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Mike - Emergency Department Physician

I love my new life. I enjoy my practice of Emergency Medicine. I especially love the experiences my family and I are having in this AMAZING country of New Zealand. Thanks Accent Health Recruitment for making this DREAM possible.

Hi there, my Name is Mike I am an Emergency Medicine Physician. I came to NZ in August from Utah, USA with my wife and 6 children. The process to come to NZ took me 12 Months from start to finish.

The easiest part of the process was finding a Job - This was greatly due to the help from Prudence and others at Accent Health Recruitment. The most challenging part of the process was doing all the paperwork and medical clearances to obtain Visas for myself and my family.

My first impressions of NZ were: GREEN, CLEAN, FRIENDLY!!  The best parts of NZ are the people (tough, friendly, do-it-yourselfers, always willing to help out). The incredibly beautiful land (pristine beaches, snow-capped volcanoes and massive mountain ranges, rivers so clean you can drink from them while you hike, huge trout ready to be caught in lakes and rivers, endless hiking and biking trails, and amazing birds that sing you to sleep and wake you in the morning with their melodic songs.

What I miss the most is friends and family that can’t afford the cost of visiting us in this magical place.

My advice if you are planning to come to NZ is remember that money cannot buy happiness. I definitely took a significant pay cut coming here, but I would do it again if offered the choice. The lifestyle has been amazing. In the six months that I have been here, I have taken a 10-day vacation with my family visiting the amazing beaches of Northern New Zealand, Sand-surfing at the Te Kuiti Stream Sand dunes, visiting the majestic Kauri Tree Forests (Think Sequoia Size Trees) of the Northeast coast, and watching the sunset from the Cape Reinga Light House at the northern tip of New Zealand. I also took one week to spend with my 12-year old son fly-fishing in the lakes and rivers of the Lake Taupo Region, and Bungy Jumping over the Waikato River, and exploring the glow-worm filled caves of Waitomo. One night we relaxed in the volcanically heated river that flows into the Waikato River at Hot Springs Park in Taupo.

I then took another week to join my 14 and 16-year-old sons on a school-sponsored adventure week in the Tongariro National Park. We hiked the Tongariro Crossing, Rappelled from cliffs in a rainforest, explored caves with a river running through them, and white-water rafted on the mighty Tongariro River. Finally I just returned from 15 days with my family exploring the South Island of New Zealand. We cruised Milford Sound, camped at the base of Mt Cook, Swam in Glacier-filled lakes and streams, rode the mountain luge above Queenstown, played hide-and-seek among the rock formations of Castle Hill (see the final battle scene in The Lion, The Witch, and The Wardrobe), and watched seals frolicking in the waters on the Kaikoura Peninsula. We also kayaked on the turquoise waters of the Clutha River and played with Kea birds on Key Summit above Milford Sound.

If you add that up, I have had 39 days of vacation in my first 6 months here in New Zealand. This does not include any time taken for CME. Each year I am given 10 days and a certain amount to spend on CME. In the next six months I will be attending conferences on the Gold Coast of Australia, in Hong Kong, and in Fiji.

My experience practicing in the Emergency Department here in New Plymouth, New Zealand has been fascinating. Three things have been especially different from my practice in the USA. First is pain control. In six months, I have given out less than 10 prescriptions for pain medications stronger than codeine. As I mentioned above, Kiwis are TOUGH. I had one 65 year old woman who was working on passing a 8mm kidney stone and when offered a narcotic pain shot, she responded, “Oh no, I think a little paracetamol (tylenol) is all that I will need.” She was not an exception, but the rule. Ibuprofen is considered the BIG GUN pain killer around here. The nurses hesitate to give more than 2mg of Morphine or 20mcg of Fentanyl intravenously at a time, and the patients are fine with such doses. Rarely does any patient require more than 10 mg of Morphine during an ED stay. Hydromorphone is not available here in an intravenous formulation, and no one seems to mind. The second major difference has been resource utilization. In the two emergency departments where I work, we do not have radiology available between 11PM and 8AM. This means that to get X-rays or CT scans during these hours we have to call a radiographer in from home. Such calls are discouraged unless the information gained from the study being ordered will change the management of the patient immediately. Ultrasounds are even more difficult to obtain. They are simply not available on an emergent basis. This has led to me learning how to use the bedside Ultrasound much more proficiently. I often do my own DVT studies and abdominal scans and then treat the patient based on the results while they await their official ultrasound which may take 2-3 days to obtain. CT scans of the abdomen/pelvis are rarely ordered before obtaining a surgical consultation. Many more patients are admitted to the hospital for serial abdominal exams rather than obtaining a CT scan to further evaluate their abdominal pain. The third huge difference has been end of life care. New Zealand has a very developed hospice system and the population has been well-educated about medical futility. It is extremely rare to have a patient with a terminal illness come into the Emergency Department in hopes of receiving intensive medical interventions. They may come in occasionally for emergent pain control, but most are admitted directly to the hospice hospital where they receive excellent psycho-social and palliative care during their last days or weeks of life. There is an extensive network of traveling nurses who also provide such care in the patient homes.

One other aspect of my work which I love is the mixture of people with whom I work. Just the other day while at work, I heard English being spoken with a Kiwi, Australian, French, Ghanaian, Irish, British, South African, Canadian, Scottish, and American accent. How fun it is to work with people from all over the world each with a unique perspective but all committed to providing excellent care to our patients.

In addition to all the fun we have had traveling as a family here in New Zealand, we have also thrived in the local community. We love serving in our local church congregation which has a nice mix of families including Maori, Tongan, Samoan, African, Canadian, European Kiwi, and American. We are raising chickens (chooks) on our lifestyle plot and our boys sell the eggs for income. Several of our children are heavily involved in the local youth music scene playing in a youth orchestra and having opportunities to perform musically at community functions. Other children have enjoyed the youth sports programs playing basketball, running cross-country, learning to surf and even trying their hand at Cricket. My wife has been in high demand for her talents as a professional pianist. She has worked accompanying other local musicians and teaching students from the community. She has even been invited to perform a concerto this year with the regional adult orchestra.