Why health cannot import or rent its way out of the workforce crisis, and what does work
Health has spent two decades trying to recruit its way out of a workforce crisis, through international hiring, agency and locums. It has not worked, because you cannot import or rent your way to a stable, capable, engaged workforce. There is a way off the treadmill, across every part of the system.
For system, provider & people leaders · Aotearoa New Zealand & Australia · 15 minute read
THE SHORT VERSION
The health workforce shortage is real, severe and decades in the making. But the dominant response to it, recruit harder, hire from overseas, and backfill the gaps with agency and locums, is treating the symptom while the cause gets worse. This paper argues that health is caught on a recruitment treadmill, and that the only durable way off it is to retain, develop and grow the workforce it already has, applying a skills-first operating model across every care setting.
There is a hard truth underneath this, and it is the critical point of the paper. Recruiting harder can make retention worse. Heavy reliance on agency staff and a permanent state of churn erode the morale and workload of the people who stay, accelerating the very attrition that drives the next recruitment push. It is not sustainable to solve a leaking bucket by pouring in more water.
PART ONE · THE PROBLEM
We will start with the scale of the problem. New Zealand employs around 250,000 people in health and carries roughly 8,000 vacancies. On current trends it faces a gap of up to 25,000 health professionals by 2032. Australia is projected to be short of between 85,000 and 123,000 nurses by the end of the decade. The drivers are structural: an ageing population needing more care, an ageing workforce heading for retirement, and training pipelines that have never kept pace. This is not a temporary squeeze that a good recruitment campaign will fix.
Because the domestic pipeline cannot meet demand, the system has leaned ever harder on two short-term fixes. The first is international recruitment. New Zealand now depends on overseas-trained doctors for 42 per cent of its medical workforce, the highest proportion in the developed world, and in a single recent year brought in around 6,000 international nurses. As one analysis put it bluntly, the country imports roughly twice as many doctors as it trains. The second temporary fix is agency and locum cover, used to plug roster gaps shift by shift.
Both are rational responses to an immediate gap, and both are treadmills. International recruitment puts a country into direct global competition for the same finite pool of nurses and doctors that the health system every other ageing country is chasing, raises ethical questions about draining workforces from lower-income countries, and does nothing to fix the domestic pipeline or the reasons people leave. Agency and locum cover is more corrosive still: it is expensive, it fragments continuity of care, and, crucially, it demoralises the permanent staff who carry the institutional load while watching short-term cover arrive on higher rates. The harder a service leans on agency staff, the faster its substantive workforce burns out and leaves, which forces it to lean harder still.
This is the trap in one sentence: the more you recruit to plug the gap, the more you erode the workforce you already have, and the bigger the gap you have to recruit for next time. Recruitment is necessary, but on its own it is like a bucket with a hole in it. The water you pour in runs straight out the bottom, labelled ‘churn’.
This treadmill runs through every part of the system, but it looks different in each. Solving it means treating these as three expressions of one problem, not one undifferentiated shortage.
Doctors, nurses, specialists, midwives, technicians. The credentialed core.
Hospitals run on registration, credentialing and scope of practice, and on training pathways that take years to produce a specialist. The shortages bite hardest in specialties such as psychiatry, oncology and radiology, and senior doctor and midwifery gaps are well documented. The treadmill shows up as heavy reliance on locums to fill rosters and on international medical graduates to provide specialist cover, even as retention of newly recruited staff stays stubbornly poor. The deeper issue is that hospitals often cannot see their own capability clearly: who is credentialed and current for what, who is ready to progress, and where the single points of clinical failure sit.
GPs, practice nurses, community and allied health. Where most care actually happens.
Around ninety per cent of health consultations happen in primary care, and this is where the pipeline failure is most visible. Over the past decade New Zealand added roughly five thousand doctors but only two hundred and sixty GPs. The country now has about seventy-four GPs per hundred thousand people, well behind Australia's hundred and sixteen, sits several hundred GPs short, and is told it cannot train or import enough to close the gap. The workforce is ageing fast, with well over half of GPs aged fifty or older and a third intending to retire within five years, and the small-business structure of general practice means a retiring GP often takes a whole patient list, and decades of relationships, with them. Practice nursing and community roles are under the same strain, and the people who could train the next generation are retiring with little support or recognition for doing so.
Care and support workers, registered nurses. The largest and fastest-growing workforce.
