JVMP Reports
MIDWIFE:
OCCUPATIONAL SKILL SHORTAGE ASSESSMENT
Current Situation: Genuine Skill Shortage
Short-term Outlook: Genuine Skill Shortage
Executive Summary
Results from the 2005 Survey of Employers who have Recently Advertised suggest employers have had considerable difficulty in filling midwife positions in New Zealand. Only 21% of positions were filled within ten weeks of advertising and there was an average of only two suitable applicants per ten midwife vacancies. This report considers these survey results in the context of trends in the demand for and supply of midwives.
|
Fill Rate | Average Number of Suitable Applicants |
|---|---|---|
| Midwives | 21% | 0.2 |
| All Professionals Surveyed | 54% | 2.0 |
Demand for midwives grew rapidly through the early to mid 1990s, followed by more moderate growth since then. It is estimated that growth in demand for midwives has measured in the order of 4% per annum since the early 1990s. The substantial growth in demand has mostly been driven by key institutional changes, such as midwives gaining professional autonomy in 1990, along with other important changes to maternity care provisions. The significant impact these factors have had on demand sets midwives apart from most other health professionals, which tend to be driven by slowly changing demographic factors.
The Department of Labour expects that demand growth for midwives will be relatively weak in the short-term. In the medium to long-term there is likely to be an easing in demand for midwives due to a projected decline of around 10% in the number of births in New Zealand by 2015. Partly offsetting this longer term easing in demand from falling births will be increasing replacement demand from a growing retirement rate for midwives with the continued ageing of the workforce – which is already slightly older on average than the professional workforce as a whole.
The number of new midwifery graduates increased considerably in 2002, and has stayed at the higher level since then. A comparison of graduate output with the number employed in the midwifery workforce indicates a training rate of around 5% over the last six years. Net migration also makes a small positive contribution to supply each year. However, these gains are partly offset by retirements (1.3% per annum) and occupational detachment. Changes associated with the introduction of the Health Practitioners Competence Assurance Act 2003 may have resulted in some practising midwives withdrawing from the workforce.
Growth in the total supply pool of practising midwives does not appear to have matched the continued growth in demand for midwives, indicating that the shortage of midwives is due to a genuine skill shortage.
The Department foresees the genuine skill shortage persisting in the short-term. In the medium term, the shortage is likely to continue, but ease in severity.
Introduction
The purpose of this report is to investigate skill shortages for midwives in New Zealand.
The following section presents key findings from the Department of Labour’s (the Department’s) Survey of Employers who have Recently Advertised (SERA). This survey provides an indication of employer’s success in filling advertised vacancies for midwives as well as other information on their recruiting experiences. The next two sections investigate trends in the demand for, and supply of, midwives. The penultimate section presents some of the issues that arise from the matching of demand and supply in the labour market. Finally, the ‘Assessment’ section considers all the information presented in the report and provides a view on whether the occupation is in shortage, and if so, the type of shortage being experienced. A short-term outlook for the shortage situation is also offered.
Further background to this occupational report, including a discussion of the methodology; a glossary of terms; and an overview of the Department of Labour’s (the Department’s) Survey of Employers who have Recently Advertised (SERA), including the survey questionnaire, can be found in the Background and technical note.
Midwives in New Zealand
A midwife (code 22317 in the New Zealand Standard Classification of Occupations 1999 [NZSCO]) works in partnership with women, on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the newborn1 .
The Nurses Amendment Act 1990 restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions in New Zealand.
In order to practise in New Zealand, all midwives need to be registered with the Midwifery Council of New Zealand (MCNZ) and hold a current midwife practising certificate. This certificate must be renewed annually to ensure the holder remains competent to practise2 . According to the MCNZ there were 2,857 practising certificates issued in the year to 31 March 20063 . The 2005 Midwifery Workforce Survey4 indicated that almost the entire active midwife workforce is female (99.3%); and the majority (52.5%) are employed by District Health Boards, with a further 23.6% being self-employed5 . The 2001 Census showed that around a quarter of midwives worked part-time (i.e. less than 30 hours per week) at that time.
