The Sunday Session with Francesca RudkinDr Ivor Popovich: Auckland-based ICU doctor on new book examining the pitfalls of the healthy system
A tell-all expose from within our health system was released this week - and it's attracting plenty of interest.
Written by Auckland-based ICU doctor, Dr Ivor Popovich, the book shares his journey from med school through the public health system.
He talks of bullying, funding and staffing shortfalls through to the inequities between private and public healthcare
Popovich says he wasn't sure how his colleagues or employers would react to the book - but he was committed to getting his experience out there.
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Tell All Expose from within our Health System is hitting bookshops this week. Written by Auckland based ICU doctor doctor Evil Popovich, the book shares his journey from med school through the public health system. He talks of bullying, funding and staffing shortfalls, through the inadequate through to the inequities between private and public health. It's incredibly honest and brave and I'm sure it's about to ruffle a few feathers within health New Zealand. Doctor Evil Popovitch joins me. Now, good morning morning. Tell me why did you become a doctor and where are you at in your training?
So I am I graduated med school about ten years ago and I am training in intensive care and I'm right at the end of my training. So in about two months time, I'll qualify as a specialist and be fully done with training. And I became a doctor. It was kind of a weird. I kind of kind of just drifted into it.
Really.
I was at the end of high school. I didn't really know what I wanted to do. I was good at science, I was kind of okay talking to people, and my parents said maybe medicine might be a good career, so kin I said, okay, I'll give it a go. I went into it and I kind of didn't really have any idea what I was in for.
Why did you write this book?
It really started off as just more of a personal adventure, just to do some writing. I've always been a kin writer, and I wanted to have something to pass my time into a bit of kind of journaling almost, And I got to the point where I'd written about twenty thousand words about different stories along the way of my career. I thought it's a bit of a shame to just to kind of let the sit and have nobody read it. And around the same time that I'd started writing this, there was a lot of stuff going on in the media about things going wrong with the healthcare system, people waiting long times to see doctors, people dying in waiting rooms in the ed. And I'd reflected on the teen years that I've been in medicine, how much things have changed just since the start in terms of the underresourcing and overcrowding. And I looked ten years ahead and I thought, one ten years, things are just going to be one hundred times worse. So I wanted to really actually try and have the public have some kind of idea because we talk a lot in the media about things underresource underfunded, but I think it's hard for people to get a really clear idea what that really means and what that looks like on the ground. So I wanted to give that idea to people and say, hey, this is a problem that we need to address if we want to have any kind of system in ten years that's going to be tenable.
This is a pretty brave, ballsy thing to write this very honest book.
Yeah, it is a little bit. I kind of got to the point where as I said, I wrote the twenty thousand words, I submitted it to my publishers, and I had to finish it off in a short amount of time, and balls rolling in the along the way. I thought, I don't know what the reaction will be like from colleagues and from my employees, but I kind of was committed, and I thought, well, I just don't think I just have to say what I have to say.
Oh, look at what I found really interesting is that I've heard, you know, a lot of the issues that you talk about. I've heard a lot of other doctors and people in the people within your field talk about these things. To me, I just feel like you've brought everything together and explained it really well to us, that we've sort of fair something. Do you think of how you've sort of described the state of the health system at the moment.
It's good to hear that, because it's good to know that other people are saying the same things and I'm not just some random extreme person.
Yeah. Yeah, So what is wrong with the culture and health these days?
Well, I think in the book I split it into kind of three main issues. I think the first one, which occupies a lot of the book, is just the amount of investment that needs to happen into the system to have enough to do what we need to do for patients. I think there's an element just the debate about are we funding the system enough and or is it just a case of we're inefficient with what we have. I trying to make the point now we need a lot more funding. We're not keeping up with population growth, not keeping up with the aging population in the demands. And then I think there's when we talk about where to invest that money. There's a lot of proposed, a lot of things that are suggested, for example, let's build another medical school, let's train more let's train more doctors. There's kind of some issues with that, and there's you know, some of some of the simple solutions are not necessarily the solutions that might that might work.
