KEY POINTS:
A doctor shortage in public hospitals has sent the cost of using casual fill-ins to plug the gaps skyrocketing.
The soaring costs have prompted health boards to consider a standardised rate for locum doctors employed on a casual basis, removing their ability to bargain for higher rates when a hospital shift desperately needs to be filled.
Regional hospitals in New Zealand have traditionally had difficulty recruiting permanent staff, but now even hospitals in Auckland are facing a shortage.
Vacancy rates in Auckland for house officers - junior doctors in their early post-graduate years - ranged between 18 and 23 per cent in May.
By the fourth quarter of this year this is expected to worsen to between 40 and 50 per cent - numbers that are already seen in some provincial hospitals.
Among the three Auckland health boards, locum costs have climbed 26 per cent over the past two years.
Boards have suggested some doctors are opting out of salaried permanent junior doctor roles in favour of temping as locums and collecting much higher hourly rates. They want a clampdown.
"The shortage, I believe, has reached a tipping point," said Dr Stephen Child, Auckland DHB's director of clinical training.
"There are enough vacant positions out there so that your average doctor can quit their fulltime job and locum instead.
"You can make just as much money, you can pick which hours you work, and where you work, and it's a much better life.
"Ninety per cent of the people on the locum bureau are already employed at the DHB so, if you like, they're moonlighting for extra money. One doctor I can think of has been locuming for almost two years now."
Overseas-trained doctors, who make up 41 per cent of the doctor workforce in the country, have traditionally helped fill the gaps, but indications are that numbers applying to New Zealand are dwindling.
To combat the existing drop-off in foreign-trained house officer applicants, health boards have begun a $1.7 million recruitment drive in Britain.
Health boards spokesman David Meates, the chief executive of the Wairarapa DHB, said employing more doctors from Britain or elsewhere into permanent positions would help reduce the reliance on locums.
"The amount being spent on locums has been increasing quite significantly over the years."
Health boards spent between $12 million and $15 million in the past 12 months on junior doctor locums alone.
Dr Child said the going rate for a locum house officer was $60 an hour, compared with $44 an hour (including benefits) for a staff member.
"But if they sit at home and wait, and we get desperate ... we'll be offering $85 or $100 an hour.
"The idea of being able to bargain for rates is something that probably needs to be changed."
Mr Meates said discussions were taking place between DHBs on rate bargaining.
