Update from a CMS Member

KIA ORA (HELLO) FROM NEW ZEALAND

By Michelle Miller, M.D.

Greetings from the Down Under! Wait…that’s Australia. Kia Ora! For those of you that don’t know, I packed my family and moved to New Zealand at the end of June. The most common question I’ve gotten is “But why?” I don’t have any family or connections to New Zealand, but like most of my medical colleagues, I had hit my wall with COVID-19 and was burnt out to the point that I was considering early retirement. By happenstance, a recruiter contacted me in December (with one of those many emails that commonly come through since I am primary care and have a LinkedIn profile). They asked if I had any interest in New Zealand and boy, did I! Between the burnout, the beauty of the country and its stance on the pandemic, having a toddler that can’t be vaccinated, and myself having Multiple Sclerosis and changing up medication to immunosuppressives from immunomodulators, I forwarded the email to my husband. He was open to discussing moving, even though we both have only lived in Florida. It took about 3 months working with the recruiter to obtain an interview with a practice that wasn’t too rural (I have no interest being the only doctor in the middle of nowhere). Then only 2 more months to get an emergency use visa approved. The flights (Orlando to Houston to LAX to Auckland) took about 24 hours total, and with a toddler were quite exhausting. Luckily, we spent two weeks in managed isolation (lots of screen time and a trolley stop outside the window to watch) with multiple nasopharyngeal swabs to confirm that we didn’t have COVID-19 before getting to move to Masterton on the North Island.

Working here has many differences but also just as many similarities. There aren't ICD-10 codes to deal with, but there is an electronic medical record with electronic prescriptions and laws about controlled substances. Coding is based on the type of visit (consultation being the most common or triage) and prices are transparent, so patients know if they must pay and how much. There is “public coverage” for accidents/injuries for both locals and visitors under ACC (Accident Compensation Corporation), as well as public coverage for citizens. There is private insurance available (certain specialists don’t take the public, or it takes longer to get the public coverage so patients will opt to go private). Some other differences: physicians meet patients in the waiting room and bring them into their assigned office - the desk and table/equipment is in the same room so no nurse/assistant bringing back patients for intake. Everyone is called by their first name so no more Dr. Miller, I’m just Michelle. There are a few differences with medications but there is a great website for the New Zealand formulary with what’s covered. Different antibiotic usages but also a great website called best practice that has the drug of choice with alternatives based on age or if allergies. The scheduling is great because there is dedicated time to do paperwork/prescription refills that are first reviewed by nursing to make sure the patient isn’t due for an appointment or labs prior to coming to the physician. “Teatime” in the morning and afternoon are dedicated break times for snacks or actual tea.

Currently, New Zealand is under Lockdown Level 4 - uncontrolled community spread with 800+ cases of the delta variant, and I still feel much safer here than back in Tallahassee. At my office, any respiratory cases are seen in a special trailer where physicians wear PPE and do covid swabs. There is also a drive through for covid swabs for those patients not needing evaluations. All appointments must first be phone triaged to see if they need to be seen in person or if they can have a phone or video consult instead. Most citizens are very keen on getting their COVID-19 jab. I’ve only had 2 patients that have dismissed the vaccine, compared to the numerous objections I heard back home prior to leaving. I had my first patient request for a mask exemption, but they were very understanding that there are strict criteria to waive this requirement and didn’t argue with me - what a change from my last few weeks back home! I have been keeping up with the local cases in Tallahassee and am very glad that I am not there but heartbroken for my colleagues and friends facing this never-ending siege. My contract is currently set to expire next July, and I sincerely hope that COVID-19 will be controlled with herd immunity - either from all the cases causing natural immunity or from vaccines, prior to any new variants that could be worse. However, I am willing to extend my contract if there is no improvement in the States, and New Zealand continues to keep this virus at bay. In the meantime, if any of my colleagues have an interest in moving to the land of the long white cloud, please look me up on LinkedIn or send me an email at md84miller@gmail.com.