and well secured. well supported. We also get weekly Adv. Medical meetings, journal club and Hutt’s ED continues to struggle as a teaching, monthly stroke and general poorly resourced department with medical MTM and monthly audit. limited oversight. It’s a work in progress,

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566968 Review of Hospitals.indd 20 14/05/15 11:26 AM with some improvement in staffing levels In general Hutt is an excellent place (both nurse and doctor) in 2014- 15, but to work, with a commitment to make ED’s resource limitation transfers work the work environment a friendly, to the inpatient specialties. The medical non-threatening one, open to change – ICU tension is improving with more and focused on providing a needy ICU- trained anaesthetists now happier community demographic with higher to manage ICU patients (and therefore quality care and appropriately engaging less resistant to admissions). We do, its tertiary neighbour, Wellington. however, still look forward to an ICU that is fully staffed 24 hours by a doctor As for city living, suffice to say most of - at present, for reasons untenable, us live in Wellington, although the new after hours anaesthetics continues to ‘Brew’d’ across the road is ripe for end of simultaneously cover ICU and theatre. run (or week, or day) drinks.

Capital & Coast DHB - Wellington Hospital ED have their own RMO admin in The RMO lounge is near the staff café Wellington and it’s good. As far as but further from the wards. Kitchen MECA breaches go, it’s no Auckland, facilities are newish and clean enough. but you do need to know your rights and There’s enough space and enough phone your delegates. lines - we just need to remind them to provide utensils. There’s a table in the The daily workload is variable and busy same room as the lounge for studying, – busier than Hutt! Both the on-call with only one computer and printer. surgical and on-call medical shifts are There are plenty of much needed beds - really busy, with a wide range of work working here you’ll often get ‘buggered’ quality and experience on the wards. - maybe the beds need allocating. cont...

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566968 Review of Hospitals.indd 21 14/05/15 11:26 AM The cafeteria is nice and clean and up or add ten or more minutes on to open to the outside, with a range of your day trying to find a park on the options, especially if you can get there street. at a reasonable time – did I mention ice cream?! The only let down is the 6 p.m. On the whole, Wellington’s the best closing time on weekends. city to live in, the people are good, but the hospital culture does have room to Car parking is expensive! It’s either pay improve.

Nelson-Marlborough DHB - Nelson Hospital Nelson’s RMO unit accommodates leave Our RMO lou nge is a long way from key requests generously - to the detriment of clinical work areas and surrounded by finding adequate cover. Rosters include creepy dark hallways. There’s one single, frequent offers of additional duties or uncomfortable bed, but you won’t get swaps to make it function. We encounter any sleep anyway because of the noise a moderate frequency of MECA from the boilers. Dinner options in the breaches which can usually be resolved cafeteria are very easily exhausted. with patience and persistence; emails to the RMO unit are often ignored and/or Two new after-hours roles have been delayed. created - admission house officer and

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566968 Review of Hospitals.indd 22 14/05/15 11:26 AM medical registrar - but we need two more designated after hours parks to accommodate them. The medical SMO is less stressed since instituting the med reg role. We have a very proactive intern supervisor, and industrial support is good.

Nelson has little night life but heaps of outdoor activities. Beautiful scenery!

Canterbury DHB - Canterbury’s RMO unit are keen to specialty. Medical SMOs give great engage and their lack of cunning industrial support. They’re keen to be means MECA breaches, while high in involved and happy to work with the frequency, are easy to spot and usually MECA.Medical training is good here. easy to fix. We get plenty of teaching and good support. Surgical and orthopaedics The RMO lounge, hidden in the seem to be popular but then so was doldrums, is not particularly clean but 50 Shades of Grey. ED is helpful and it does have lockers and a TV. Natural well-staffed so referrals are reasonable. light is for losers. The fridge works. The hot water works. There is one The city is a work in progress and the phone but no study area. There are hospital rebuild means it’s a building site three computers but no beds, shower at both work and play. When you’re in it, or toilet facilities. Secure lockers are day to day, you don’t notice much (apart available – but you have to be quick. from the drilling). Outside work, night Hospital car parking facilities are a life is there but takes time to find. The moveable feast. Despite regular updates new bar scene is worth hunting for. no one knows where it will be in a few months’ time.... Luckily the cafeteria is easy to find, close to where it’s needed, has enough space - and has okay food.

