I recently caught up with my friend Chris Kennel, a U.S.-trained otolaryngologist in New Zealand. We did ENT residency together and he went on to complete an otology fellowship prior to moving to New Zealand.
He knows the American surgeon experience from the inside (the hours, the call, the CYA defensive documentation, the pressure to produce) and now he knows, just as clearly, what it looks like to practice in a system built on very different assumptions about labor, time, and professional boundaries.
Work Hours for Unionized Doctors
In New Zealand, how much a surgeon works depends on a few concrete variables:
- whether they practice only in the public system or also do private work
- how many surgeons are in the call roster
- whether registrars are available to share call
- whether the practice is urban or regional
In larger cities, call can be as spread out as 1:10.
In more regional areas, where recruitment is more challenging, it’s often closer to 1:6.
When Chris was doing public work only, his schedule averaged:
- ~30 hours of clinical work per week
- ~10 hours of non-clinical work per week
That ratio is intentional.
Public specialists are represented by a union—the Association of Salaried Medical Specialists—and under the collective agreement with Health New Zealand, full-time work is explicitly structured as roughly 70% clinical and 30% non-clinical.
Non-clinical time includes administration, teaching, research, meetings, and continuing medical education. As Chris put it, if you’re efficient, some of that time can also function as actual breathing room.
Now that he’s added private practice, his schedule looks different:
- ~45 hours of clinical work
- ~5 hours of non-clinical work
That shift was a choice, one that he owns and made based on individual values.
On-Call: Expected, But Not Exploitative
Here’s one of the most striking contrasts.
In many U.S. systems, being on-call can feel like a second job layered onto the first: porous, undefined, and quietly limitless. In New Zealand, call is expected, but it is also bounded.
- Registrar call is capped, typically around 1:3
- Consultant call is usually 1:6
- Only urgent issues tend to come through overnight
- Non-urgent consults wait until morning
If call becomes excessive, the burden isn’t silently absorbed. The system is designed to respond.
As Chris explained it, safeguards around call are respected by public employers; if they’re violated, physicians have real recourse. At one point, his call schedule crept up to 1:3. Rather than “powering through,” the consultants refused to run clinics or operate on days they were on call, citing excessive workload and encroachment on their lives outside the hospital. Within a short period of time, the hospital hired locums and restored a 1:6 call schedule.
On average now, he takes call one weekday per week and one weekend every six weeks.
That’s real leverage.
New Zealand physicians value organization and unionization in a way U.S. doctors largely have not yet embraced—and the difference shows up not in rhetoric, but in outcomes.
Training via Two Tracks
Surgical training in New Zealand operates on two tracks:
- Non-training roles
- Formal training roles
The terminology is confusing, because registrars are trained in both.
Non-training roles are typically one-year hospital appointments and often serve as stepping stones toward getting onto a formal training program. Registrars in these roles may be early in their careers, testing out specialties or strengthening applications. Many spend 1–5 years in non-training positions before entering a formal training track.
The formal training track is typically five years long and culminates in independent specialist practice.
Because most doctors in New Zealand enter medical school directly from high school, the overall age at completion of training ends up being comparable to the U.S.
Registrars are unionized. Ordinary work hours are 40 per week and not more than 8 per day, to occur between 7 am and 5:30 pm. Total weekly hours are capped at roughly 60 hours per week, and call frequency is limited. If work exceeds the cap, the hospital must pay them. This consists of an hourly rate of $60-120 for daytime extra work or $90-180 for nighttime extra work. If registrars work over 72 hours in any given 7-day period, they receive an additional $550 payment, and if this persists and they work over 140 hours in a 2-week period, they receive an additional $1,000 payment. A long day for a registrar is considered over 10 hours, and there is a cap of 2 long days in seven. Registrars must have 24 hours off each week, or 48 hours off every 10 days, and they can’t work more than 4 nights in a row or 2 weekends in a row (if 2 consecutive weekends are worked, they must have the following 5-7 weekends free, depending on the location). Rostered shifts must have an 8-hour uninterrupted gap between them, and for each instance the time is less than 8 hours, the registrar receives $160. This even applies if the registrar is called in to the hospital for an emergency. Registrars are paid $8-10 / hour for home call (unless they’re covering an absence of a colleague in which case the amount rises to $25 / hour) just for being available. When the on-call registrar receives a phone call, they bill for one hour at $90-180 / hour, and if they have to come into the hospital, they bill for $90-180 / hour, with a 3-hour minimum, and this includes commuting time.
Except for when doing emergency work, registrars can’t be required to work more than 5 hours in a row without a 30-minute meal break, and 10 minute breaks for morning and afternoon tea are also required. The hospital must supply the registrars with free coffee, tea, milk and sugar, and if the registrar works over a meal time, a free meal must be provided as well for a regular day or two free meals for a long day.
They are paid as junior doctors, with compensation that is based on hours typically worked and level of seniority. The range is about $95,000 to $247,000 [?generous?] compared to U.S. trainees.
Responsibility increases based on demonstrated competence rather than rigid hierarchy.
At Chris’s current site, there are only non-training registrars. As a result, those registrars work directly with consultants and are allowed to do essentially everything they are capable of doing without layers of senior trainees above them.
Case Mix, Competence, and the Fellowship Tradeoff
The structure of the public system shapes what trainees see.
