Medical Services in New Zealand and The Pacific
III: Recruitment of Medical Officers
III: Recruitment of Medical Officers
Recruitment of members of the medical profession for military service, whether overseas or on home defence, was brought under strict control and conducted in an orderly manner from shortly after the outbreak of war in September 1939. The following recommendation made by the Director-General of Health on 14 September 1939 to the Minister of Health was approved by the Minister as the basis for the release of doctors for military service:
While it is imperative to ensure that the medical needs of the Army are adequately met, it is equally imperative that the needs of the public hospitals and the civil community should not be overlooked. In order to make sure these requirements are met it is considered that the best system would be to ensure that no medical men, other than those at present under military obligations, are accepted for service until their case has been reviewed by a competent authority. At the present time there is such an authority in the Medical Committee of the Organisation for National Security. This Committee consists of the Director-General of Health as Chairman, the Director of Medical Services (Army) and a representative of the British Medical Association. It is recommended, therefore, that the procedure outlined above be adopted and that no medical men should be withdrawn from hospital service or from private practice for military duties except with the consent of the above-mentioned Committee.
Thereafter no medical men were accepted for service until their names had been submitted to the Medical Committee for the necessary review as laid down in the Minister of Health's approval.
At its meeting on 26 September 1939 the National Medical Committee resolved that ministerial approval be sought to have all page 351 applications from medical men for permits to travel abroad, whether for enlistment in the British forces or otherwise, endorsed by the Director-General of Health before such permits were issued by the Internal Affairs Department, it being understood that the Director-General of Health would consult with the Medical Committee. This arrangement was approved by the Minister of Health and carried into effect.
At the same meeting it was resolved that it be a recommendation to the appropriate authority that in no circumstances should the course of medical students at the medical school be shortened, but that they should complete this course and serve in addition one year1 as a house surgeon in a New Zealand hospital before they were eligible for military service.
Doctors volunteered for service overseas and were selected for medical units or as regimental medical officers according to their qualifications. Where the release of these chosen men was desired by any of the three services, the Medical Committee referred the names to the local Medical Officer of Health and the Medical Superintendent of the local hospital for a report. In addition the emergency committee of the local division of the British Medical Association was approached to ascertain the responsibilities each man had in relation to hospital and community services. All facts were taken into consideration in deciding whether or not to release medical practitioners for service with the fighting forces. In the case of doctors in the employ of the Mental Hospitals Department, the question of release was the subject of recommendation by the Director-General of that Department who at all times was most helpful.
Under the National Service Emergency Regulations 1940, medical students enlisting were classified under the provisions of Part II of the schedule of important occupations as ‘Temporarily postponed’. With this provision the National Medical Committee agreed, but in addition decided to recommend to the Manpower Committee that any medical student who had completed two years of his medical course, including one year of the preliminary sciences and a year of anatomy and physiology, should not be called up for military service, but should be compelled to carry on and complete his course.
1 Later shortened to nine and then to six months.
Where doctors and dentists were drawn in ballots the War Cabinet decided that the usual appeal procedure was to be observed. Appeal Boards and Manpower Committees were instructed to refer all such cases to the Director of National Service for reference to the National Medical Committee. This enabled the committee to decide the desirability of allowing doctors or dentists to undertake military training or service in their specialist capacities, or to recommend that their calling up should be postponed, on the grounds of public interest. The National Service Emergency Regulations and emergency legislation in general did not provide for the total or automatic exemption or reservation of any particular class or occupation, but that individual exemptions had to be obtained through the usual appeal routine. The War Cabinet had decided that the regulations must be adhered to in all cases.
Under the arrangements the National Medical Committee was enabled to continue to exercise its previous functions of selection and reservation, and its recommendations were always substantially met.
In the middle of 1940, with the expansion of the Territorial forces for the defence of New Zealand, there was an increased demand for medical men to staff the Territorial field ambulances and to act as RMOs of Territorial units in camp. In some centres the depletion of medical personnel was beginning to be felt acutely, whereas in other areas little change had taken place. The British Medical Association began to make surveys of the position in each district, and also recommended all its members to volunteer for such service as they were considered suitable for. This would have overcome a number of difficulties as men could have been selected from the districts from which they could have best been spared. The response to the appeal, however, was limited. The demands of the Territorial forces were met to some extent by the use of house surgeons who offered their services at the conclusion of their hospital appointments, but these house surgeons were not always released by the hospital boards.
