Abstract
New Zealand (NZ) has a predominantly publicly funded and provided health system with a parallel private health sector. Over 40% of senior clinicians (consultants) who work in public hospitals also work privately in an arrangement known as dual practice. Despite being a common phenomenon internationally, there is little empirical study of the reasons why consultants choose to engage in dual practice, particularly in high-income countries.
This thesis aimed to explore the motivations and experiences of consultants engaged in dual practice in NZ.
**Methods
Twenty qualitative, semi-structured interviews were conducted with consultants who worked in dual practice in the region formerly known as Southern DHB. Purposive sampling was used to recruit consultants from 13 unique specialties across three geographical centres and three decades of medical qualification. Interviews were transcribed, and thematic analysis was used to identify major themes and sub-themes.
**Results
Motivations to engage in dual practice were multi-faceted. Participants described strong drivers into private work, including greater remuneration, more autonomy over their time, satisfaction with getting work done effectively, and alleviating a sense of ‘moral injury’. Proceduralists valued the private sector for skill development and maintenance, with some surgeons considering it indispensable to meet necessary clinical volumes.
Despite these private sector motivations, participants all remained anchored to the public system because of some combination of a strong sense of public system commitment, specific clinical interests, and a greater sense of collegiality. They worked in both sectors to gain the benefits of each and alleviate the frustrations of working in one sector only. Further, they did so with the perspective that dual practice is normalised and positively affects the public system.
**Conclusion and Implications
Dual practice is an ingrained arrangement in the NZ health system for several distinct reasons, with both financial and non-financial motivations playing important roles. The findings of this study support the need for policymakers and clinicians to take a holistic view that considers the implications of all aspects of the dual health system in the design of health workforce policy in order to optimise healthcare delivery and foster a more resilient health system in NZ.