This is the biggest part of the system by headcount, the fastest growing as the population ages, and the most exposed to the treadmill. It carries the lowest pay, the highest turnover, and a constant churn that agency backfill only deepens. New rules requiring registered nurses on site around the clock, and recent pay decisions, have begun to help, but demand is outrunning supply. The striking thing is that most of these workers want to stay: aged-care workforce surveys consistently find the great majority love the job, yet feel stretched too thin to do it well. That is a retention problem dressed as a recruitment problem, and it is the clearest case in the whole system that the answer is to keep and grow people, not just to hire replacements.
| Dimension | Acute & hospital | Primary & community | Aged & disability care |
|---|---|---|---|
| The workforce | Doctors, nurses, specialists, technicians | GPs, practice nurses, community & allied health | Care and support workers, registered nurses |
| The defining pressure | Specialist shortages and roster gaps | An ageing GP workforce and an access crisis | Explosive demand, lowest pay, highest turnover |
| How the treadmill shows up | Locums and IMG-dependent specialist cover | Importing GPs faster than training them | Constant agency backfill and revolving-door churn |
| What's missing | Credential visibility and clinician development | Succession for retiring GPs and top-of-scope teams | A career path out of an entry-level, high-churn role |
Two forces run through all three settings. The first is demographic: an ageing workforce retiring at the top, a third of registered nurses in Australia approaching retirement this decade, while an ageing population drives up demand. The second is burnout. Chronic understaffing, mandatory overtime and the emotional load of care are pushing people out, and today's health workers, like everyone else, increasingly weigh flexibility and wellbeing alongside pay. In New Zealand there is a third, equity dimension: Māori and Pacific peoples are significantly underrepresented in the workforce relative to the population they serve, and a system that cannot retain and grow its own people cannot build a workforce that looks like its communities.
Notice what almost none of this is about. It is not, at root, about a failure to recruit. It is about a failure to retain, to develop, and to give people a reason and a pathway to stay. Those are fixable. They are simply not being seen.
The single root, across every setting: most health employers cannot see the capability they already hold. Scopes of practice, credentials, registration currency, competencies and professional development sit scattered across rosters, spreadsheets, training logs and managers' memories, joined up nowhere. So the service cannot answer the questions that decide whether it sinks or swims: who could work to the top of their scope, who is ready to progress, whose credentials are current, who is at risk of leaving, and who could be grown into the role it is about to advertise overseas. You cannot retain, deploy, develop or grow capability you cannot see.
THE TURN
Recruitment will always be part of the answer; no one is arguing a stretched service should stop hiring. The argument is that recruitment alone is a losing strategy, because it pours water into a bucket that leaks faster the harder you pour. The durable lever is the one the whole sector has underinvested in: retaining, developing and growing the workforce it already employs.
That reframes the problem from a supply question into a capability question. Importing and renting treat the workforce as something you acquire from outside, in a global market that is running dry. A skills-first model treats it as something you keep and grow from within. In health, that approach has a particular force: the same record of skills, scopes and credentials you build to develop and retain people is the record you need to deploy them safely, to their full scope, and to satisfy the bodies that register them. The compliance burden and the capability engine become one system. That is what TalentJam is built to do.
PART TWO · THE SOLUTION
TalentJam is a skills intelligence platform built on a continuous loop. Skills feed Performance, Performance feeds Growth, and Engagement runs through all of it. The four disciplines apply in every care setting; what changes is which one carries the most weight. Together they are the practical machinery for getting off the recruitment treadmill: keeping the people you have, and growing them into the people you need.
TalentJam builds a living capability profile for every person: skills, competencies, scope of practice, credential and registration currency, in one place rather than scattered across logs. That does three things at once. It lets a service deploy people to the top of their scope, one of the few genuine productivity levers in health, instead of leaving capability unused because nobody could see it. It surfaces who is ready to progress and where the single points of failure are. And it turns credential and competency tracking from an audit headache into a live, trustworthy record. In hospitals it pinpoints clinical risk; in primary care it maps the whole team's scope around the GP; in aged and disability care it reveals the hidden capability in a workforce too often treated as interchangeable.
Capability profiles / Scope of practice / Credential currency / Top-of-scope deployment / Succession visibility
Health already runs on competency: sign-offs, supervision, preceptorship, recertification. TalentJam makes that native, with verifiable competency sign-off and light, regular, skills-anchored check-ins that sit alongside clinical supervision rather than a forgotten annual review. This matters most at the point people are most likely to leave: the first year. New graduates and new recruits who feel supported, developed and seen stay; those who are thrown in and left adrift do not. Equipping charge nurses, practice leads and team managers to develop their people is among the highest-return retention investments a service can make.
Competency sign-off / Preceptorship & supervision / Continuous feedback / New-graduate support
Burnout is the engine of the treadmill, and it rarely arrives without warning. TalentJam's engagement capability gives services low-friction listening and structured recognition that surfaces a struggling or disengaging team member while there is still time to act, rather than discovering it in an exit interview or an agency invoice. Recognition, flexibility and feeling valued are what the evidence says health workers most want and most often lack. Protecting the wellbeing and morale of the substantive workforce is not a soft extra, but rather, the difference between a stable roster and a spiral of agency cover.
Pulse listening / Recognition / Burnout early-warning / Retention of substantive staff
This is the pillar that gets a service off the treadmill for good. The workforce the global market cannot supply has to be grown at home, and grown deliberately. TalentJam maps real clinical and care pathways, healthcare assistant to enrolled nurse to registered nurse to nurse practitioner, or support worker to senior carer to clinical roles, and ties each step to the specific competencies and credentials required to climb it. That builds the domestic pipeline international recruitment has been papering over, turns the lowest-churn ambition into a career rather than a dead-end shift, and gives a service a way to grow a workforce that reflects its community, including the Māori and Pacific workforce the system has struggled to build by hiring alone.