A shortage of medical men in the services developed during 1940 and 1941. A meeting of the National Medical Committee was called on 11 March 1941, at the request of the Prime Minister, to give urgent consideration to the question of the release of further medical men for service with the armed forces to meet the existing shortage, which was viewed by the War Council with some concern. The page 353 meeting thoroughly examined the position as is shown in the following record of its deliberations:
1.(a) Estimate of Army Department's Requirements
The Director-General of Medical Services advised in a memorandum dated 10/3/41 the Army Department's requirements which were summarised as under:
|For Air Force||3|
all of whom would be required before January 1942.
In the event of mobilisation of the Territorial Force, a total of 111 medical men would be required for full-time service.
(b) Medical Resources in New Zealand
The Chairman furnished members with a return showing the medical resources in New Zealand as at 31/1/41, which had been compiled following a recent revision of the Working Medical Register. An attempt had been made therein to set out the age constitution of members of the profession.
Quite apart from the unsatisfactory position as regards civilian medical services disclosed by the return, it was necessary to take into account the number of men who must be retained in the Dominion in connection with additional work arising out of the war but undertaken by purely civilian personnel such as:
The Hospital treatment of Camp sick, and sick and wounded returning from overseas.
Specialist examination and remedial treatment for recruits for the Armed Forces carried out at Hospitals.
Medical boarding of recruits for the Armed Forces and men boarded out of Camps and returning from overseas.
Treatment at Convalescent Hospitals to be maintained and staffed by the Department of Health.
Hospital staffing for Emergency Hospital purposes.
It was obvious therefore that some special measures must be taken, if the Army Department's requirements were to be met in full and at the same time the minimum numbers necessary to provide for civilian needs were to be retained.
After a full consideration of the position the Committee decided that the following steps should be taken.
(c) Further Review of Medical Resources
An Advisory Committee to be set up in each Health District to make a thorough examination of the medical resources in the district and advise:
The number and appropriate particulars of men who can safely be released from private practice or hospital appointment.
Any possible means as to how, in the opinion of the Committee, existing medical resources in the district could be used in a more economical manner in order to free as many men as possible for the Armed Forces.
In view of the various factors to be taken into consideration and to enable the situation to be reviewed in proper perspective it was resolved that each Advisory Committee should include representatives of the various interests involved, and that the personnel should be as follows:
The Medical Officer of Health (Convener).
A representative of the local Division of the N.Z. Branch of the British Medical Association.
The Regional Deputy.
The Medical Superintendent of the Public Hospital in the locality in which the position is being reviewed.
The Assistant Director of Medical Services, Army Department, in main centres when available.
It was resolved to write to the Executive of the New Zealand Branch of the British Medical Association and seek the co-operation of the Association in nominating suitable representatives in each district.
(d) Further Review by Army Department
It was considered that the Army Department might also review the question of their medical personnel and ascertain whether by re-allocation of medical officers some more economical use might not be made of existing staff. In particular it was suggested that two base hospitals of 600 beds already established overseas might be consolidated as one hospital of 1200 beds, thus effecting an appreciable economy in medical staffing.
2.Advancing of Final Medical Examination
It was considered that if the University Authorities would agree to advance the Final Medical examination by 6 months this year, this would enable Hospital Boards to recruit fresh residential staff from graduates before the end of the present year, thus freeing House Surgeons with some measure of Hospital experience for duty with the Armed Forces.
It was resolved to communicate with the University Authorities, strongly recommending that this course be adopted.
3.Utilisation of Services of Alien Medical Students
It was decided that should the University find it possible to advance the final examination as suggested, that some 13 alien medical students who would normally present themselves for Final Examination in December 1941 might be given the opportunity of sitting the earlier examination.