Because patients are triaged based on acuity, registrars encounter a disproportionate number of complex cases—cancers, tumors, abscesses—and fewer low-acuity, high-volume procedures.
In otolaryngology, this means trainees rarely perform routine nasal surgery such as septoplasties, because nasal obstruction sits low on the public triage scheme.
Combined with reduced work hours, this narrower exposure often necessitates fellowship training before independent practice.
Chris was clear-eyed about the tradeoff.
For all of its flaws, he said, the U.S. system produces surgeons with extraordinary breadth and volume. He feels competent practicing a wider range of ENT than many of his Australian, New Zealand, and European-trained peers, precisely because of the intensity and comprehensiveness of U.S. training.
Time Off Is Real, and Actually Taken
In New Zealand, time off isn’t theoretical.
Full-time public specialists receive:
- 6 weeks of paid vacation per year
- 12 paid public holidays
- 2 weeks of paid CME leave annually (which accumulates if unused)
For every 10 years of service, vacation increases by 2 additional weeks.
After 20 years, specialists are entitled to take a full year off as an extended paid leave.
Every 5 years, specialists are also entitled to a 3-month paid sabbatical, during which they continue to receive full salary, including an average of their usual call pay.
If a specialist has been working particularly onerous hours, they may also qualify for onerous duties leave, typically five additional days per year.
If you work on a public holiday, you’re paid for the holiday and receive a day in lieu to use later.
This time off isn’t aspirational. It’s used.
Hospitals hire locums to cover gaps. Entire services slow down over Christmas and New Year’s. In some regions, nurses are required to take leave during this period, which means elective clinics and surgeries largely shut down anyway. Even private hospitals often close for several weeks. Working straight through isn’t admired; it’s structurally discouraged.
Sick Leave, Parental Leave, and Bereavement Are Protected
Sick leave in the public system is effectively uncapped, though extended absences are reviewed on a case-by-case basis after several months.
Paid parental leave is 14 weeks, with the option for up to 12 additional months of unpaid leave for either parent — with job protection.
Bereavement and family leave are also protected. There is no hard cap, only a reasonableness standard. If leave extends beyond five consecutive days, documentation may be required; if it exceeds three months, it is reviewed.
One policy stood out to me in particular.
If a doctor becomes sick or experiences a bereavement while on vacation, their annual leave days are credited back. Annual leave is meant to be enjoyed — not consumed by illness or grief.
Burnout Exists, But It’s More Self-Imposed
Chris was careful not to oversell New Zealand as a paradise.
Public physician pay is low by international standards.
New Zealand does not train enough of its own doctors.
There are real workforce shortages and infrastructure challenges.
But burnout, at least in his specialty, does not look like what many U.S. surgeons experience.
Many of his colleagues moved to New Zealand specifically for quality of life—from the U.K., the U.S., the Netherlands. Among them, burnout is uncommon.
When it does occur, it’s usually tied to self-imposed overwork in private practice, not structural coercion. The desire to earn more money can still drive people to push themselves too hard. But the public system itself is manageable.
Clinic volumes are realistic. Initial visits often last 20–30 minutes; follow-ups are around 20 minutes.
The workday includes scheduled breaks: morning tea, afternoon tea, and a full lunch hour.
Documentation is simple. Notes exist to support patient care, not billing optimization or insurance warfare.
Less CYA Medicine; There’s No Tort System
Private practice looks very different as well.
Chris’s overhead is roughly 15%, compared to the 50–70% common in U.S. private practice. There is no tort system. Malpractice insurance is inexpensive (his costs around $700 per year), and this is to cover legal representation in case there is a coronial inquest to investigate a negative outcome. Coronial inquests are fact finding rather than punitive, and the goal is to provide answers to families and recommend changes to prevent recurrences.
Health insurance is affordable because catastrophic care is covered by the public system. On the public side, there are no insurers to negotiate with, no peer-to-peer calls, and few of the administrative forms that dominate U.S. practice.
Ironically, a system many Americans assume would be highly bureaucratic is, in practice, far less so.
A Different Cultural Tradeoff
New Zealand medicine reflects a broader cultural context.
It is less materialistic. Doctors don’t tend to spend money on luxury cars or status symbols. There is less pressure to accumulate, less expectation that professional success should translate into visible consumption.
Public wages are lower—and in exchange, work demands are lower. That tradeoff is explicit.
The system blends what Americans often think of as opposing values: strong unions and public hospitals alongside low overhead, minimal litigation, and a business-friendly environment for private practice.
It’s not perfect. Chris is the first to say that underfunding of the public system has consequences, and that New Zealand loses doctors to Australia every year because public pay is higher there.
But the system is honest about its priorities.
What the U.S. Could Learn, But Probably Won’t
When I asked Chris what the U.S. could learn from New Zealand, he didn’t hesitate.
The American system, he said, is too encumbered by powerful interests to adopt most of what works here. Insurance companies, litigation, and entrenched financial incentives make meaningful reform unlikely.
Still, the contrast is hard to unsee.
In New Zealand, surgeons are treated as skilled professionals whose time matters. The system assumes they need rest, boundaries, and a life outside the hospital, and then builds accordingly.
In the U.S., we often ask individual doctors to compensate for structural failures with resilience, sacrifice, and silence.
The difference isn’t philosophical.
It’s architectural.
%20(1).jpg)
.jpg)
.jpg){kind=avatar}