Being an MP is hard, don’t get me wrong, [but] primary care’s hard – it’s tough, it’s demanding; and, every time I go back and locum, I’m reminded, yep, this is a real coal-face profession
The National Party electorate office in Whāngārei, opposite the police station, is air-conditioned and blue: blue carpet, blue chairs, the blue of the New Zealand flag. It’s quite empty apart from a few pot plants, some toys and a framed Hundertwasser print emblazoned with the words, “Imagine Tomorrow’s World”.
It’s a relief to be inside away from the oppressive Northland heat.
Shane Reti emerges from an inner office looking chilled in his light blue shirt and blue striped tie. After 27 years as a GP and three-and-a-half years as an MP, he’s used to seeing people in waiting rooms.
As we sit down, Dr Reti launches into an explanation of how he got here. Although he was born in Hamilton, his “people” are from the North. And being an MP is actually his third career, he says. His first was as a GP in Northland and it wasn’t all air-conditioned offices then. “I’ve done the Panguru clinic when the hospital car wouldn’t get through the mud.”
These days, he does the minimum to meet clinical requirements and retain his medical registration; working as a locum during Parliament’s summer recess and running a MOPS group. It’s important to maintain credibility, he says. “If I’m going to be a health expert in Parliament I don’t want anyone from across the benches to say, ‘When was the last time you touched a patient?’
“I also find the closer I get to the patient, the closer I get to the truth.”
It’s the sort of perfect line you’d expect from a politician. But Dr Reti is surprisingly frank in some of his views. He is also very well prepared.
The latter could be a byproduct of his second career, which started in 2007 when he was headhunted to go to Harvard University on a Harkness Fellowship. One year turned into seven during which he taught as an assistant professor, worked with Portuguese students on “fuzzy logic” artificial intelligence and became an expert on the interface between informatics, business and clinical medicine. He also worked on projects in the Middle East, representing New Zealand Trade & Enterprise.
Those were heady days, when he was encouraged to dream big. But when Whāngārei MP Phil Heatley retired in 2014, Dr Reti decided to return home to contest the seat, and start his third, and possibly final, career. He held the seat in last year’s “Shane versus Shane (Jones)” showdown.
He clearly relishes the political life. Three terms on Northland DHB set him up for it, he says, grinning as he recounts a story about a kuia at his final DHB meeting who predicted, ‘He’s going to end up in politics’.
“I would make the case that every doctor is actually a politician to some degree,” he adds. “To influence policy is a privilege and a responsibility of every doc.”
Perhaps some more than others, though. At one point he seamlessly reaches over and picks up a plastic folder which I hadn’t even noticed was there. It’s that preparation again. He starts referencing stories which I have written for New Zealand Doctor about concerns in general practice over GPs having to be urgent care accredited to offer after-hours services, particularly in Auckland. It’s something he’s been tackling health minister David Clark about in Parliament since the election. “You’ve OIA-ed it, and I have too,” he notes.
Being in opposition gives him access to “different tools”, such as written questions for the minister. One of the biggest differences between being in government and in opposition, he says, is “proximity to the funder”.
Another issue he’s been involved with in recent months is medicinal cannabis. He spoke in favour of the Government’s bill, and against the more radical one proposed by the Greens, drawing upon his wide network of medical colleagues, here and in the US, to firm up his own position.
“I’d reach out to my medical colleagues in Oregon and in California and in Nevada and back in Boston and say, look we’re going to be discussing medicinal cannabis. Tell me what it’s like from a primary care perspective. Tell me the progression from medicinal cannabis to recreational cannabis, which you have all done. Tell me what it’s like to get a medical marijuana card in California. Tell me how it was that initially it had to be only with a consultation, and then that changed to an online consultation and now you’ve got docs on bicycles riding down Santa Monica beach saying ‘I can give you a medical marijuana card for $45’. Tell me that and the failures because I never want to get to that.”
But it’s not something to be afraid of, he stresses. “I believe it should be treated like any other medicine.”
Inhabiting the dual roles of MP and GP, mixing his first and third careers, is a balancing act. He has three “sort-of homes” - residences in Whāngārei and Wellington, “and my suitcase”.
His locum stints back in Whāngārei serve to remind him what general practice is really like, although his status as a nationally known politician can make for some interesting consults.
“I have my Dr Shane Reti name tag on. [I say] ‘I’m your locum for today, how can I help you?’ Nine times out of 10, about three-quarters of the way through the consultation...‘I know you’...they’ve seen my billboards or something...‘Aren’t you the MP?’...I say ‘I am your MP, but today I’m your doctor, how can I help?’”
Political discussions sometimes ensue, but he says the most common reaction he gets from patients is, “We need more docs than we need politicians. You should be a doc again.”
Inevitably, he sometimes finds himself sitting opposite a dyed in the wool Labour supporter. “It’s never been an issue,” he claims. “Ever.”
But the overriding impact of returning to practice is a realisation of how challenging it can be.
“Being an MP is hard, don’t get me wrong, [but] primary care’s hard – it’s tough, it’s demanding; and, every time I go back and locum, I’m reminded, yep, this is a real coal-face profession, this is hard work.”
Locally, the “anomaly” of Whāngārei practices shut out of the VLCA system and struggling to survive is one of his concerns. He argues that some kind of special exception should be made for these practices to enable them to compete on a level playing field (see story Page 6). It’s a situation the National Government failed to address in its nine years in power.
Asked to name the biggest challenge facing primary care in the rest of the country, he doesn’t hesitate.
“Workforce. Without a doubt.”
As deputy chair of the health select committee, he’s been involved in the annual reviews of DHBs, and hears first-hand about the workforce issues they face. “Every single one of them says ‘We are well at capacity.’”
The approaching cliff of GP retirements in the next five to 10 years worries him. “You don’t grow a primary care doctor like that,” he says, snapping his fingers. “There are seven years minimum, then the other stuff on top. You can have policy and you can have money – the human capital part of that you don’t get quickly. I don’t see a lot of planning around where this human capital is going to come from.”
Dr Reti does not attempt to portray himself as a GP playing politics. This third career is clearly his main focus now, and he makes no secret of his aspirations.
“Politics is my ambition and my career. I don’t know if there will be another career after this.”
In response to the comment we need more doctors rather than more politicians, he points out, as a GP, he used to serve a cohort of 2000 people. “As an MP, I’m responsible for 77,000.”
Although Jonathan Coleman retained the health portfolio in the recent Opposition reshuffle, Dr Reti does see himself as a future party health spokesperson and, one day, health minister.
And medicine?
“Do I see a clinical role after this? No. I see a Shane-the-grandparent role…I think the three careers are the three careers I want to maintain.”
Until then, he’ll continue with his constituent meetings, his visits to the Saturday farmers’ market, his weekly commutes between Whāngārei and Wellington.
In a way it’s the kind of approach which led him into politics and to that Buzz Lightyear award back in 2004. New Zealand Doctor recognised him for his efforts travelling around Northland doing a DHB health needs report; traipsing through mud, being bitten by a dog, knocking on doors and venturing into a gang house.
When I ask him if there was a moment in his first career when he realised there was a link between what he was seeing and politics, when he saw a future opportunity for himself to effect change, he cites that formative experience.
“That was when it really struck me, as I’m trudging around the back of the Hokianga...asking, have you taken any drugs lately, have you had any family violence, is there any cancer in your family – and they’re giving me the answers. I’m thinking, y’know, the solutions to this are actually policy driven, and they’re actually a step above the operational, hands-on level of general practice and primary care.
“But that information gives you knowledge, and knowledge gives you the ability to influence policy. And that’s what politicians do.”