Yes, I think you called the idea of the Waikato Medical School like a fart in the wind. I think have I got that right? And let's talk about a few of the things that you do bring up the shortage of doctors? How do we sort the shortage of doctors? Where are we short at the moment?
So where we're shortened is we know we're short of specialists of every type of specialty. But I think about twenty percent was the figure that I had. What we're not short of is the number of doctors graduating medical school. When I graduated, we had more doctors graduating than there were jobs for them. And that's been the case, I think, long before and ever since. And what happens is we have there's a limitation, there's like a bottleneck in the amount of because once you graduate medical school, you go down a training pathway to train in the specialty you want to do. To do that, you have to be given a training spot, training position, and so there's a bottleneck in the amount of training positions that allowing people to progress through the system and become specialists at the end. And so there's this real bottleneck happening, and then a lot of the doctors not able to acquire training positions will go overseas. And that's further made worse by the fact that things in Australia are much more attractive than they are here.
And we should make it clear who decides how many people get to train in specialties.
So it's a bit of a it's a bit of a muddy situation. It's not really clear to most people, and I don't know specifically. What I do know is it's determined both by the amount of government funded training positions yep. And also each specialty has like their college which works across Australia and New Zealand, and so the college decides at the end of the day how the amount of training positions there are. It's also influenced by government fundings of both of those are an issue, and I don't really know exactly who makes the fund how it all happens.
So potentially we could fund more people to move through into those specialties faster here in New Zealand and potentially stay here in New Zealand. That's right, Okay, all right there, let's talk about the need for better community services because I think there were a couple of things that really fascinated me in the book, and that is the number of people who are not sick who are in hospital because there is nowhere else for them to go. We really need to be providing more community beds for people who have recovered and are ready to move but can't return home and we can't find care for them.
Yeah. I think that's a really bigger show. Had Poda kind of a whole chapter to that. It's something that surprised me from the minute I stepped foot in the hospital as medical student. Is still to this down, I think the situation is getting worse all the time. So a lot of patients who were they come in to hospital because they've had a fall, They can't return home. They need to leave hospital and go to a nursing home or a private hospital or some kind of strict help perk care they need at home. But there's just such limited spaces and availability of that and not really a streamline process to get them there. They end up being stuck in hospital for weeks, sometimes even months. They get sick because there's other sick patients in hospital, they can be infections, they pick up infections.
Yeah, I mean you kind of make a joke about it in the book. I mean, what was a percentage of people sometimes you know, who are getting infections from being in hospital?
Yeah, I mean that was I think the line I used in the book. I was being slightly facetious, but I think I was based on this one. So I had this one round that I did, and I saw these passions and that I said, I only percent of my ward rounds on in hospital because they're sick, other than the ones who are sick because we've made them sick because they've picked up infections from other people.
Let's talk about the private public balance as well. How do we balance the public and private system to benefit New Zealand.
Yeah, that's a really hard question. I think there's a lot of answers that I think the main thing to realize when you talk about balancing them is they're they're not kind of different systems that exist in isolation. The same doctors are work in private are the same doctors who work in public, by and large, And the only reason that private provides a better service to people is because it's so exclusive, because it's expensive and you need insurance. And so I refer it in the book as a zero sum game. So any stuff that you put into one system takes away from the other. So I don't have any a great solution I can tell you right, no, this is the solution. But I think that's something we need to keep in mind when we talk about that public private.
I think a lot of people will be surprised though that, you know, you have a consultant, a specialist who's working in the public sector who you know, maybe on a day when they're supposed to be on call, is actually also working in their private practice, so they're not actually really available to the public service which is currently paying them to be available.
Yeah, exactly, there's I mean it's not everybody, but there is definitely a repeated case of people double dipping and they're supposed to be on call in public, as you say, but they're off in their private clinics, so they're kind of available by fund but not really because you ring up and they say, I'll just call me back after my clinicalist is done later this morning.
Do you regret not going into a specialty? Were you buy you could be working in private and public a little bit more evil?