Note on Occupational Classification
Household Labour Force Survey and External Migration data from Statistics New Zealand are only available at the 3-digit occupational level, with midwives falling in the 3-digit category nursing and midwifery professionals. As midwives comprise only a very small proportion of this broader group (6% in the 2001 Census), trends in employment and migration cannot be assessed through these sources.
Survey of Employers who have Recently Advertised
This section presents the key SERA findings of employers’ experiences in recruiting midwives.
The SERA allows the Department to gain insights into skill shortages by investigating how difficult it is for employers to fill vacancies. A ‘fill rate’ is calculated for each occupation – this being the proportion of vacancies included in the SERA sample which were filled with an adequately qualified and experienced person within ten weeks of advertising. Occupations with fill rates lower than 80% are typically regarded as being in shortage, while fill rates lower than 40% usually indicate that the occupation is in acute shortage.
Results from the 2005 SERA show that only 21% of midwife vacancies included in the survey were filled within ten weeks of being advertised, a decrease from 33% in 2003. The 2005 fill rate for midwives was considerably lower than the fill rate for all surveyed professional occupations (54%). There was an average of only 0.2 suitable applicants for each midwife vacancy compared with an average of 2.0 for all professional occupations surveyed.
| Number of Employers | Number of Vacancies | Fill Rate | Average Number of Suitable Applicants per Vacancy | |
|---|---|---|---|---|
| Midwives | 11 | 29 | 21% | 0.2 |
| All Professionals Surveyed | 791 | 1141 | 54% | 2.0 |
1 The ‘All Professionals Surveyed’ fill rate and average number of suitable applicants per vacancy figures were both weighted to compensate for any under or over sampling of individual professional occupations in the 2005 survey.
Eight of the nine employers who completed interviews in the 2005 SERA indicated that they considered there to be a shortage of midwives. Employers were asked if they thought it was easier or harder to find midwives compared to the last time they tried, and four of the seven who responded to this question thought it was harder, with the other three saying it was about the same. The two most common responses from employers to a question on how they coped during times of shortage were to make more use of overtime (six of seven), or to look to recruit from overseas (six of seven).
Demand for Midwives
This section investigates trends in the demand for midwives and the factors underlying these trends. Demand is measured by the number of midwives required by employers at current wage rates.
Historical Demand
Employment for midwives grew moderately between 1996 and 2001 (1.6% per annum), following an extremely rapid increase (7.1%) in the previous five years (see Table 3). Over the ten year period, employment rose by an annual average of 4.3%. This growth was greater than that for registered nurses, all health professionals (excluding nurses and midwives), and all professional occupations over the same period.
Prior to 1990, only medical practitioners could take primary responsibility for the care of women through childbirth. However, the Nurses Amendment Act 1990 gave midwives professional autonomy to operate as fully independent providers of pregnancy and childbirth services without reference to or supervision by medical practitioners. In July 1996, a new Notice was issued under Section 51 of the Health and Disability Services Act 1993 concerning the provision and payment6 for maternity services. The Notice introduced the concept of a Lead Maternity Carer (LMC) who would have overall clinical and budgetary responsibility for a woman’s primary maternity care. All women are expected to choose and register with an authorised practitioner (i.e. a midwife, a general practitioner, or a obstetrician) as their LMC during their pregnancy.
| Annual Average Growth in Employment | |||
|---|---|---|---|
| 1991-1996 | 1996-2001 | 1991-2001 | |
| Midwives | 7.1% | 1.6% | 4.3% |
| Registered Nurses | -0.3% | 1.8% | 0.8% |
| All Health Professionals (excluding nurses and midwives) | 0.6% | 3.5% | 2.1% |
| All Professionals | 2.7% | 4.0% | 3.4% |
Demand for midwives to lead the maternity care for women grew considerably after the 1990 legislative change. This is reflected in the rapid growth in employment of midwives of 7.1% per annum between 1991 and 1996. The issuing of the 1996 Section 51 Notice also appeared to increase demand for midwives as a consequence of increased numbers of general practitioners withdrawing from offering maternity care7 . By 1999, 66% of women chose a midwife as the original LMC. The figure continued to grow in subsequent years, reaching 78% in 2003, before dropping to 75% in 20048 .
