''We've got some tough choices. We can't do everything, and we can't have everything, and to make those choices I need the clinicians standing beside me.
''We need to get a grip of the money.''
Ms Heatly was responding to the resignation of Dunedin Hospital orthopaedics clinical leader Associate Prof David Gwynne-Jones this week.
In an email obtained by the Otago Daily Times, Prof Gwynne-Jones, who will continue as a surgeon, described a lack of leadership and poor relationships with senior management. Ms Heatly said Prof Gwynne-Jones wanted to advocate ''solely for orthopaedic surgery'', and the board had wider responsibilities.
Two other senior clinical leaders had also stepped down or were in the process of doing so, but Ms Heatly said in an organisation of the board's size, it was not unusual. Ms Heatly has spent the past couple of weeks meeting senior doctors to discuss concerns.
''They're frustrated with the amount of time it takes to make decisions.
''They're frustrated that every single penny is under scrutiny.''
Doctors needed to be aware of the board's challenges.
''It's not all about orthopaedics; it's not all about Dunedin Hospital. It's about a district health board that looks after 300,000 people with 4500 staff,'' she said.
Ms Heatly said board management was considering greater scrutiny of doctors' timetables before appointing them to clinical leader roles. Some were already juggling multiple roles, and for some, it was too much to ask, she said.
''People are really fed up that we're in a deficit position. They're fed up that we scrutinise every penny ... so, yeah, it wears them down, there's no doubt about it.''
Association of Salaried Medical Specialists executive director Ian Powell said Prof Gwynne-Jones had given the board a ''powerful message'' and it needed to listen to his concerns.