Clinical career pathways / Grow-your-own pipelines / Earn-and-learn progression / Representative workforce
Most services already own fragments of this: a credentialing register, an LMS, a roster system, a wellbeing survey (that nobody acts on). They sit in silos, and capability falls through the gaps. The loop is the point. Capability data lets you deploy people safely and to full scope. Performance and support keep them, especially early on. Engagement catches the burnout that drives attrition. Growth builds the people the market cannot supply, which reduces the dependence on agency and overseas hiring, which lifts the morale of everyone who stays, which feeds the next turn. Each pillar makes the others work harder, and the compounding effect is what finally slows the treadmill instead of running faster on it.
THE SYSTEM OPPORTUNITY
For a national or regional health system, the largest health sector employer of all and the one most trapped on the treadmill, this is not one option among several. It is the only sustainable lever remaining. The global pool of nurses and doctors is contested and finite, the ethics of recruiting from lower-income countries are becoming ever more visible, and agency spend at system scale is both vast and corrosive. A system cannot import or rent its way to stability. It can only build it.
A system that can see capability across its whole workforce, deploy people to the top of their scope, retain its substantive staff, and grow its own staff, including clinicians, along visible pathways, reduces its dependence on the temporary fixes that are failing it. It also gains something no recruitment strategy can buy: the data to plan its workforce based on the capability it actually holds, rather than vacancies it is forever chasing. That is a longer build than a hiring campaign, and a bigger conversation than a single service. It is also probably the only one that bends the curve.
IN PRACTICE
Consider a primary and community care organisation, a network of practices and community services, with an ageing GP workforce, practice nurses working below their potential scope, a constant battle to recruit, and a quiet but steady loss of good people to burnout (or overseas). Nobody can say with confidence where the network's real capability sits. Here is how the loop changes the trajectory.
From a treadmill to a pipeline
→ Quarter one. Everyone gets a capability profile, and the network sees its workforce on one screen: scopes, credentials and currency, who is working below their scope, where the single points of failure are, and that several senior GPs will retire within three years with no successor and no plan for their patient lists.
→ Quarter two. Practice nurses are supported to work to the top of their scope, easing pressure on GPs and improving access, with competency sign-off held in one trusted record. New recruits get structured support in their first year, and an engagement signal flags a valued nurse heading for the exit in time to act.
→ Quarter three. Two healthcare assistants are placed on a mapped earn-and-learn path toward enrolled and registered nursing. The network starts growing the clinicians it could never reliably recruit, and reduces its reliance on locum cover.
→ Year two. Capability planning and credential assurance run from the same system. GP succession is being managed rather than feared, the substantive team is more stable, and agency and overseas dependence is falling. The network is building its workforce rather than chasing it.
The same loop eases the access crisis through top-of-scope working, protects the substantive workforce from burnout, and begins growing clinicians at home. That is the advantage of solving the treadmill with one model rather than three disconnected fixes.
THE TIMING
The pressures on the sector are converging and none is easing. The population is ageing and so is the workforce, the retirement wave is arriving, and the global competition for the same scarce clinicians is intensifying just as the ethics of international recruitment come under sharper scrutiny. Agency spend is straining budgets that are themselves under pressure. Every system in the developed world is now reaching the same conclusion: the supply-side fixes have run their course, and the advantage will go to those who retain and grow rather than those who recruit and burn.
The services and systems that come through the next decade in better shape will not be the ones that hired the most aggressively. They will be the ones that could see, keep and grow the capability they already had, deploying people to full scope, supporting them through the years they are most likely to leave, and building their own pipeline while the rest of the market fights over an external pool that keeps shrinking. That is an advantage no competitor, and no labour market, can take away.
Keep your people. Grow your own. Get off the treadmill.
TalentJam gives health services and systems a live picture of the capability inside their workforce, and the loop to retain, develop and grow it, so the answer to a vacancy is no longer only to recruit. To see what it looks like for you, visit www.talentjam.io to book a walkthrough.
SOURCES & NOTES
Health New Zealand Te Whatu Ora Health Workforce Plan (2024) and related reporting: workforce size, vacancies, and projected gaps. OECD and Medical Council of New Zealand data, via University of Waikato and Commonwealth Fund analysis (2023 to 2026): international medical graduate share, and the ratio of imported to trained doctors. Royal New Zealand College of General Practitioners GP Future Workforce Requirements: GP numbers, ageing profile, retirement intentions, GPs per capita, and the GP shortfall. Health Workforce Australia modelling and subsequent industry analysis (2021 to 2026): projected nurse shortfall to 2030. Australian Institute of Health and Welfare and aged-care workforce reporting (2024 to 2026): aged-care demand, turnover, registered-nurse requirements, pay decisions, and workforce-census sentiment. Industry and college commentary (2025 to 2026): burnout, agency and locum reliance, retention, and flexibility. Several figures are projections or modelled estimates and are described as such; figures cited as ranges or as approximate reflect variation across published studies, methods and dates.