KEY POINTS:
Hospitals in Auckland are facing their busiest time of year with an unprecedented shortage of junior doctors.
Up to a third of roles in some specialties are vacant.
The pinch is felt most acutely among second-year house officers - a fifth of all house officer positions in the three Auckland district health boards are unfilled.
House officers are medical graduates in their first or second year of practice, doing on-the-job training in various roles in the hospital.
Of 346 house officer positions in Auckland, 72 (21 per cent) are vacant. Sixty-seven of those are for second-year house officers.
The typical vacancy rate is around 3 per cent.
The situation is a worry for the hospitals, which is increasingly reliant on locums, or casual fill-ins, to plug the gaps.
Auckland District Health Board has been advertising for GPs to provide locum services at the Starship hospital from late May until November.
"Some of the hospitals are maybe looking even at 25, 30 per cent shortages in some areas," said Auckland DHB's director of clinical training, Dr Stephen Child.
Patients were not at risk, he said, although the situation raises concerns about continuity of care and supervision.
"If you're in hospital on Tuesday night, one locum sees you, and then on Wednesday night a different locum sees you.
"I can be working with five or six or seven different doctors in a two-week period now. How am I supposed to supervise them and also, how am I supposed to teach them?"
It also costs the health boards more. Locum rates are $60 an hour for a house officer.
"Of course, if we're short, and we really need someone ... you do get instances where junior doctors say, 'well, I'll do it, but only if you pay me $120 an hour'.
"My personal feeling of why we've seen a major jump up is because we've created a locum market.
"I believe that the vast majority of the shortage we're seeing is that doctors are opting out of regular jobs, because it's more lucrative to locum."
Dr Child said Europe, Australia and the United States were all experiencing similar shortages. The situation in Auckland has also been driven by increases in hospital admissions, a gradual reduction in working hours, a sharp fall in overseas doctors seeking work here, and a feminisation of the workforce.
"Statistics would tell us that female doctors on the whole work less hours than male doctors."
Waitemata DHB is estimating a 28 per cent house officer vacancy rate for its third quarter, which starts later this month.
It expects the rate to worsen later this year.
"This is not a 'blip' - this is a sustained national problem that is getting worse," said a spokeswoman.
Peter Guthrie, general manager for Auckland Regional Resident Medical Officers Service, which employs and trains junior doctors, said the reasons for the sudden shortage were unclear.
"There is comment from [the union] that they're going to Australia. We have no evidence to support that. Our perception is that RMOs - house officers in particular - are choosing to work as locums for lifestyle reasons and choosing that over and above permanent training positions within the DHBs."
The service is attempting to pinpoint a reason for the shortage.
Surveys by the Medical Council have shown no changes in the number of medical graduates heading overseas.
National's health spokesman Tony Ryall said indications were that Auckland hospitals could soon be reaching "crisis point".
"If there are too many staff vacancies, wards will be closed."