The number of registered live births in New Zealand decreased from nearly 60,000 in 1991 to 54,000 in 2002, before increasing in the next two years to be 58,000 in 2004. In 2005, there were just under 58,000 births. The ‘crude birth rate’ (i.e. registered live births per 1,000 estimated mean population) decreased from 17 in 1991 to 14 in 2001, and has remained relatively stable at this lower level since then9 .
As the birth rate in New Zealand has remained static since 2001, but the proportion of women choosing midwives as their LMCs has increased, this has probably meant that there has been moderate demand growth for midwives since 2001. The significant impact of the institutional changes described above on demand for midwives probably sets it apart from most other health professionals, which tend to be driven by slowly changing demographic factors.
Future Demand
Growth in demand for midwives is likely to be relatively weak in the short-term, before easing in the medium to long-term due to a projected significant decrease in the number of births in New Zealand. The annual number of births is expected to decrease from the current 58,000 to about 51,000 by 201510 .
Partly offsetting this longer term easing in demand from falling births will be increasing replacement demand from a growing retirement rate for midwives with the continued ageing of the midwife workforce – which is already slightly older on average than the professional workforce as a whole. (See section 5.3 for further discussion)
Supply of Midwives
This section investigates the various sources contributing to the supply of midwives. Supply is measured by the number of people willing and able to work as midwives at current wage rates.
Midwifery Graduates
Historically, most midwives in New Zealand were registered nurses who had completed additional midwifery-related education (e.g. in a hospital-based programme, as a midwifery option within an Advanced Diploma in Nursing, or by completion of a Diploma in Midwifery). The Nurses Amendment Act 1990 made it possible to offer pre-registration midwifery education to people with no previous nursing registration (referred to as ‘direct-entry’ midwifery). A three year Bachelor of Midwifery degree course was established in 1992 as the main route into midwifery. Students with prior health-related education can apply for recognition of their prior learning to gain credits or partial exemptions towards parts of the midwifery degree. However, registered nurses who have a Bachelor of Nursing degree have a standard credit which enables them to complete a shortened midwifery degree programme (usually in two rather than three years).
Only a minority of the current midwifery workforce are direct-entry midwives who have achieved the Bachelor of Midwifery degree11 . Prior to being registered as a midwife, these students must also pass the National Midwifery Examination set by the MCNZ.
The number of new midwifery graduates has generally increased over time (see Table 4).
Year |
Number2 |
|---|---|
| 2000 | 105 |
| 2001 | 96 |
| 2002 | 127 |
| 2003 | 122 |
| 2004 | 128* |
| 2005 | 138* |
Notes:
1 Not all graduates add to the supply pool of midwives. Some people may choose not to enter the workforce in New Zealand (e.g. because they go overseas) and some people may already be midwives and they were upgrading their academic qualification to a bachelors degree.
2 Figures marked with an * were estimated by the Department because of incomplete data.
The training rate for midwives has averaged 5.3% per annum since 2002, compared to 4.2% over the previous two years (see Table 5). The training rate is a measure of training output relative to employment in the occupation and is a rudimentary measure of the rate at which supply can potentially grow through training. The training rate for midwives in 2005 (5.2%) was lower than that for all professional occupations (6.6%).
