Te Whatu Ora staff shortages: Bay of Plenty’s $8m locum bill for 2023

More than $8.6 million was spent on outsourced/locum medical specialists for Te Whatu Ora Health NZ hospitals in Bay of Plenty last year, records show.

A union for medical specialists said
this demonstrated the cost of the shortage of senior medical officers.

“With so many vacancies, Te Whatu Ora is reliant on locums. To attract locums, Te Whatu Ora has to pay higher rates,” Association of Salaried Medical Specialists executive director Sarah Dalton said.

She said there would be “real financial benefits” if Te Whatu Ora employed a full roster of doctors and was not “reliant on paying locum rates and additional duty rates to cover gaps”.

Te Whatu Ora said locums have been used “for decades” to fill service gaps, cover sickness and leave, and reduce surgery wait times.

Initiatives to grow the medical workforce included adding medical school places, creating immigration hubs overseas to help recruit specialists, and helping more junior doctors train faster for specialist roles.

Which department received the most money for locums?

Records released under the Official Information Act showed Te Whatu Ora Hauora a Toi Bay of Plenty spent just over $8.6m last year on outsourced/locum medical specialists at Tauranga and Whakatāne hospitals.

The department recording the highest spend was the mental health department, where about $3.1m was spent.

The gynaecology department followed, with a spend just under $960,000. This was followed by paediatric specialists costing about $790,000.

The document said there were 142 individual senior medical officer locums during this period.

It said these senior medical officers may not necessarily be providing vacancy or roster cover and it included resources associated with the provision of services Te Whatu Ora Hauora a Toi Bay of Plenty may not directly employ staff for.

This number was a “distinct count” of individuals, irrespective of how long they were engaged.

Risk of fatigue, burnout for locum doctors

Dalton said the data showed the cost of the shortage of senior medical officers in New Zealand and the need to train and retain the medical workforce.

She said locums were used when there were not enough employed specialists to cover staffing gaps.

Dalton said Te Whatu Ora had 738 vacant positions for senior medical officers in November.

She said there were also unadvertised vacancies and “many services and departments” that did not have the staffing to provide the expected level of service.

“Reliance on locums also carries other costs, such as less ability to train and support resident medical officers.”

Dalton said many locums were already employed in other parts of the health system and performed locum duties on top of their workload. She said doctors recognised staffing gaps would cause patients to suffer.

“They undertake locum work and additional duties to minimise the disruption in their care. But this comes at the risk of fatigue and burnout and contributes to their inability to take leave.”

Dalton said the union’s collective agreement with Te Whatu Ora had annual salaries for specialists between $185,380 and $267,980.

Te Whatu Ora responds

Health New Zealand Te Whatu Ora chief people officer Andrew Slater said the agency knew its medical workforce across the board was under pressure and addressing this was a “top priority”.

Slater said its senior medical officer workforce grew in the 12 months to December 2023 by 207 full-time equivalents to a total of 5359.

“Our vacancy rate has continued to trend downwards.

“While we have more doctors per person than ever before, we’re still well short of the number and diversity needed to provide everyone with exceptional care, especially in rural areas.”

This meant, from “time to time”, it needed to use temporary and locum staff to fill gaps to ensure service continuity or reduce surgery wait times, Slater said.

“This is something the health system has done for decades.

“Our absolute preference is to have permanent staff performing these duties wherever possible, noting it takes many years to train our medical workforce and we face global competition for staff.”

Permanent staff were better placed to offer continuity of care, knew their community, and strengthened local services.

Initiatives under way to grow the medical workforce included adding 50 new medical school places from this year and two pilots to help a further 20 overseas-qualified doctors practice in New Zealand each year.

They also included a commitment to launching physical immigration hubs in key locations overseas to help recruit specialists and working to establish more training and fellowship roles to help more junior doctors train faster for specialist roles.

Slater said locums were used for a range of reasons and varied from area to area, often driven by the size of the local team.

Reasons for employing a locum included staffing gaps due to sickness, leave or unfilled posts. Locums are most often required for weekend and acute calls, he said.

“At times locums can also be employed to address surges in demand or reduce numbers of people waiting.”

Decisions about locum use were made locally based on the ability to staff a service, the cover available from local staff, and workload.

Locum availability was also an increasing factor behind when they were used. While a locum may be considered necessary, their services could not always be secured, Slater said.

In the neighbouring Lakes district, $5,092,110 was spent on outsourced/locum medical specialists last year.

Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.