More than 5000 senior hospital doctors and specialists have walked off the job for an unprecedented 24-hour strike in protest over stalled contract negotiations.
Health NZ insists its offer is fair and reasonable, and expressed disappointment that thousands of patients were having their care disrupted.
However, the Association of Salaried Medical Specialists said its members were fighting for the future of the public health system, which was failing to recruit and retain doctors with the low-ball salaries on offer.
Coromandel builder Mark was supposed to have surgery on Thursday on his severely infected leg, but had been warned it was likely to be postponed due to the strike.
It was the second time in six months that Mark had been caught up in industrial action, after waiting four weeks in November for reconstructive surgery on his shoulder after an earlier accident.
"I spent about eight, eight-and-a-half hours in surgery in the Monday. And then on Tuesday they got me out of bed and shunted me out because of the nurses' strike and said come back for a check-up in six weeks. Well, I came back in six weeks and another surgeon said to me 'Oh, it's frozen up, because you should have been back moving it after three weeks'."
On Tuesday, he spent more than 12 hours in Waikato Hospital's emergency department after being sent there from Thames Hospital.
"There was elderly in there well into their 80s and 90s just waiting for a bed at 1am and they'd been waiting all day. It's just unreal."
Despite these experiences, the striking doctors have his support.
"All the doctors and nurses have been fantastic. They are working flat out, it's awful for them."
Health NZ Chief Clinical Officer, Dr Richard Sullivan, said plans were in place to ensure hospitals and emergency departments would remain open during the strike action and clinical staff - including doctors - would still be available to treat patients who needed care.
"We are concerned about the impacts the strike action will have on patients waiting for planned care and specialist appointments," he said.
"It is estimated that 4300 planned procedures will have to be postponed due to the strike action causing further harm to patients waiting a long time for treatment and will set back our work to provide New Zealanders with faster access to care."
To maintain patient safety, some clinics would be closed.
Any appointments that were deferred due to the strike action would be rescheduled for the next available opportunity.
"We value our doctors and want to do the best we can for them, but the reality is that Health NZ has limited budget available for salary settlements within its tight financial constraints."
Under the offer rejected by the union, senior doctors would have received increases to base pay ranging from $8,093 to $29,911 to depending on experience, he said.
The Association of Salaried Medical Specialists president, Katie Ben, said she was sorry for patients affected by today's strike.
However, the same thing was happening every day, year after year, to patients who could not get treatment because of chronic staff shortages, she said.
"I hate having to go to a patient and saying 'I'm really sorry, we're not going to be able to do your operation today, we just don't have the time, the theatre space, the theatre staff, we don't have a bed on the ward for you to be able to go to afterwards.
"Patients have turned their lives upside down to get ready for their surgery - taken time off work, organised people to look after their children... it's very distressing."
Health NZ's pay offer was a 1.5 percent cap on total salary increases over the two-year term, which amounted to a pay rise of 0.77 percent per year.
"They do have the money, they're spending it in the wrong place. So for example, they spent more than $380m trying on locums and temporary staff trying to plug the gaps.
"If they had put that money into front-line, full-time, permanent staff, this would not be an issue."
Dr Ben said she and her colleagues did not want to strike. However, the chronic workforce shortages leave them no choice.
When she is on call, she is the only anaesthetist at Nelson Hospital.
"And If I'm in theatre with a trauma and they call me for an emergency obstetric intervention, I cannot be there.
"And there are no other anaesthetists to help me - that is a horrendous situation to put anyone in. I do not want to make those decisions.
"Do I leave my patient on the table unattended? That's not going to happen. Do I leave a woman in labour who's in extremis without intervention? That's not going to happen either. What do I do?"
Tairāwhiti Gisborne has a 44 percent vacancy rate for senior doctors, according to the most recent head count by heads of department - the worst region in the country.
Local union president Carol Chan, a paediatrician, said her own department has a new doctor starting in July, but they have lost three since the start of last year.
They should have six doctors doing filling the equivalent of five full-time roles, but instead they have three people doing 2.4 FTE.
Shortages in other specialities were also hurting her young patients.
There is no child psychiatrist in Tairāwhiti.
The shortage of surgeons means long waits for elective surgery.
"Accessing dental surgery is taking a year, that's just not fair. ENT [ear nose and throat] services are also extremely short and children are waiting for grommets for a year without being able to hear - that's just inequitable."
Dr Chan said it was not about the money.
"I don't think any of us who are still here necessarily want a payrise. But what we're getting is not attracting colleagues and keeping them here.
"That's the problem."
Northland cardiologist Marcus Lee is currently trying to recruit another specialist for his team of five - but said they really needed another three to cope with all the patients needing their help.
"Our major issue is recruiting people to come to New Zealand. People come and they say 'It's beautiful'.. but then they look at our salaries and say 'Thanks very much'."
He regularly receives offers to work in Australia paying two to four times as much as his current position.
Taranaki resident Denise, who had her long-awaited wrist surgery cancelled today for the second time in a month, does not blame doctors for moving across the Tasman.
"I moved to Australia, I lived there for nearly 30 years and it's incredible the difference in pay. But we need to keep them here, we need them to have a reason to stay. And if we can't even pay them properly... I mean, why would you?"
