Bonny's View from down under

We are  currently staying at a Bed and Breakfast in Feilding, NZ (it was voted fourteen times the friendliest town in NZ and the population is 15,000) there are no traffic lights.  The couple, Reena and John Wallis, owners of the B&B are very nice and we are cooking together and sharing recipes.  They have a small garden and a few chickens and we have fresh eggs and vegetables. They have a compost bin in the kitchen and are very eco-friendly We use the clothes line to dry our clothes.

Today we met with a couple going to the UK and Africa for five weeks so they are going to let us stay at their home for 5 weeks, this will give us a chance to find a place to live. We really love their home and would love to live in something similar.    We bought a Toyota Highlander yesterday, got a great deal because it was the last day of the month and their fiscal year.So we can seat 7 and go off-road when visitors stay with us.  So start planning your NZ vacation.

Steve starts work on Tuesday, April 2nd.  Good Friday is a mandatory holiday and the government will fine you unless you have special permission to open your business so the majority of the businesses are closed today (which is your tomorrow - we are 17 hours ahead)  The hospital also celebrates Easter Monday.

Jeffery is studying in London so he was able to visit over his spring break and it was so nice to see him  He was so glad to see the sun and spend a relaxing time with us.

We miss you.

Love,

Bonny and Stephen

Burned out American Cardiologist

A national survey published in the Archives of Internal Medicine in 2012 reported that US physicians suffer more burnout than other American workers.[1] Some 45.8% of physicians were experiencing at least 1 symptom of burnout: loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In Medscape's current survey, when cardiologists were given the same criteria, 38% responded that they were burned out and 62% said that they were not.

Doctors are happier in New Zealand and my APC.

Today I met with Imojini Kotelawala of The Medical Council of New Zealand in Wellington to get my APC (Annual Practicing Certificate). My APC will allow me to practice Cardiology in New Zealand for the next year. I start as senior consultant in Cardiology at Palmerston North Hospital on April 2nd. Today I found out Kiwi GP's are pretty happy compared with the rest of the world. In a survey of primary care doctors 82% of Kiwi GP's are satisfied or very satisfied in their work, this is in contrast only 68% of GP's in the US. While 53% of Kiwi doctors feel the system works well only 15% of US doctors feel the system works well. A lot of the frustration stems from a lack of health-care access in the US. In 2012 59% of American doctors reported that their patients had difficulty paying for care. Also, there appears to be a problem with coordination of care in the US. 55% of New Zealand primary care doctors say they always receive information about patients visit to the ER opposed to 23% in the US. Only 16% of primary care doctors in the US are notified about changes to patients medication while 44% are notified in New Zealand.  Despite this the unit costs for health care are significantly higher  in the Unite States. Clearly the health care system in the United States is broken and in need of repair.

Washington Post November 15, 2012

Fly Fishing Poronui, New Zealand

Caught the Big One near Lake Taupo a 4 1/2 pound 23 inch rainbow trout. Great Fun!

Why you will live longer in New Zealand "she will be right"

In New Zealand people have a overwhelmingly positive outlook on life. They truly believe it when they say "no worries mate she'll be right". Kiwi's believe life will work out for you so enjoy it, don't worry be happy. There are so many positive things to enjoy in New Zealand it seems silly to worry about things that may never happen to you. For instance there is no traffic, no lines, no airport security for domestic flights,  no charge BYO wine at restaurants.  The air is clean and the water crystal clear.  The rivers and oceans are full of fish, clams, oysters and mussels, The people are relaxed, honest and genuinely friendly. It's hard to get stressed out in New Zealand. That is why I believe I will live longer as a Kiwi. I should mention I have not started work yet and am still on vacation.

Sailing Bay Of Islands

No-fault Medical Indemnity Insurance NZ

Today I paid $1,397.25 NZ dollars (1,117 US) for my yearly subscription to the Medical Protection Society. This is the equivalent of medical malpractice insurance in the US. This covers me as a Cardiologist practicing in New Zealand. My yearly coverage in the Florida was well over $60,000.00 US dollars. The Medical Protection Society is a no-fault compensation system that  "harmonizes injury compensation, provider accountability and patient safety".  In New Zealand, patients seek compensation not through malpractice suits but rather through the ACC a no-fault government-funded compensation.* The compensation is decided by a administrative panal and usually takes weeks to months to resolve. On the other hand the US system of medical compensation is decided by legal action which may take years to resolve and has very high administrative costs with each side hiring a team of medical experts. A medical malpractice settlement may involve 50% of the compensation going to the attorney for administrative costs. Our medical compensation system cost billions of dollars to date compensation for medical injuries has cost New Zealand $29 million dollars. Despite this the US has a much higher incidence of patients being harmed by medical error 9.7% vs 5.6% in New Zealand. The US system is expensive does not improve patient safety and serves the interests of MALPRACTICE LAWYERS  MORE THAN THE INTERESTS OF PATIENTS. Food for thought from down under!
*Reference: The Commonwealth Fund, Feb. 2006/Volume 30

Bay of Islands

Arrived Kauri Cliffs spectacular views of the Pacific Ocean from the cliffs along the golf course!

Saturday in Auckland

Limited clothing options for women

Dinner at the Depot

Lobby Hotel Debrett Auckland

Auckland

Arrived this morning and took Ferry to Davenport. Fine day clear and 78.

Bon Voyage!

