The cost of junior doctors having to work extra hours to cover staff shortages has skyrocketed to more than $70 million a year.
Costs for 2022-2023 were more than double the year before, when they were $33 million, figures from Te Whatu Ora for RNZ show.
They were also 2.6 times higher than the $23 million paid in 2020, when doctors worked long hours to tackle the Covid pandemic.
Health NZ was forced to virtually double the rate it paid per service in June 2022 due to major gaps in schedules.
“My reaction when I saw the numbers was, 'Wow, it really is that bad,'” said Resident Doctors Association (RDA) national secretary Dr. Deborah Powell.
“These were new figures for me, but with 400 to 500 vacancies for general practitioners, they were not a surprise.”
Health NZ agreed to pay almost twice as much per hour by mid-2022 for 'additional duties' where trainee doctors worked evening, night and weekend shifts on top of their regular working hours, as well as a much smaller amount for 'cross-cover'. ” working to fill gaps in the day shifts.
These higher rates were supposed to stop last month, but they continued.
“There are still gaps because some services and services have not been able to close the gaps,” Health NZ said in the OIA provided to RNZ.
Out-of-hours shifts have historically been difficult to fill.
“The enhanced payments were intended to recognize that we needed coverage for those services.”
Powell said it was a “vicious cycle,” where plugging holes at high cost takes money away from regular pay increases needed to retain staff.
“It took an increase in rates to get them to do the coverage,” she said.
“But they don't want that. They already work 60 hours a week… they don't want to suffer the consequences of fatigue and making a mistake.”
She said young doctors were not abusing the system. 'No, the residents [junior doctors] know that we have to take over the services, otherwise there will be no doctor.”
It took more than a year for Health NZ to give the junior doctor information to RNZ; by law it should last five weeks.
“I am very sorry for the delay,” wrote Sasha Wood, head of public services.
The high costs increased pressure on districts that received government orders last month to find $105 million in staff savings by the end of June.
“The higher rates are higher than budgeted, which will impact the bottom line,” the Whanganui district said of the rates for junior doctors.
The Resident Doctors Association's 2,500 trainee doctors are taking industrial action over wages.
A strike on Tuesday will be followed by a two-day strike starting next Thursday morning. Senior doctors have often had to vouch for them.
Most received a 20 percent pay increase, but not all; others would receive a 12 percent pay cut, creating a division that motivated strikers.
“We are such an undervalued but integral part of the hospital,” a Waikato Hospital medical officer said on picket.
OIA figures show some districts will pay more than twice as much between the 2021-2022 and 2022-2023 budget years. Northland paid almost four times as much – $3.2 million versus $840,000 – Waikato paid 3.3 times more and MidCentral's costs were 2.6 times higher.
Capital and Coast paid 2.3 times as much, and it also exceeded the total cost for additional rights and coverage of all districts: $13.4 million, an increase of $7 million in just twelve months.
This was well above Canterbury ($10 million) and Auckland ($8.7 million).
The beleaguered southern district had to find an additional $2.27 million to cover additional pay for doctors in training, which it had not budgeted for.
While the higher rates had helped plug the gaps, 'labor shortages' and higher levels of unplanned holidays by both junior and senior doctors had weighed the other way, the OIA found.
This was reflected in the Hutt, Capital Coast and Wairarapa districts stating: “Whilst these rates contribute to the district's overall wage bill, this is offset by the districts' RMO. [resident medical officer] vacancy.”
Vacancies were the problem, Powell said.
“If we can solve our retention issues, we won't have to pay this money.
“An investment in getting retention right will be rewarded by us not having to pay this money and overall we will be in a much better situation financially – and have enough doctors to care for our patients.”
Health NZ Chief People Officer Andrew Slater said in a statement that the pressure on staff was being felt on the frontline “and these shortages are impacting our people”.
“We recognize their contribution and dedication to serving their patients and communities,” he said.
“We cannot solve these shortages quickly.”
Fifty new medical school places were opened from this year as a “first step” to boost local training, and a support service for doctors in training was developed, Slater said.
In the OIA, Te Whatu Ora said there was no evidence that trainee doctors would abuse the system – for example by using replacement days with the agreement that a colleague would work for them, collect the higher additional duties and then request their own replacement day . .
A joint organisation-union group met to ensure any breaches were addressed and “it was not raised as a concern or practice witnessed by either party”.