New Zealand plastic and reconstructive surgery workforce: update and future projections

Objectives: Population growth in New Zealand (NZ) has occurred faster than previously forecast. As a result, previous workforce predictions are outdated and must be adjusted to ensure adequate access to plastic and reconstructive surgery (PRS) services. This paper presents an update of the PRS workforce and its projected needs, and the distribution of reconstructive surgeons (PRSn) in NZ. Methods: The number of practising PRSn and trainees, and the total medical workforce were reviewed, along with population statistics modelling with a focus on the ageing population. Comparisons were made to previous data and forecasts from 2013. Results: Previous population modelling predicted that NZ would reach five million by 2027. However, updated population data show that this figure was surpassed in 2020 and that the population will be approximately 5,374,655 in 2028. The PRS workforce has continued to grow in relation to overall population growth. The PRSn to population ratio (PRSPR) has improved since 2013 with a current ratio of approximately 1/69,000. However, a vast workforce maldistribution remains. Conclusion: The overall PRSPR in NZ appears satisfactory for the ageing population. However, the vast workforce maldistribution remains unchanged and this presents a barrier to equitable access to public PRS services, especially in provincial NZ.


Introduction
The New Zealand (NZ) population has grown more rapidly than forecast by Statistics New Zealand/ Tatauranga Aotearoa at the time of the last plastic and reconstructive surgery (PRS) workforce study in 2013. [1][2][3] Previous population forecasts predicted that the population would exceed five million by 2027. 3 Updated modelling from the 2013 census, which includes more accurate net migration data and data from the 2018 census, shows that this number was surpassed in 2020. 2,4 In 2013, an NZ PRS workforce analysis identified six service centres providing public PRS services but that the plastic and reconstructive surgeon (PRSn) to population ratio (PRSPR) in NZ was lower than in Australia, the USA and other comparable countries. 3 A recommendation was made to increase the PRSPR to the level of comparable countries and to address the maldistribution of PRSn by increasing the number of centres offering public PRS services nationwide. A total of 12 service centres with a minimum of three PRSn per centre was proposed, to ensure equitable access to public PRS services for all New Zealanders. 3 This follow-up analysis provides an update on the current PRS workforce in NZ.

Methods
The population data and projections from Statistics

Results
The number of practising PRSn in NZ increased from 57 in 2013 to 72 in 2019. Over the same period, the NZ population increased from 4,442,100 to 4,917,000. 5       In 2013, an additional five public PRS service centres were proposed nationwide in order to improve equity of access to public PRS services and to correct the vast maldistribution of PRSn among the NZ population. Furthermore, it was proposed that the Counties Manukau regional centre be subdivided into three service centres including Auckland and Waitematā, and the Hutt Valley regional centre be subdivided into four service centres including Hawke's Bay/Tairāwhiti,

Mid Central/Taranaki/Whanganui and Nelson
Marlborough, as illustrated in Figure 2. Table 3 presents these 12 public PRS service centres named      The delivery of tertiary PRS services at the DHBs affects the workforce requirements in each region.
For example, there are four regional PRS burns centres at the Waikato, Hutt Valley and Christchurch regional PRS service centres, while the Counties Manukau regional PRS service centre provides regional burns services and also hosts the National Burns Centre. There are approximately six PRSn practising in these four regional PRS service centres who primarily provide burns services to patients from their regional catchments. Similarly, cleft lip and palate services are also provided in these four regional PRS service centres by eight surgeons, and craniofacial surgery is provided in two locations by five surgeons. Supra-regional services such as vascular anomalies including laser surgery, gender affirmation surgery, head and neck resection and reconstruction, skull base surgery and sarcoma reconstruction are also provided by one or more of these regional PRS service centres. It is recognised that this simple population based model is imperfect as the catchment area for subspecialised tertiary hospital services will encompass multiple regions thereby slightly underestimating the workforce needs of large regional centres and overestimating the needs of the smaller centres.

Conclusion
The NZ population has increased faster than predicted. Despite this, the overall PRSPR appears satisfactory for the ageing population. However, the vast PRSn workforce maldistribution remains unchanged, presenting a barrier to equitable access to PRS services, especially in provincial areas. A strong mandate from the central government is required to resolve this longstanding problem of increasing inequity to public PRS services in NZ.