A five-day nationwide strike by junior doctors will continue after talks between their union and district health boards (DHBs) broke down today.
The DHBs' chief negotiator, Nigel Murray, said employers agreed that junior doctors' conditions needed improvement, and has suggested setting up a committee to discuss the issue.
But RDA general secretary Deborah Powell said talks had confirmed junior doctors' fears that DHBs were trying to undermine the junior doctors' contractual rights.
Dr Powell said the RDA had offered a "committee with a compromise" - including the introduction of trial rosters to limit hours - in an effort to get the strike lifted.
"But it didn't allow for the undermining of our collective employment agreement."
Dr Murray said it was disappointing that after four days of talks this week "we've gone backwards".
He said DHBs had protected the junior doctors' existing agreement and conditions, and had also offered a pay increase which for most first-year trainees would mean 3 per cent on top of a starting package of $70,000.
Some junior doctors unexpectedly turned up to work at hospitals after the five-day strike began this morning.
Counties Manukau and Auckland health boards said they were surprised but pleased to see some staff turn up. However, it appeared the majority did go ahead with industrial action from 7am today.
Public hospitals have been emptied of as many patients as possible to cope with the five-day national strike after more than 13 hours of talks yesterday failed to break the dispute.
The Resident Doctors' Association and the 21 district health boards are at loggerheads over pay and working conditions, sparking what is the first national strike by doctors.
Health Boards reported a quiet start to the strike today and Counties Manukau District Health Board spokeswoman Lauren Young said: "Some have chosen not to strike, they thought better of it, so we're quite pleased about that."
She was unsure at this stage how many extra juniors have gone against union action.
Other Auckland hospitals experienced a similar scenario.
Auckland District Health Board (ADHB) hospitals -- Auckland, Green Lane, National Women's, and Starship Children's Hospital -- are reported to be running at 70 per cent patient occupancy.
ADHB spokeswoman Fleur Young said juniors had also unexpectedly turned up to work.
She said it was business as usual for the emergency services "We're still busy. For us it's just the non-urgent that aren't being dealt with."
Anxious hospital managers said they could maintain services for acutely unwell and emergency patients and women giving birth, but with the usual winter load of patients they had little room to manouevre.
About 17,000 patients have had non-urgent surgery or outpatient appointments - ranging from heart procedures to children's epilepsy clinic visits - deferred because of the strike by more than 2000 house surgeons and trainee specialists.
By yesterday about 2100 were members of the association, the employers said, leaving around 400 who were expected to work, although the numbers were changing as some of those joined the union.
Under a law to ensure provision of life-preserving services, a handful of union members will be on call to help at each hospital if needed and some will be on duty. Senior doctors will fill the gaps left by strikers.
A national contingency co-ordination centre will oversee transfers of seriously unwell patients between hospitals if some cannot cope. Staff may also be transferred.
The general manager of North Shore and Waitakere hospitals, Rachel Haggerty, said they had been emptied of patients as much as possible by winding down elective surgery. That, and the postponement of 2000 outpatient appointments, had released senior doctors.
Four unionised junior doctors would be on call to help, which she said was an "extremely limited cover".
"We do have some non-union [junior doctors]. The numbers are shifting constantly as people have signed up. It's less than 50 and reducing every day. We have a small number ... just under 10 ... who are [union] members who wish to work as well. If people wish to work we are putting them on duty."
Middlemore Hospital acute services manager Dot McKeen said the union had agreed members would return to work if a "mass-casualty event" occurred.
Asked if the strike would put lives at risk, she said: "I wouldn't like to scaremonger. We all have concerns, particularly at this time of year with winter, with the usual workload."
Outside Auckland City Hospital last night, visiting Sydney doctor David Kadrian, here completing his two-year neurosurgical training, said he had a philosophical objection to the strike, which would potentially threaten patient safety.
"We're not working in a non-essential service.
"I think the conditions of junior doctors are pretty good, compared to those of other Western systems. They don't have it worse than junior doctors in Australia."
Peter Mews, in his fourth year out of medical school, agreed. He arrived in January to complete two years of neurosurgical training, before he returns to Australia to train for another three years.
"Junior doctors here have the most protected hours and conditions of any hospital I've been in," said Dr Mews.
But a recently-graduated nurse had a different view. "They have to do long night shifts. One of the doctors had to do seven 10-hour nights in a row. ."
The dispute is more over working hours than pay.
The union says junior doctors' hours are too long, putting patients at risk, but the employers argue that New Zealand's junior doctors have it good compared with the rest of the world.
The health boards want to create a working party with members from both sides to look at working hours and conditions but the union has rejected this idea.
So near yet so far on the waiting list
Gael Xuereb made her way to the top of the waiting list, only to be foiled by the junior doctors' strike.
The west Auckland woman has been waiting nearly a year for a sterilisation operation at Waitakere Hospital.
"I had the date. I was just about there. Then I got the call saying I had been cancelled because of the doctors' strike. I was a bit frustrated. I thought finally I was going to get sorted out."
The 41-year-old, who with her husband Tony - a sickness beneficiary after an injury many years ago - has three children aged 10, 6 and 2, said they could not afford to have any more.
She held no view on doctors' strikes, but said: "I understand they have got their reasons".
Dave Wilson, a 63-year-old groundsman from Stanmore Bay, is another whose non-urgent surgery - at North Shore Hospital - has been put back by the strike. He is waiting for a golf ball-sized growth to be removed from his neck.
Mr Wilson said it would not be known whether it was benign until after it was cut out, but the delay in having the operation did not worry him greatly.
He had already waited for six months, during which time various investigations had been carried out on the growth. "Another week doesn't worry me."
- additional reporting: Maggie McNaughtonBy Maggie McNaughton Email Maggie, Martin Johnston Email Martin, NZPA