It was accordingly resolved to recommend the Medical Council to agree to the proposal on the condition that authority be given to the National Medical Committee or some other appropriate body to require these refugee students on qualification, to take up hospital appointments and remain in such positions as long as they might be required to do so by the Committee.1
1 Unfortunately this was never made effective.
By the meeting of 19 June 1941 the results of several surveys were available. Reports had been received from all advisory committees estimating the number of medical men who could safely be released in each district. The totals were only 64 for overseas service and 14 for home service, including in many cases house surgeons in public hospitals who would be replaced by sixth-year medical students under the arrangement approved by the Medical Council.
As a result of a questionnaire sent to all medical practitioners resident in New Zealand, some 911 replies had been received. These had been classified into Health Districts. It was decided that the Army Department should comb through the Advisory Committee's reports and the survey by Health Districts with a view to adding to the number eligible and physically fit for military service.
The effect of all these investigations was that the immediate needs of the Army for medical officers at the middle of 1941 were substantially met and the National Medical Committee expected to be able to provide most of those likely to be required up to the end of that year, but the position thereafter was not reassuring.
The position then was that some 225 medical men were on service with the armed forces, 161 overseas and 64 on full-time duty in New Zealand. Additional requirements up to the end of 1941 were placed at 55, of which number 34 would be provided under the house surgeon replacement plan, the remainder to be drawn from private practice and part-time hospital staffs.
The ranks of private medical practice had been denuded of young fit men under the system of voluntary enlistment of medical officers, and with the absorption of all fresh graduates into the Army there were no young men to replace in private practice or in the public page 356 hospitals those older men who by reason of age or infirmity might be compelled to retire. There was a relatively large number of men over 60 years of age still in practice.
In 1941, too, more attention had to be given to making provision for essential requirements for home defence. It was necessary to maintain and train on a part-time basis a staff of medical officers in connection with the existing scheme of Territorial training of reservists. Plans had also to be made for the provision of adequate medical staff for the various local Emergency Precautions Schemes which had been drawn up to come into operation in the event of attack or other national emergency. Medical officers would be required for casualty work and for duty with Home Guard and other EPS units which might be mobilised.
In connection with the Emergency Precautions Scheme the National Medical Committee decided on 7 October 1941 to arrange for committees to be set up in the main centres to explore the position in regard to medical officers and report to the Medical Committee. The local committees consisted of the Medical Officer of Health, the ADMS of the military district, the controller of the medical section of the EPS and the Regional Deputy.
With the mobilisation of three divisions in New Zealand in the early months of 1942 there was an increased demand for medical officers, which had necessarily to be filled. It was at this stage that the civilian authorities began to view with apprehension the position of medical services for the civilian population. It was felt by the Director-General of Health and others that in some communities the medical profession had been depleted to a dangerous degree and that the number of doctors left in practice was not adequate to attend to local medical needs.
The Minister of Health on 23 January 1942 suggested to the Prime Minister that War Cabinet consider whether any further doctors should be sent overseas with the fighting forces, and also whether the number of medical men on service in New Zealand could not be reduced. As the Director-General of Medical Services (Army and Air) was able to point out, little reduction was possible in the strength of medical officers overseas if the servicemen and servicewomen were to be given the medical care and treatment they deserved, and which their relatives in New Zealand expected. Reinforcements had to be sent to meet the casualty rate, which had been fairly high among medical officers. As it was, New Zealanders were not supplying medical officers for lines of communication but were relying on British and Australian services in this respect. As regards home defence forces it would be extremely dangerous, while invasion remained imminent, to reduce the number of medical officers mobilised.page 357
In December 1942 the Minister of Health again asserted that the number of medical men serving with the forces was unnecessarily high, and that this was creating a serious position in regard to civilian medical services. The DGMS defended the position with a detailed statement of the duties and demands involved in the maintenance of an army medical service in war, and also emphasised the fact that the strain on the civilian medical service was contributed to by the unzoned system under which the service was operating and by the demands of social security medical services. It was also pointed out that no medical practitioner was released for service with the armed forces until he had been the subject of searching inquiries by the National Medical Committee. In fact, it was a principle of that committee that where there was any doubt as to the needs of the civilian population a doctor's release was postponed pending further inquiries.
