"All these conditions are generally associated with pain. They are under diagnosed because of lack of knowledge or awareness of these problems. People don’t die from these issues; they just try to live with the pain and their dysfunction."
Falling through the cracks
Many of the problems arise following an accident, that may have seemed to be relatively minor at the time. Or these problems may arise as a result of just daily living activities, and can be worse with age. But young people can be similarly affected. Some of these lost functions are simple, bending to put on shoes or socks, reaching up to put washing on the line, vacuuming, mowing lawns. Everyday activities. Or it can just be pain that limits what one can do. All these conditions are all generally associated with pain. They are under diagnosed because of lack of knowledge or awareness of these problems (3). People don’t die from these issues; they just try to live with the pain and their dysfunction. Many people can’t work as a result. Many have had a minor accident and don’t qualify for ACC, or have been declined by ACC.
These people all fall through the cracks in the health system. Undergrad teaching of MSM conditions is lacking and surveys of GPs reveals a huge lack of knowledge of MSM conditions, and as a result, this leads to an increasing number of patients being referred into the secondary sector leading to ‘choking’ of orthopaedic and rheumatology clinics (1). Academics in Dunedin have made calls for undergraduate teaching, but these calls have fallen on deaf ears to date (2, 3).
Training more specialists is key
The New Zealand College of Musculoskeletal Medicine (NZCMM) is responsible for training future musculoskeletal medicine specialists and providing post graduate training and peer support for fellows and members of the College. There are no MSM services in most of the public hospitals, so for post grad trainees, there is no suitable opportunity to learn on the job, like the almost all the other disciplines. There is no funding available from the clinical training agency to support these young doctors to do their training in the community, like there is for general practice, so the Foundation was formed to initially support the training costs, and supervision for these doctors. Most are young doctors who are still paying off the student loans, maybe paying a mortgage, and need to generate an income. Many of the trainees come from a background in general practice or orthopedics. Our specialist numbers are climbing, but at the same time, there are a number of our specialists reaching retirement age, so we are encouraging them to stay involved and help with the instruction of the trainees, in the regions especially.
Getting the right supervision for trainees is a challenge. If there is no specialist in their region, the trainee has to travel to work alongside an Instructor. The travel is a cost, as is accommodation. The Foundation is particularly trying to focus on the needs of the trainees in the regions initially. These young trainees have the need to travel for Instruction, to work in the big cities alongside specialists who can teach them in the discipline. This adds to the cost for the trainee, or for the Instructors and supervisors to travel to the region in order to provide that necessary supervision.
The Foundation
The Foundation was set up in 2020 and registered as a charitable organization. We are initially seeking funds to help our trainees. If we bring in a supervisor to work alongside the trainee, the locals where the trainee is based, can get the specialist consultation and advice in their local home region without the need to travel to the main centres. This is a huge help for rural communities.
Until we get more specialists working throughout the country, these conditions will continue to just smolder away. The main centers of Christchurch, Auckland and Wellington have some cover, but not nearly enough to meet the demand. The rural communities are sadly very deprived, nationwide. Once we have specialists in all regions, our focus will be on more widespread teaching of the discipline. Ultimately, we thought we would like to be able support patients, who do not have ACC cover or insurance, to be able to access the care needed, especially in the rural communities. But the first priority, is to increase the number of MSM specialists in the country.
There is plenty in the media about health care nationally, but especially in the regions. There is a huge shortage of MSM specialists nationwide, but accessing these skills in the in the public system is almost non-existent. MSM problems are a source of huge morbidity rather than mortality. These people are in pain and just must struggle on. They fall under the radar of Health NZ and the training agencies. We are here to try to fill that gap.