Year |
Midwives | All Professionals12 |
|---|---|---|
| 2000 | 4.5% | 7.9% |
| 2001 | 3.9% | 8.1% |
| 2002 | 5.4% | 6.9% |
| 2003 | 5.2% | 7.0% |
| 2004 | 5.3% | 7.2% |
| 2005 | 5.2% | 6.6% |
Retirements
Based on 2001 Census data, it is estimated that 1.3% (approximately 35) of the midwife workforce retires each year. This is the same retirement rate as that for all professional occupations (1.3%). Census data shows an ageing of the midwifery workforce occurred between 1991 and 2001 (see Figure 1). In 2001, only 16% of all midwives were aged under 35 years compared with 28% in 1991. The percentage of midwives aged 40 years or more rose from 56% to 66% between 1991 and 2001. The estimated average age of midwives in 2001 is 44 years, which is slightly older than the estimated average age for all professionals (41 years). As the midwifery workforce ages, the number of midwives retiring each year will increase.
Figure 1: Age Profile of Midwives, 1991-2001
Registration
The Midwifery Council of New Zealand was established through the Health Practitioners Competence Assurance Act 2003 (HPCAA). The MCNZ took over the responsibility for the regulation of midwives from the Nursing Council of New Zealand on 18 September 2004. All midwives must be registered with the MCNZ. Once registered, those midwives wishing to practise must obtain a practising certificate on an annual basis from the MCNZ.
The number of annual practising certificates (APCs) issued for midwives has decreased significantly from 4,914 in 2002/03 to 2,857 in 2005/06 (see Table 6).
Year |
Total Number of Annual Practising Certificates Issued | Change in the Number of Practising Certificates Issued | New Registrations |
|---|---|---|---|
| 2000/01 | 4,886 | - | 176 |
| 2001/02 | n/a | n/a | n/a |
| 2002/03 | 4,914 | n/a | 229 |
| 2003/04 | 4,859 | -55 | 206 |
| 2004/05 | 3,490 | -1,369 | 188 |
| 2005/06 | 2,857 | -633 | 212 |
Prior to the HPCAA and the establishment of the MCNZ, it was typical for a large number of people who had joint nursing and midwife registration to take out both a midwife APC and a nursing APC each year even if they were not currently working as a midwife (noting that the cost of APC’s were low at $50 per annum, and there were no on-going competency requirements). However, the cost of an APC issued by the MCNZ is now $600 per annum, and midwives are now required to show their continued competence to work across the scope of practice for midwives13 . For people with joint registration who want to maintain both their midwife and nursing APCs, they need to demonstrate their continued competence under both the nursing and the midwife scopes of practice. These changes appear to be the main reason for the decrease of around 2,000 APC’s issued between 2003/04 and 2005/06. Other reasons for midwives choosing to cease midwifery practise are discussed later in section 5.5.
Given these changes since the introduction of the HPCAA, the current number of midwives holding APCs is likely to be much more indicative of the actual practising workforce in New Zealand14 .
New registrations of New Zealand-trained midwives increased slowly over the period 2000/01 to 2005/06, reflecting a higher number of new midwife graduates from 2002 (see Table 7).
The number of overseas-trained midwives newly registering was greater than the number of New Zealand-trained midwives registering each year between 2000/01 and 2002/03. This pattern has reversed since then, with the number of new registrations of overseas-trained midwives being lower than the number who were New Zealand-trained. A number of factors determine whether overseas-trained midwives are accepted for registration in New Zealand. These include the nature and extent of their educational qualifications and experience, and their English comprehension and communication skills15 . The vast majority of newly registered overseas-trained midwives in 2005/06 came from either the United Kingdom (76%) or Australia (10%).
Year |
New Zealand-Trained | Overseas-Trained1 | Total |
|---|---|---|---|
| 2000/01 | 85 | 91 | 176 |
| 2001/02 | 89 | n/a | n/a |
| 2002/03 | 110 | 119 | 229 |
| 2003/04 | 104 | 102 | 206 |
| 2004/05 | 110 | 78 | 188 |
| 2005/06 | 119 | 93 | 212 |
Notes:
1 Of the 93 overseas midwives registered in 2005/06, 71 were from the UK, 9 from Australia, 3 from the USA, and 3 from South Africa. The other 7 were from a variety of other countries.