Not really, I just to clarify for this, So ICE Intensive Care doesn't have any kind of real opportunities for private, I don't think so. I chose what I wanted to do best and what interested in me, and either way where if you work in public private, you will still make a comfortable liking.
You're okay, Hey, I'd just like to touch on the start of the book. Your first ship shift at a new hospital was the day of forkari White Island, which was just it's a really harrowing read. Did this experience stare you into ICU that you know, confirm that this is, you know, where you wanted to.
Be At that point, I'd already was it. Let's see, it was twenty nineteen, so I'd already been intensive training for three years at that point, so it was already kind of committed. I think it was an experience I reflect on a lot. I've reflected on a lot from that point, and I think you build really the people you work with in that sign of setting a build really close relationships with Does.
The job take a toll on you? And I don't just mean having to deal with days like that, but also the other thing you do talk a lot about the is the toxic environment. And this isn't across the board. It's not everybody who works in hospitals. But you know, there's definitely an issue worth bullying and humiliation as a form of training, isn't there?
Yeah? I think yeah. I mean one of the chapters I described in the books, kind of a medical student and I turned up in the operating room my first day of my surgery rotation with my friend who's of Asian descent, and this particular professor likes to refer it all Asian students as either Bill or Bob. And then he asks my tells my friend to go back to the take of my shop. I think that kind of stuff. I think the thing that takes a toll is seeing there's always going to be individuals like that in the system. What makes it frustrating is that they're hard to get rid of because the rest of us around them kind of just saying, well, that's just there more, it's just too hard to make an effort to try and kind of speak up about this. So that's the thing that takes a toll is seeing the people around going, I We'll just leave the slide, because you know, I've worked with this person for ten years and I'm just it's always been like that.
It's interesting because you note a lot of the behavior, and you have to deal with some pretty difficult people as well throughout your career and the stories that you tell in this book, But you also catch yourself, you know, when you maybe don't don't speak to a nurse well, or don't have the patience to deal with something, you know. So it's obviously you're obviously really quite conscious that. I mean, if we don't you know, you've got to make an effort to kind of break this cycle, don't we. Well, this is just the way doctors act.
Yeah, I think everybody has a three shold yeah, where it stretch just gets too much and they turn into a bit of a jerk. But I think would still be self conscious about those things, and in our colleagues as well.
You mentioned that you don't know how your colleagues are going to receive this book. Or you're a bit nervous about it.
I'm a little bit nervous. I think there's a I held off telling you my colleagues at the moments until about a few weeks ago, I said, I'm publishing a book. Here, here's the link. I think most people that I've talked to are kind of excited, and they've bought it and they're eager to read it, and I think mostly the action will be positive. But you know, there's some of the things that I talk about you never really know how they're going to be received or you know, even I've worked in medicine for ten years, but ten years in the grand scheme of things is there's not a long time. There's people who have been in there for twenty thirty, you know, a lot more than I do. And so there's a sense of it, you know, in my this person people looking thing, Well, who's this guy who's not been there that long talking about these things? Who are you to talk on? Behalf of us?
So you're going to be fully qualified in August. Where is your future? Is it in the public health system here in New Zealand?
Yes, so I'm in August. Once I qualify, I'm going overseas for a year to the UK, which is a pretty normal thing to do once you finished, to get a bit more experience.
That's not a fellowship, is it.
It's a fellowship.
That is a fellowship. Okay, cool, yep.
And then I'll come back after that and yeah, my future is in the public system here, an intensive care somewhere.
And I hope that if someone did take offense would have died down by the time you get back.
That's right. It might be the perfect time to plan my travels.
Even really appreciate it. The book is really revealing. I appreciate your honesty, and also for the rest of us who don't quite really understand what it's like to work day and day out, night and day in a hospital, really appreciate the book. Thank you so much.
Thanks a lot.
That was intensive care doctor Evor Popovic. His book A Dim Prognosis is in stores this tues
For more from the Sunday Session with Francesca Rudkin, listen live to News Talks it B from nine am Sunday, or follow the podcast on iHeartRadio.
