Skyrocketing wages for locum doctors of up to $375 per hour have left South Island rural hospitals scrambling for specialist cover, managers are warning.
In an open letter, representatives of clinical directors and administrative staff "on behalf of South Island rural hospitals" expressed their "growing concern regarding the increasing difficulty of recruiting locum doctors at our facilities".
"A significant contributing factor to this challenge is the apparent inconsistency in adherence to the nationally recognised locum hourly rate of $260.
"We have observed several hospitals in the North Island — namely Taupō, Taumaranui, Thames and Tokoroa — are offering substantially higher rates, $375 per hour."
Gore Health chief executive Karl Metzler said he did not know who was the source of the letter, but he agreed it was an issue that needed to be addressed.
"You can imagine as a trust hospital, with our uneven playing field and funding, how tough it becomes for us to try to compete with locum rates that HNZ [Health New Zealand Te Whatu Ora] operates," he said.
"It’s not always about the money, but unfortunately, it’s mostly about the money. I get that.
"These are the realities."
The working culture of a trust hospital was important, especially as they couldn’t compete with the locum fees of an HNZ-facility.
"We are very fortunate in that we have long-standing locums that we will call on to help."
Generally, most lived almost "locally" (including Te Anau or Queenstown) "and they know the hospital really well and they actually really enjoy working here".
"They enjoy the people they work with and they enjoy the kind of work that they get to do."
Mr Metzler said he was familiar with locum fees spiking in high-demand instances or areas.
"What I find frustrating as a trust hospital is ... [HNZ] will say that the locum rate is set nationally, but we all know in reality it’s not.
"So they’ll tell you to set it at, say, $260 an hour, but it’ll move — I’ve heard instances of it going north of $300 an hour and there’s just no way we can compete in that space."
Mr Metzler said they also relied heavily on the expertise of nurse practitioners in situations of skill shortages.
"So that kind of thing which helps the affordability aspect.
"But having said that, we also have some highly skilled specialists who are prepared to come and work."
HNZ director of rural health Rachel Pearce said the organisation was aware of concerns about variation in how these rates were applied and was working with relevant districts to ensure there was better alignment across the country.
"HNZ recognises the importance of consistency and transparency across the system, including in locum workforce arrangements."
There were nationally agreed hourly rates in place for locum doctors, which are negotiated at a national level and provided to districts to implement.
"These rates differ depending on the workforce group, including senior medical officers and medical officers."
Districts were expected to apply these nationally agreed rates, she said.
"As with other parts of the health system, some variation in funding arrangements exists across the country.
"This reflects a range of factors, including historical agreements, different contracting approaches, service configuration, and local operational requirements."