The day to leave for our new life in New Zealand has arrived. We greeted the day with a sense of excitement and apprehension for the unknown adventure ahead. Started out with one bag each and now are up to 2 with trouble getting them to close. Will ship the rest along with golf clubs and I Mac. Bonny will return in May to get our 2 dogs. Meet our son  Jeffery in Auckland on Saturday then it's off the Bay Of Islands.  Kauri Cliffs for golf then Opau Wharf for bareboat sailing on a 40 Leopard Cat. Jeffery leaves the 17th then we blackwater raft with the glow worms and go fly fishing for rainbow and brown trout in the clear mountain streams of Taupo. Finally I meet with Ministry of Health on the 25th in Wellington. Drive up to Feidling to find a house and get a car. First day of work at Palmerston North Hospital as Senior Consultant in Cardiology is April 2nd. Will keep in touch. Cheers

Why New Zealand?

I have been asked why are you moving to New Zealand to practice medicine?  First and foremost I have become disillusioned by american physicians loss of control of their patients care and the over emphasis on productivity and profitability. They used to ask how can I help you deliver better care to your patients, they now ask how can we make you more productive? As a hospital employee I was told that all my patients would receive a 12 lead ECG at the time of visit if they had not received one in the past year. Clearly healthy asymptomatic young people with a normal ECG do not need them repeated yearly. When I asked why, I was told that insurance will pay for yearly ECG's and the administrators felt it was a good way to increase revenue. This is a example of a important philosophical shift in american medicine whose first priority is not what is in the best interest of the patient but rather what is in the best financial interest of the health system. One example of how New Zealand has got it right is their lower incidence of medical errors 5.6% to 9.7% in the US*. One important reason is their integrated electronic medical record system enabling rapid digital communication among doctors. For example, a patient's primary-care doctor is electronically notified if a specialist changes his or her treatment. This is not the case in the US were electronic medical record systems are fragmented. Im sure  I will find out a lot more about the New Zealand health system in the next year so keep logging in to "Kiwi Adventure" Cheers!
*Source: Health Expectations

Global Medical

Global Medical is locum tenens company in Salt Lake City, Utah who's motto is "Go Far - Do Good". In August of last year my wife Bonny was on their internet site and found this cardiology position in New Zealand. It sounded like a dream job no call no weekends and they would supply a car and a house. Wow! my wife exclaimed I love New Zealand and I don't mind driving on the left side of the road. I thought there is no way that this job is going to happen, but I encouraged my wife to get more details, and so our journey began. Original medical degree, original board certification, medical qualifications, recommendations, phone interview, travel to New Zealand and another round of interviews. Negotiate job offer, job offer letter, apply for practicing certificate medical council New Zealand. Get certification for performance of transesophageal echocardiograpy. Medical certification approval letter, medical examination for visa, blood work for visa,  chest x-ray, send passports to embassy in Washington, get visa approval, make appointment for medical council interview in Wellington.  Last but not least get all orifices swabbed and cultured for MRSA and pack ALL BLACKS rugby shirt (they are crazy for rugby in New Zealand). It is hard to believe that the day to leave has almost arrived. Thanks to Global Medical and everyone who helped complete this 6 month journey. Te Aroha!

"Up skill" in TOE

Prior to starting my job as a cardiologist in New Zealand I was required to "up skill"  to obtain competency in a technique that required me to place a ultrasound probe down a patient's mouth and into their esophagus. While a ultrasound of the heart can be performed by placing a probe on the chest for a close look of the heart, to rule out clot or infection of the valves, this transesophageal technique is essential. As I looked about for training opportunities I found the only programs available were for anesthesiologist. They use this technique to monitor the heart during surgery. I decided the best course was to do two preceptorships one at Duke University Medical Center and one at one at The University of Nebraska Medical Center. Duke because of its reputation and Nebraska because they offered a online review of the studies you do in practice. Having signed up for two courses I looked about for someplace where I could get hands on experience doing the studies. I soon realized that cardiology training programs are not interested in training anyone who is not their cardiology fellow in transesophageal echocardiography. Fortunately cardiologists Mike Koren and Ramon Castello agreed to preceptor me a Memorial Hospital. Thanks to these physicians and their cardiology colleagues at Memorial I was able to perform 40 of these TEE procedures (TOE in New Zealand they spell esophagus with a O). So Im off to New Zealand with a new skill, ready to make my mark on Kiwi Cardiology!

Lost Dream

My name is Stephen Stowers I am a cardiologist who has practiced in NE Florida for the past 29 years. I was very happy in private practice and was living the american dream of owning my own business. I was able to build close and lasting relationships with my patients. As I watched reimbursement for my services decline, my referring doctors practices bought out by competing hospital networks and my overhead escalate I decided to sell  my cardiology practice to the hospital. As a hospital employee my dream turned into a nightmare. Once they owned my practice the hospital administrators no longer cared what I thought. They closed my office and dispersed my employees. They even changed the name of the hospital and I became a outsider in my own institution. I lasted for 19 mo's and my last day of employment was Nov. 15th. It is sad that the american dream of owning your own practice is fading in the United States. So it's off to New Zealand. I have accepted a position as a senior consultant in cardiology at Palmerston North hospital in Palmerston North, New Zealand. My new adventure starts April 2, 2013. I plan to spend the next month doing a walk about on the north island with my wife Bonny, and for a week with my 20 year old son Jeffery, who is on a spring break from his studies in London.

New Adventure in NZ

On my way New Zealand Thursday next week!

Stephen Stowers