The year 1942 was, however, the period of peak demand for medical services. With the passing of the invasion threat to New Zealand and the reduction of home defence forces, certain of the army medical officers were released to assist in civilian practice. At its meeting of 7 September 1942 appreciation was expressed by the National Medical Committee of the action of the Army Department in this respect. From February to September 1943 there were forty-four more such releases made. This did not mean that the needs of the Army were entirely fulfilled. Much difficulty was experienced in the staffing of 3 NZ Division and measures for expansion had to be curtailed, whereas 2 NZ Division in the Middle East, having established additional medical units overseas, was almost continually understaffed through sickness, casualties, and time lag in replacements coming from New Zealand. With the beginning of furlough and replacement schemes in the second half of 1943 a measure of interchange between 2 NZ Division and New Zealand was possible. Here again the time lag was a complicating factor, as was the demand for experienced surgeons.
The shortage of medical officers continued to be a problem in 2 NZEF in the Middle East and Italy throughout 1944. Doctors in New Zealand were nominated for exchange with long-service medical officers overseas, but adequate provision was not made by means of reinforcements for normal wastage from sickness, or for men returning on compassionate leave or furlough. Medical officers serving overseas felt that they were entitled to furlough at the same time as combatant officers of comparative service, but had to be informed that the lack of reinforcements precluded them from this respite even after four and a half years' service in some cases.
The authorities in New Zealand, including the Department of Health, the National Medical Committee and the British Medical page 358 Association, were anxious that long-service young medical officers should be returned to New Zealand and be replaced by house surgeons from hospitals in New Zealand. It was felt that it was necessary, in order to maintain the standard of medical practice in New Zealand, that the returning young medical officers should have the opportunity of gaining further experience as house surgeons in public hospitals before commencing civil practice.
This rehabilitation measure was the subject of two conferences in the middle of 1944, one between the Minister of Defence, the Minister of Health and representatives of the Army and the Department of Health, and the other between the National Medical Committee, representatives of the British Medical Association, Rehabilitation Department and Otago Medical School. At both conferences it was indicated that with the reduction in strength of 2 NZEF in the Pacific, a pool of young medical officers would be available for such an exchange. The problem of exchange was made more difficult by the fact that civilian hospitals had been increased, both in size and number, to deal with returning sick and wounded servicemen and with the increasing social security demands from the civilian population. Another factor that increased the difficulty was that, owing to the war, for five years none of the younger medical men had been able to take higher qualifications and specialise. Hence the number of specialists in New Zealand had decreased and most of them were then middle-aged or over. There was thus a definite shortage of specialists for the requirements of the country, and this was the main factor hindering the replacement of this class of officer overseas. In order to effect an exchange, either the Army overseas or a civilian hospital had to be deprived of the specialist for a period of at least four or five months. Before specialists could safely be released overseas they had to be replaced from New Zealand.
The British Medical Association circularised all its members asking them whether they were prepared to replace their colleagues overseas. This method of exchange was, however, limited to those who were partners or who resided in the same town as the man to be replaced.
It was the disbandment of the New Zealand force in the Pacific which granted the greatest relief in this matter, as a large proportion of the medical officers were transferred to 2 NZEF in the Mediterranean theatre. Six of these officers were despatched by air in August 1944. By the end of 1944 the position as regards medical officers became relieved to a sufficient extent to enable some medical officers to proceed on furlough at approximately the same time as their respective reinforcement groups. Until the end of the Italian campaign there were insufficient surgeons available, and in the final page 359 battles of the campaign considerable strain was thrown on the senior experienced surgeons. With the cessation of hostilities there was a steady flow of medical officers back to New Zealand with their respective reinforcement groups, and this relieved the pressure on the civilian medical service in New Zealand.
Alien Doctors and Students
At its meeting on 18 October 1939 the National Medical Committee received a resolution from the British Medical Association that no enemy alien practitioners should be employed in the military forces of the Dominion. This resolution was conveyed to the Army Department. In actual fact, no alien doctors were employed in the military forces.
