Taken last year by the New Zealand Institute of Rural Health (NZIRH), the survey said all rural hospital managers who took part felt there was a shortage of qualified medical staff, with two-thirds rating this as either serious or critical.
The survey covered 29 rural hospitals, including those in Otago and Southland, and was co-authored by institute chief executive Robin Steed, Professor Ross Lawrenson of Waikato Clinical School and Dr Garry Nixon of the University of Otago's department of rural health.
The survey showed hospitals were struggling to fill their allocated positions - with 80.9 full-time positions for general medical staff budgeted for, but only 53.9 employed, meaning 33% of positions were either not filled or covered by locums.
To make matters worse, 92% of managers said there was a lack of locum staff, with just over half rating the shortage serious or critical.
Gore Health chief executive Karl Metzler said all rural hospitals struggled to attract and retain staff.
"[Gore Hospital] are probably one doctor down and, because we only have a staff of five doctors at any one time, one down makes a significant impact," he saidBeing short on staff inevitably adversely affected the standard of care, he said.
Oamaru Hospital manager Robert Gonzales said his hospital was in a different position from some others because it had an internal medicine specialist on the staff, meaning it could provide supervision for other staff.
The sorts of services provided by the hospital increased its attractiveness to prospective employees.
The survey highlighted the pressures rural hospitals faced, Ms Steed said.
These pressures created a "less than ideal situation for both the health professional and the patient", she said.
Prof Lawrenson agreed, telling a conference of rural GPs the situation represented a "major" risk to both patients and doctors.
"There are a significant proportion of hospitals that have no recognised medical leadership, do not appear to credential their medical staff and have no formal clinical governance structures," he said in a presentation to the New Zealand Rural Practice Network this year.
"[The survey] represents a major risk to the organisations and to their patients, especially given the large proportion of generally/provisionally registered medical practitioners and the wide use of locum staff."
Another finding was that only 53% of rural hospitals credential their doctors, which was not ideal, Ms Steed said.
Credentialing is the process by which doctors receive authorisation to work in different areas of medicine.
Lack of credentialing meant doctors could not be sure they were permitted to carry out specific operations and procedures, so hospitals were unsure if a patient should be moved to a larger hospital, she said.
The situation was not all bad, with recent developments in the training of rural doctors steps towards making rural medicine a more viable pathway, Ms Steed said.
Rural doctors surveyed suggested ways to improve the situation would include the development of the rural hospital fellowship and training, better pay, better access to further education and a better relationship or balance between management and clinical leadership.
Rural Women New Zealand health spokeswoman Anne Finney said the situation in rural hospitals often meant long waiting times and long drives to hospitals in larger cities.