While New Zealand gains a significant number of immigrant midwives each year, it is important to note that the country also loses some midwives via emigration. It is likely that overall, there is a small net gain of midwives – much like trends shown for other health professionals, and all professionals as a group.
Occupational Detachment16
The number of APC’s issued to midwives in 2005/06 was 910 (26%) lower than the previous year. The MCNZ conducted a survey of the midwives who did not renew their practising certificate, and half responded. It was found that, despite holding an APC, 5% had never practised in New Zealand; 23% had kept up their APC for 10 years or more after ceasing practise as a midwife; 21% were not working in the paid workforce; 11% were working in a midwifery-related field (for example, as an educator); and 48% were working as a nurse17 .
Much of this disconnection from the midwifery workforce between 2004/05 and 2005/06 was, therefore, the severing of ties by women who were not at that time practising midwifery.
However, a number of respondents to the survey also indicated that there were other reasons for ceasing practise as a midwife. The top reasons given were: stress, burnout or not wanting responsibility (12%); a career change or movement into management (8.6%); or they were unhappy with the work hours (7.8%). The supply pool is also depleted by some midwives leaving due to childcare or family responsibilities, or to go overseas.
Many midwives who have left the workforce (for example, to raise a family, or go on an OE) may return to work either part-time or full-time. It can be noted that returning to work part-time may raise issues for some midwives due to the costs incurred from renewing the annual practising certificate, as well as the need to meet the ongoing competency requirements. Also, midwives who have not practised midwifery or held an APC for three years or more may have applications for APCs declined by the MCNZ until they have successfully completed the MCNZ’s Return to Practice Programme.
The findings above indicate that occupational detachment does have some impact on the midwifery workforce. However, five of the seven employers interviewed in the SERA 2005 said they thought midwives left the occupation to go do something different less often than in other occupations, and the other two said it occurred about as often as in other occupations. They also said that some midwives do go overseas to work to places like the United Kingdom – where often the pay is better. Employers also mentioned that aspects of the job such as high workloads and long hours puts some people off becoming a midwife.
Matching of Supply and Demand
This section considers some of the issues that arise from the labour market matching of the supply of midwives with the demand for midwives.
Salaries
Data from the 2001 Census show that midwives had a mean salary of $41,292 per annum. This was almost 30% higher than the mean salary for registered nurses18 ($31,958), but 11% lower than that for all professionals ($46,585). While this data is somewhat out-of-date, it is expected that the gap between registered nurses and midwives salaries is still substantial.
Assessment
This section considers all the information presented in this report on employers’ recruiting experiences, supply and demand trends, and matching issues, and offers a view on whether there is a shortage of midwives and the type of shortage. A short-term outlook for the shortage situation is also offered.
Demand for midwives grew rapidly through the early to mid 1990s, followed by more moderate growth since then. It is estimated that growth in demand for midwives has measured in the order of 4% per annum since the early 1990s. The significant impact of the institutional changes from 1990 on demand for midwives probably sets it apart from most other health professionals, which tend to be driven more by slowly changing demographic factors. The birth rate has remained static since 2001, but moderate growth in demand has continued as a greater proportion of women have chosen midwives as their lead maternity carers.
The strong growth in demand since the early 1990s is unlikely to have been matched by growth in supply. Newly qualified midwives have added to the supply pool by about 5% per annum since 2000, and net migration has also made a small contribution to supply. However, these gains are offset to some extent by retirements (approximately 1.3% of the workforce per annum) and occupational detachment. Changes associated with the introduction of the Health Practitioners Competence Assurance Act 2003 may have resulted in some practising midwives withdrawing from the workforce.
