GUEST BLOG: Ian Powell – New Zealand public hospitals increasingly dependent on ‘place-holder’ senior doctors

The word locums originates from the Latin term ‘locum tenens’ which means ‘to hold the place of.’ Medical doctors and the clergy are where they are most likely to be found.

Aotearoa New Zealand’s public hospitals operated by Health New Zealand (Te Whatu Ora) are becoming increasingly dependent on ‘place-holder’ (locum) senior doctors (largely medical specialists).

Increasing reliance on locum tenens instead of permanent senior hospital doctor positions is an inevitable but detrimental trend

This is both indicative and the result of the senior doctor workforce crisis. There will always be a need for some locum senior doctors in our public hospitals to cover, for example, longer periods of sick leave and delays in filling permanent positions.

Locums cost more than permanent appointments. They come from two main sources – locum agencies which are very expensive, especially when recruiting internationally, and short-term locums filling in from other hospitals in New Zealand.

The latter source has its own risks with the high level of fatigue among senior doctors, including many who have experienced burnout.

Place-holder locum doctor blow-out

RNZ journalist Jimmy Ellingham reveals a new record high of locum costs

On 21 July Radio New Zealand journalist Jimmy Ellingham published a piece reporting that Health New Zealand was spending a record high of $200 million on locum senior hospital doctors: Locum doctors hit a new spending high.

In the 2025-26 financial year, Te Whatu Ora spent about $220 million on locums. This compares with about $208 million in 2024-25 and $209 million in 2023-24. In the organisation’s first year of operation (2022-23) the spend was $168 million.

Dr James Irwin offers valuable insights into use of locums in public hospitals

Ellingham draws upon the experience of Dr James Irwin who generated much publicity recently when he resigned as the last full-time permanent specialist gastroenterologist at Palmerston North Hospital. The service is now staffed by locums and “fill-ins” from other districts.

[Note: Gastroenterology is the diagnosis and treatment of disorders of the gastrointestinal tract (digestive) and related organs.]

Dr Irwin notes that there are positive and negative side of using locums in public hospitals:

In a department, where you’ve got a full department and then someone is sick or goes away for a period of time, getting a locum is great because it helps fill holes and helps get work done.

You have an expectation that you’re going to have a full department going forward to deal with all of the long-term stuff and all of the departmental planning, and so forth.

However, the negative side was when reliance on them became more of a medium-term arrangement, or longer.

As a longer-term employee you’re then the one that’s dealing with all of the chronic disease management and planning for the department.

‘Place-holder doctor’ reliance negatively effects continuity of patient care

Irwin also focussed on the effect on continuity of care for patients of “constantly changing faces”:

It’s a consequence of the transactional model of healthcare.

If you employ a locum and pay them money to do something for six weeks, they come and do that, but they’re not going to want to take on additional responsibility that continues after they finish.

You need to be employing people in a situation where it’s clear that they’re going to be providing long-term care. That requires a long-term [permanent] appointment.

Te Whatu Ora response

Health New Zealand’s response, as reported by Jimmy Ellingham, was evasive ignoring the key issues.

Robyn Shearer defends Health NZ’s approach – sort of!

Its National Director of People, Culture, Health and Safety (a pretentious mouthful of a title to say the least; not the choice of the incumbent to be fair) Robyn Shearer largely based  the response on abstract generalities.

She did acknowledge that New Zealand was in a competitive market for medical specialists but then largely confined the solution to “working hard to promote the country as a great destination.”

She attributed an unquantified “influx of doctors from America” to the pull factor of New Zealand as a country rather than the push factor of the authoritarian and chaotic Donald Trump; a highly contestable attribution!

The other part of Health New Zealand’s solution is cost control; that is, cutting the budget for the 2026-27 year to $179 million! Reducing the need for locum dependence appears not to be part of the solution.

Meanwhile Executive Director of the Association of Salaried Medical Specialists (ASMS) Sarah Dalton, responded to the reported blow-out by noting that:

When you’re relying on locums to help run a service, anything from the complete collapse of the gastroenterology service in Palmerston North through to another service in another part of the country that needs locums on a regular basis to fill gaps in rosters, it is a cost to patients and to colleagues.

Health Minister’s response

Health Minister Simeon Brown has instructed Health NZ to move away from locum dependence

Jimmy Ellingham also reports Health Minister Simeon Brown’s response to this locum cost blow-out. Writing to the Chair of Health New Zealand Brown instructed that:

As a priority I expect you to monitor and prioritise shifting away from dependence on locums to recruiting permanent senior medical officers to vacancies – with an initial focus on regions that have high dependency on locums.

Further, the Minister’s office told RNZ that:

…the long-term goal is to build a stronger, more stable workforce, with more permanent staff delivering care across the country, and the minister has made that expectation clear to Health New Zealand.

Sounds good but there’s something missing – cause

It is hard to disagree with either the health minister’s instruction to Te Whatu Ora or his rationale for it.

But there is something missing. The locums blow-out is a symptom or consequence; it is not the cause of the fiscal problem.

Rising acute hospital demand a key driver of increased locum reliance

The cause is the deadly mix of:

1. Increasing acute hospital admissions (at a higher rate than population growth) largely due to increased impoverishment, population aging, and population growth.
2. Entrenched and widespread health professional and practitioner shortages in public hospitals, including doctors and nurses.

The locum cost blow-out is one of the direct consequences of this deadly mix; predictably so. But nowhere is there even a sign of awareness of this by health system decision-makers.

Arguing the benefits of New Zealand as a country to recruit overseas senior doctors, as Te Whatu Ora does above,  is fine but badly compromised when its health system is in such a chaotic and crisis-ridden state.

It is also badly compromised when there is an at least 40-hour week salary gap of between 60-65% with Australian public hospital medical specialists. The reality is that Health New Zealand is competing in and against an Australian medical labour market.

This is a critical narrative that ASMS occasionally refers to but needs to raise much more often, forcefully and persistently.  Advocacy of a graduated pathway over time to overcome this devastating pay gap is long overdue.

If they want to reduce the expensive cost of locum tenens (place-holder doctors) in our understaffed and over-stretched public hospitals, then government and Health New Zealand need to strategically focus on the cause, not the symptom or consequence.

In other words, provide responsible leadership.