Doctors’ workloads ‘unsafe’

A doctor shortage across Auckland hospitals is leaving those at the coalface fatigued and feeling ‘‘unsafe’’.

While Auckland’s population and demand for medical care have ‘‘exploded’’, its three metro district health boards have been ‘‘behind the eight-ball’’, the resident doctors’ union said.

As a result, doctors were forced to ‘‘cross-cover’’ outside of normal hours to fill gaps, landing them with ‘‘unsafe’’ workloads, a resident doctor at Auckland City Hospital told Stuff.

New Zealand Resident Doctors’ Association (NZRDA) national secretary Dr Deborah Powell said the region was ‘‘very short’’ of resident doctors.

She said Auckland’s resident medical officer (RMO) shortage was a ‘‘rapidly developing issue’’, first sparking concern last year.

The term RMO covers house officers, senior house officers and registrars. Figures from the union show Auckland DHB was short six house officers and 9.5 registrars in July.

Waitemata DHB was down seven house officers and three registrars, while Counties Manukau DHB was missing 12 house officers and 5.4 registrars, according to the union.

All three DHBS declined to confirm or comment on those figures, citing ongoing bargaining with the NZRDA.

The two sides are in talks about their multi-employer collective agreement (Meca) – looking at safe rostering and pay negotiations.

At Auckland City Hospital, ‘‘everybody is under pressure’’, the doctor said. When he started in November 2016, it ‘‘didn’t feel like there was a bad shortage’’ but there had been a ‘‘noticeable’’ change since then.

In general medicine it was routine for four, five or six people to be missing from any given shift, he said. ‘‘You get on with it’’ – people pick up the slack – but ‘‘it wears them out’’.

Staff are not just stretched, some have had job allocations changed by the DHB in order to fill vacancies, impacting on their training and job satisfaction, he said.

‘‘Certainly from our end we’re not seeing much being done ... doctors don’t feel they’re being looked after that well.’’

Powell said the issue was three-fold: patient demand has increased, but the number of doctors (across the region) has not; Auckland DHB let its reliever capacity drop creating a deficit before the shortage came to a head; and DHBS weren’t moving quickly enough to remedy the situation. All doctors face fatigue from rostering and the level of physical and intellectual activity the job requires – a shortage makes things that much harder, Powell said.

RMOS are not allowed to work more than 16 hours a day, 72 hours a week or 12 days in a row without two days off.

Those treating acutely ill patients – medical, surgical and obstetric, for example – are not supposed to work more than 10 days in a row.

‘‘We are deeply concerned about the fatigue they are suffering from,’’ she said.

The issue is not limited to Auckland, but it is particularly bad here. Powell said Auckland DHBS saw the growth and demand coming and did not increase the number of doctors to deal with it.

‘‘The thing that deeply upsets me is I don’t think the district boards care for them ... there’s certainly a lack of care for these people and the people they care for,’’ she said.

A spokeswoman for Auckland DHB said it was not appropriate to make comment on work conditions at this time, given the bargaining under way.

Demand for hospital services meant it had been a ‘‘challenging winter for all our people’’, the spokeswoman said.

‘‘We are working hard to support their health and wellbeing.’’

There had been a significant increase in RMO positions across the Auckland metropolitan region, with 90 new fulltime equivalent added in the 2018 teaching year, which the DHB is ‘‘actively recruiting’’ for.

‘‘We are deeply concerned about the fatigue they are suffering.’’ NZ Resident Doctors’ Association national secretary Dr Deborah Powell