Growth in the total supply pool of practising midwives does not appear to have matched the continued growth in demand for midwives, and this is reflected in the very low fill rate (21% in 2005), indicating that the shortage of midwives is due to a genuine skill shortage.
Demand for midwives is likely to ease in the future due to a projected significant decrease in the number of births in New Zealand. The annual number of births is expected to decrease by around 10% by 2015 (from the current 58,000 to about 51,000). However, partly offsetting this will be increasing replacement demand from a growing retirement rate for midwives with the continued ageing of the workforce – which is already slightly older on average than the professional workforce as a whole. Overall, the Department foresees the genuine skill shortage persisting in the short-term. In the medium term, the shortage is likely to continue, but ease in severity.
For queries regarding this report please contact philip.spier@dol.govt.nz or info@dol.govt.nz.
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Endnotes
1 Excerpt from the Midwifery Scope of Practice, Midwifery Council of New Zealand website.
2 Prior to relevant provisions of the Health Practitioners Competence Assurance Act 2003 coming into force in September 2004, practising certificates for midwives were generally reissued automatically. However, now midwives are required to show they are competent to practise each year before being issued with a new certificate.
3 It can be noted that not all midwives with current practising certificates will actually be practising midwifery. For example, some may be involved in management or teaching midwifery, or be undertaking research or further education.
4 New Zealand Health Information Service (2005). Midwifery Workforce: Summary results from the 2005 Health Workforce Annual Survey. Ministry of Health, Wellington.
5 These midwives claim fees under the Maternity Services Notice issued pursuant to Section 88 of the New Zealand Public Health andDisability Act 2000.
6 The method of payment altered from separate payments for each visit, service or hour of labour care for the entire maternity episode, to modular payments for the second and third trimesters, labour and birth, and postnatal care. The first trimester of pregnancy continued to be paid for on a ‘fee for service’ basis.7 Health Funding Authority (2000), Maternity Services: A Reference Document, notes that the number of general practitioner LMCs dropped by 32% between 1997 and 1999.
8 Source: New Zealand Health Information Service (NZHIS), Report on Maternity series. The figure for 2004 is provisional. This data relates to the lead maternity carers who have submitted a registration form to provide maternity services under the Maternity Notice. This does not include women who gave birth using hospital-based midwifery care, as these are not funded as primary maternity services. Some caution should be taken in interpreting these figures due to changes over time in the proportion of all maternity events captured in the Maternity and Newborn Information System held by NZHIS.
9 Source: Statistics New Zealand, Births data.
10 Source: Statistics New Zealand, National Population Projections, Projected Births. These figures assume medium levels of fertility, mortality and net migration of 10,000.
11 According to MCNZ registration data for 2004, 21.4% of midwives gained their qualification through direct-entry programmes.
12 The training rates for ‘all professionals’ were calculated by expressing the total number of bachelor degrees achieved in New Zealand, as a proportion of total employment in all professional occupations.
13 The principal purpose of the HPCAA is to protect the health and safety of the public by providing ways to ensure that health practitioners are competent and fit to practise their professions (s.3). Professional development to maintain competence is an important part of meeting competency requirements.
14 Not all midwives with current APCs may be practising as midwives due to factors such as: retirement, parental or child care responsibilities, or they may be working as nurses etc.
15 Section 16(b) of the HPCAA states that “No applicant for registration may be registered as a health practitioner of a health profession if he or she does not satisfy the responsible authority that his or her ability to communicate in and comprehend English is sufficient to protect the health and safety of the public”.
16 ‘Occupational detachment’ refers to individuals who choose not to continue practising in their occupation but retain a connection to the occupation (e.g. move into a management or supervisory role, or retain professional registration), or who leave the occupation entirely (e.g. by changing occupation or withdrawing from the labour market).
17 Although the survey asked for only the main reason they ceased practising midwifery, some respondents gave more than one reason. Hence the percentages given total more than 100%.
18 NZSCO codes 22311 to 22316.