Dire level of vacancies among full-time permanent senior doctor positions at Taupō Hospital

• Barely a third of senior doctor positions are filled at Taupō Hospital
• Fixed-term and locum staff fill gaps in roster
• Pressure mounts on permanent senior doctors to work weekend and night shifts
• Senior doctor union says situation cannot continue.

There is concern at the dire level of vacancies among full-time permanent senior doctor positions at Taupō Hospital, where gaps remain in the roster for the coming two months.

Fixed-term and locum senior doctors there are relied on to fill such gaps, a situation the senior doctors' union says is unsustainable.

Figures obtained by RNZ show just 3.3 out of nine full-time equivalent senior doctor positions in the town are filled.

Rosters for May and June, seen by RNZ, show just 28 percent of all shifts are filled by permanent senior doctors.

And 22 shifts over that period remain unfilled, including night shifts, where only one senior doctor is rostered on to cover the entire hospital - its emergency department and wards.

Ralston D'Souza has worked for almost two years in Taupō as a rural hospital medicine specialist.

He said the permanent doctors had little choice but to take on the arduous hours of weekend and night-time work.

"We kind of know what the consequences are if those shifts aren't being filled - essentially, the hospital would have to be shut down, and we know that our community wouldn't have that after-hours care.

"Obviously, at the core of it we care about our community. We want to do the best as possible, but we want to as well make sure we're looking after ourselves to have a long career."

No GP practices in Taupō offer after-hours care.

If the hospital were to close due to a lack of staff, the only options for people needing medical care were telehealth or a one-hour drive to Rotorua Hospital.

"Because the night shifts aren't popular for locum doctors to pick up, the burden of those night shifts falls on the permanent doctors to pick up," D'Souza said.

"The only way to reduce the amount of night shifts that you do is to drop your over-all, permanent hours."

That's what senior doctors have done - the 3.3 full-time equivalents are made up of six people, although one is about to leave.

D'Souza said senior doctors could see 15 to 20 people on a night shift, compared with an average of eight to 12 around the country.

"Most emergency departments that have this level of presentations will probably be having at least two-three doctors per shift. That more higher volume of patients makes it not a very attractive job for senior medical officers."

That made recruitment harder.

Patients were affected too, particularly if an emergency cropped up.

"You could be dealing with an emergency resuscitation where you have to give all your full attention to that patients and there might be 12 other patients waiting in the department, and their waiting time increases."

Although many senior doctors had left in recent years, D'Souza said he had no plans to, and could see some light at the end of the tunnel with the hope of supervising Australian junior doctors in rural medicine.

The hospital recently received accreditation for that, but would need appropriate numbers of permanent senior doctors to do it.

Education and training were not a focus in hospitals with short-term and locum staff, he said.

Patient Voice Aotearoa's Malcolm Mulholland recently held a public meeting in the town. There, he was approached by a hospital worker concerned about staffing, who told him about contingencies if shifts were not filled.

"Over the past year, due to the shortage when it comes to doctors, they've had to draw up plans multiple times to shut the hospital down. That includes the ED and the ward.

"If that was to happen those patients who were in the hospital at the time would have to be transferred to Rotorua Hospital."

No shut downs have happened, but Mulholland said they would be a concern given the pressure Rotorua was under too.

Association of Salaried Medical Specialists executive director Sarah Dalton said the constant rostering squeeze was exhausting for the senior doctors the union represented.

"We think we've got it sorted and then another gaps opens up. That's the problem when you're so under-staffed - one person leaving can tip you right over.

"It's just a continually vulnerable service."

From next year junior doctors would join the night shift roster, as happened in other hospitals, and Dalton said the union was working with Health NZ on easing the situation for overworked staff.

"It's a bit like running instead of walking, so that wears you out pretty fast.

"It's riskier. You may be really tired when you're trying to make clinical decisions. It's bad for relationships if all of the staff are stretched and stressed."

Health NZ group director of operations for the Lakes district Alan Wilson said it had increased staffing at Taupō Hospital in the past five years.

As well as senior doctors, there were two full-time junior doctors there. It was advertising for more juniors.

Outpatient numbers had increased 70 percent in recent years.

"We have been growing Taupō Hospital's capacity to provide care to more local patients with the introduction of a new CT scanner, which is also available for patients from the South Waikato and Taumarunui; echocardiography services; and the development of a dedicated unit for chemotherapy and medical day-stay services."

Wilson said Taupō Hospital was continuing to provide important health services to its communities, and there was no intention to close or downsize it.

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