The National Medical Committee on 19 July 1940 considered a letter addressed to the Prime Minister by some eighteen refugee doctors and dentists undergoing courses at Otago University, wherein they unreservedly placed their services at the disposal of the Government to be utilised in whatever capacity it might be decided would be of most use in the country. They agreed to practise only in such places as should be determined by the Government, and stated that they would welcome the passing of regulations making these undertakings binding upon them.
At the same time a letter was received from the Medical Council recommending that, in view of the fact that many New Zealand doctors were leaving their practices to render war service, the Government should be asked to introduce legislation which would enable control to be exercised over the practising location of foreign doctors in New Zealand.
The National Medical Committee recommended to the Government that the offer of the refugee students at Otago University be accepted; that power be taken to send these students, at the completion of their courses, to such places as the Government appointed on the recommendation of the National Medical Committee; and that for the protection of the interests of New Zealand doctors absent from their practices on military service, similar powers be taken to enable the National Medical Committee to control the locations of practice of such other refugee alien doctors as were practising in New Zealand. Representations on similar lines were received on 17 August 1941, in view of the fact that about ten alien students were due to qualify at the end of that year. The Government, however, was not prepared to move in the matter.
On 14 April 1942 the National Medical Committee forwarded on to the Minister of Health a resolution from the Medical Advisory Committee, Auckland, that some authority be created and a scheme devised whereby the services of alien doctors could be controlled page 360 throughout the Dominion. In his reply of 27 April 1942 the Minister of Health stated that he could see no justification for selecting any group of those doctors who had qualified and placing them in particular localities. The alien doctors, he stated, had, with one exception, all agreed to work in districts that appeared to require most the services of medical men, and they had co-operated with the Minister of Health in his desire to improve the medical service in different localities. The Minister of Health did not see that any action could be taken to compel alien doctors to submit to the decision of some authority unless it applied to all medical men.
On this last point the National Medical Committee had in September 1940 and February 1941 urged that authority be vested in the committee to determine the practising locations of newly qualified or newly registered medical practitioners and to regulate the establishment of new practices, but without any results. Similarly, a recommendation made by the Controller of Manpower in September 1943, and endorsed by the National Medical Committee in October 1943, that this measure of control be applied, as it was in the case of dentists, met with no response from the Government.
Sixth-year Medical Students
Students in their final year were granted provisional medical registration and were employed as house surgeons in hospitals where there were two or more fully qualified doctors on the staff. In some cases up to half of the staff of house surgeons was composed of sixth-year students. The students also were given military commissions and temporarily posted as medical officers in camps in New Zealand. The Medical Council, as the authority in charge of medical registration, acted jointly with the National Medical Committee in the matter. The action proved highly successful in the relieving of qualified men for service in the forces and for civilian practice, and at the same time provided the sixth-year students with valuable clinical and military experience.
The numbers of medical men in the fighting forces at 14 January 1942 were as under:
|(1) Total who have entered Army, Navy, or Air Force since outbreak of war:|
|(a) Army and Air Force||298|
|(2) Posted to Overseas Units:|
|Killed in action||4|
|Prisoners of war||13|
|Returned to New Zealand||15|
|(3) On service in New Zealand:|
|On full-time duty in New Zealand at Headquarters, Camps, Fortresses, Air Stations, etc., together with reinforcement medical officers awaiting despatch overseas||75|
|(This total of 75 includes 8 of the 15 returned from overseas.)|
|Total present effectives||274|
|Returned to civil practice||4|
|Returned from overseas but awaiting decision re retention||3|
In addition to the 274 shown as present effectives, the Army estimates that further requirements were as under:
|(1) Estimated number required during 1942 for Middle East as reinforcements and replacements||48|
|(2) As reinforcements at Fiji||6|
|(3) In New Zealand on full mobilisation:|
|Total Establishment||Present Strength|
|Middle East (2 Division)||153||143|
|2 NZEF IP (3 Division)||81||74|
|Pacific Islands garrisons, United Kingdom and Hospital Ships||24||24|