Daily workload depends on the job but is usually not too bad. The roster varies – most are one in seven. On-call medical workload is steady, the quality of work varied, with a good mix of general and

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566968 Review of Hospitals.indd 23 14/05/15 11:26 AM South Canterbury DHB - Timaru Hospital Sadly, our previous RMO coordiator computers, a printer, and is warmer and has left. Without her things are not more comfortable. as good as they once were. Our new person is trying her best but currently There is a bedroom next door to the has little understanding of our day-to- lounge, complete with yellow 1970s day jobs and the pressures, stressors bedspread and styling. Again it and responsibilities we face. Things are doesn’t get used as it’s pretty old and a lot less flexible and getting leave or uncomfortable and miles away from the study/study leave approved has become where you are much more difficult. The departure of based. There’s a toilet and bath with a our previous RMO coord inator also shower over it next door – pretty clean appears to have resulted in a change in but old and run down. There are no policy of locum use and has resulted in secure lockers. We tend to store our some detrimental effects to our rosters. bags in the RMO offices on the wards. We’ve been actively working with the Only one of these is a secure area with RMO office to iron these out and, while a keypad. still not ideal, we hope that things will continue to improve. The cafeteria staff are a lovely bunch. There are plenty of tabl es and an outdoor Our RMO lounge is pretty old and covered balcony if you need some fresh tired looking and often about the same air. Meals are generally ok, although they temperature as the Antarctic. To be can get a bit repetitive, but there are lots of honest no one really uses it as it’s not snacks on offer. We highly recommend very conveniently located in regards to the cinnamon scrolls on Tuesdays and the wards. It’s frequented more often by Fridays for morning tea! You have to the orderlies who have an office across plan ahead if you want meals while the corridor and sneak in to watch a bit you’re on nights or weekend long days. of telly, or occasionally for bike storage. There’s plenty of free parking across The kitchen facilities are separate to the from the hospital. After hours there lounge and are shared with the orderlies. is a secure carpark out the back of the They are pretty basic and again, as it’s hospital. not in close proximity to the wards, rarely used. Timaru is ideally situated if you love the outdoors. It’s just over an hour’s drive to There’s one phone line available in Tekapo, and Mount Cook National Park the RMO lounge and one desk with a is roughly another hour from there. computer where you can access lab/xray results etc but most house officers prefer There are plenty of places for running, to use the library to study; it has more biking and even some surfing. The local

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566968 Review of Hospitals.indd 24 14/05/15 11:26 AM swimming pool and gyms are pretty your sanity) at times. You can call the good as well. We are roughly halfway SMOs when you need to, although some between Christchurch and Dunedin so are less receptive to being called than if you’re craving some bigger city action, others (but never be afraid to call if you it’s not all that far. Night life in Timaru need to - for your patients’ sakes!) is at your own risk.... but seriously there are some really nice restaurants and That said, our SMOs are a pretty good pubs around. bunch. There are plenty of opportunities for one on one teaching and supervision We haven’t had too many major issues of procedures that you might not get to in the way of MECA breaches recently, do in larger centres. There is no sitting but we have come close. Once pointed on the wards doing paperwork while the out to the RMO co-ordinator these are registrar goes to theatre as we have no generally sorted. registrars! That means that on theatre days you are the first to assist for the Your daily work load at Timaru is highly bulk of the procedures and it’s a brilliant dependent on the run. Usually the hours learning opportunity. are fairly reasonable, but it does depend on what run you’re on and the time of When the possibility of strike arose year. The medical ward during winter earlier on in 2015, our surgical SMOs is fairly full on. Our nights roster is still were very supportive of our right to do seven nights and as a small DHB there is so and encouraged us to stand up for reluctance to change this as working less ourselves! consecutive nights would mean more frequent night shifts. We do work 12 Medical on-calls are usually a lot busier day stretches and those on the surgical than surgical. There are normally weekends work two consecutive long a lot of admissions to do and you days which can be killers if busy. Recently also cover medical ICU patients, there has been a lot more crosscover required due to rostering issues.

For surgical on-call the workload is highly variable. You cover the surgical/orthopaedic ward, maternity, paediatrics and any surgical patients in the ICU. Sometimes it can be pretty hectic if you end up in theatre for most of the night and still have admissions to do via ED. As the surgical on-call RMO you get great hands on experience that will almost certainly challenge your problem-solving skills (and possibly cont... 24

566968 Review of Hospitals.indd 25 14/05/15 11:26 AM AT&R, and the Kensington (Mental (covers all disciplines). As per the Health Unit). Any patients that are a surgical SMOs, the medical SMOs are cardiac triage bypass our Emergency generally very supportive of our rights. Department and are seen by the medical RMO in the CCU. This can be a bit Timaru is generally a great place to get daunting at first, especially if you end hands on learning experience. If you’re up with more than one at the same the type of person who learns by doing time. Never fear though, you are able and thrives on responsibility then we to fax ECGs through to the on-call highly recommend considering Timaru SMO (assuming they have remembered for you r PGY1 or PGY2 year. The nice to pick up the on-call ipad) and get thing about a hospital our size is that guidance from them as you need. you do get to know everyone really well, from the orderlies and nurses through to Medical on-call is good experience the admin staff and cleaners! and by the end of your time here you will be an expert in managing a bunch We would suggest to anyone coming to of common presentations including Timaru to ensure that they plan their COPD, CHF, AF and CVAs. Timaru leave well in advance and get requests for has one of ’s largest elderly study programmes or training courses populations, so if you’re interested in in as early as possible to allow for roster geriatrics then this is the place for you! planning. Our Clinical Directors are always happy to listen and discuss You get lots of one-on-one time with the issues. We also have a new educational medical SMOs and often handove r is a supervisor this year and the standard great place to discuss cases and learn. of our weekly house officer teaching There is also a weekly grand round sessions has greatly improved.

