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Shortages of junior doctors have hit an all-time high, putting hospital patients at risk of mistakes by stressed staff, the Resident Doctors Association says.
The shortage has worsened as hospitals head into their busy winter season.
Auckland is hardest hit by the nationwide crisis, being 91 short for the region's 346 positions for house officers, the most junior medical graduates.
Some rosters are up to 50 per cent short, including at Starship children's hospital, Waitakere Hospital and Middlemore Hospital's orthopaedics, and maternity and women's health services.
"It's a crisis, without a doubt," the association's executive secretary, Dr Aimee England, said yesterday. "It's national. You would be hard pressed to find a roster that's working with a full complement of resident doctors [house officers or registrars] at present."
Even worse, the association asserts, the shortage has led to junior doctors frequently not being replaced when they are unavailable for an after-hours shift, leaving the remainingdoctor or doctors to cover that work and their own.
Hospitals' after-hours staffing varied with their size, Dr England said. The medical service of a big-city hospital could have 24 junior doctors during the day, dropping to four at night and weekends, while some rural hospitals had just one after hours.
Union general secretary Deborah Powell said in a letter to the chief executives of the three Auckland district health boards that after-hours staffing was already at the minimum, with no "safety net".
Health boards were flouting the junior doctors' collective agreement by forcing them to cover extra work after hours, which was expressly forbidden, and the breaches were becoming more common.
"To have even less staff than the minimum available imposes un-acceptable risk both to the doctors and, through them, to the patients they serve."
The union sent a copy of the letter to Health and Disability Commissioner Ron Paterson because of the health risks and his earlier comment that failings he identified at Wellington Hospital when investigating a patient death could occur elsewhere.
Dr England said it was unfair to expect doctors to do extra after-hours duties, but some might feel they had no choice "because if they don't, who will?"
She blamed the shortages on long hours, lack of part-time work, and hourly pay rates averaging $22, compared with casual rates up to $60 for house officers and $180 for registrars.
The Counties Manukau and Waitemata boards' human resources general manager, Sam Bartrum, said the union was positioning itself ahead of pay talks this month.
Dr England denied this.
Waitakere and North Shore hospitals' general manager, Rachel Haggerty, acknowledged the severe shortage, and said hospital managers sometimes "might" ask doctors to work on despite an after-hours absence, but never knowingly per-mitted unsafe practices.
Waitakere's shortage had been eased partly by reducing the number of house officers per medical team to one, from two. The teams also have a registrar and a senior doctor. The reduction was not ideal but was still safe.
She said Auckland-wide efforts to retain more junior doctors included considering a retention payment, allowing more part-time work and providing more support for house officers.
Dr Aimee England was for one shift last week the only doctor for 18 patients at North Shore Hospital. Photo / Dean Purcell
'It was incredibly unsafe and incredibly stressful'
A house officer who works only occasional shifts because she is raising a family, Dr England was for one shift last week the sole doctor for 18 patients at North Shore Hospital.
"It was incredibly unsafe and incredibly stressful," she said yesterday. She had telephone access to a consultant, which is a common practice, but she should also have had a registrar as her senior colleague.
Her patients had the typical conditions seen on a ward, including respiratory and heart problems.
"One lady was quite ill following a large heart attack. There were patients that waited up to six hours before I got around to see them. Normally you would do a round within a morning.
"All I could do was make sure they were alive and breathing, and that we were going to keep them alive till the next day. Patients could have gone home if I had had more senior input.
"There's no doubt, had we had the full staffing level there, that patients would have received better care."
Hospital general manager Rachel Haggerty had not heard of the matter until the Herald told the hospital.
"We would never expect somebody to be in that situation. It should never have happened."
Delaying the discharging of patients "fills up the system" and left people in beds needed by new patients.