West Coast DHB, Grey Hospital, Greymouth West Coast RMO unit are very helpful sea and great meals. There’s a huge and friendly and very supportive. The volume of free car parking. The city RMO lounge is not very comfortable. night life consists of clear skies and It’s a small, smelly, windowless room fantastic sunsets. We’re close to heaps of with no natural light and no kitchen. choice places. There are enough phones and we have two working computers. There’s one bed We don’t really get MECA breaches and that is changed weekly and showers are our daily workload is pretty reasonable. nearby, but we don’t have any secure Rosters though, are heavy duty. Two in lockers. six weekends and frequent double long days. The on-call shift is manageable The cafeteria is great. It’s clean and very with varied experience. There’s no accessible with a beautiful view of the bedside teaching from the surgical

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566968 Review of Hospitals.indd 26 14/05/15 11:26 AM SMOs; it’s all experiential. The on-call medical shift is also manageable and varied. You get heaps of experience - like a registrar. Again, all teaching is experiential.

Greymouth is a great place to work overall with a fantastic group of junior staff. SMO knowledge is there; you just need to ask. :-)

Southern DHB - Dunedin Hospital Dunedin’s RMO unit is going through nowhere to study and minimal desk a turbulent time with frequent space. We don’t have a shower or toilet. resignati ons and inexperienced front Some cubby holes are the closest we office staff. Whilst they do take some have to lockers. consideration of your career path in allocating runs, this is not the case for Dunedin’s cafeteria is clean and everyone. MECA breaches are increasing accessible. Threats to open it up to in frequency. It’s difficult to get approval the public seem to have diminished. for study activities and leave. There’s no car parking at Dunedin Our RMO lounge is next to the lecture Hospital. There is a parking building theatres in the main hospital building, five minutes’ walk away - otherwise not far from lifts to wards. We have it’s game on for competing with other 4 comfortable couches but they don’t hospital staff, students and uni staff make up for the lack of beds. Windows for nearby parks. Many people cycle look out onto the street overlooking the and there is a good undercover swipe medical school - a common route for card bike shelter. We suggest investing students from flats to bars - these are in a bike or pay a significant amount not soundproof. While a sleep room has for public parking every month. been discussed, it is in the ‘unapproved phase’ of hospital developments. The rosters include split nights for house surgeons. We have a single long We have a TV with Sky, paid for by our day over weekends for house surgeons social fund, and a small fridge, usually (i.e. no more than 6 days in a row). As full of meals for night staff. Our two always some runs are busier than others compute rs now work and the printer - particularly internal medicine and usually has paper. There are 2 phones, general surgery. We have 24/7 registrar sufficient for answering pages, but cover for surgery and medicine – cont... 26

566968 Review of Hospitals.indd 27 14/05/15 11:26 AM orthopaedics and surgical sub -specialties busy for house officers and registrars. are on call. Attempts to decrease Medical registrars spend the majority of overnight workload for registrars by their time in ED. introducing a second evening registrar on the on-call surgical shift has only Come to Dunedin if you want access led to more hours worked. Surgical to great outdoor activities, to extend SMO support is good but it’s hard to get the student lifestyle or to be close to teaching. The on-call medical shift is ‘Central’ - Queenstown and Wanaka.

Southern DHB - Kew Hospital, Invercargill Southern DHB are refusing to pay O&G natural light and no beds, secure lockers senior house officers for telephone calls or changing, shower or toilet facilities, when on-call, even though they are but we’re ok with phones, study area and doing the same job as registrars. The IT facilities. 24-hour on-call for O&G still sucks. It makes any formal teaching programme The coffee at Kew is pretty good and impossible to run. It can be stressful the friands are amazing! Staff are very when it’s busy out of hours as there’s friendly. The cafeteria is light and airy only you and the consultant on. On the with an outside area on nice days – yes whole though, the O&G department is we do get nice days in Invercargill. The a fun and well-supported place to work. hot food is generally better than cold (as The daily workload is either quiet or long as you’re not trying to lose weight). busy; rarely in between. There’s oodles of carparking and it’s free.

Our RMO unit staff are generally You don’t come to Invercargill for the helpful and friendly. For unclear reasons night life to be honest! The hospital is all paperwork now has to be sent to about 3.5km from the town centre. It’s Dunedin for authorisation – that cheap to rent and very cheap to buy. includes authorisation of leave, payments Nothing is more than a 15 minute drive. etc – and has slowed everything down. Queenstown, the Catlins, the Otago The RMO lounge is a long way from Valley, Fiordland and Dunedin are all the delivery suite and wards . There’s no within three hours’ drive.

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566968 Review of Hospitals.indd 28 14/05/15 11:26 AM