Some Auckland surgeons are being paid more than $6000 for a day's work at a public hospital.
The Waitemata District Health Board scheme has divided doctors over concerns that the surgeons involved can earn nearly four times as much as general physicians and psychiatrists on their collective agreement's top step.
Forty-four per cent of the DHB's surgeons have taken part and more than half of anaesthetists, although the latter's pay differential is less.
The scheme operates only at Waitakere Hospital, where it was introduced to make use of a mothballed theatre, attract staff, increase efficiency and reduce waiting lists for elective surgery.
It is also being considered for North Shore Hospital's soon-to-be-built $37 million Elective Surgery Centre - for which the health board is refusing to rule out private-sector involvement.
The Waitakere "pilot" project pays orthopaedic surgeons a contract rate of $2200 for each total hip or knee replacement package of care. This comprises $1320 for the operation plus $880 for daily patient review, any call-backs during the hospital stay, availability for six weeks after surgery and a six-week visit.
Surgeons mostly work in the scheme for one day a month, some for two. Typically they replace four joints in a day (worth $5280), and occasionally five ($6600). Critics calculate it would typically be an eight-hour day for four joints, for which the surgeon is earning $660 an hour.
On the union-negotiated multi-employer collective agreement, specialists of all kinds on the highest step earn an annual base salary of $206,000, or $99 an hour, but this increases to around $170 an hour when leave, KiwiSaver and allowances are factored in. Some specialists are paid above the collective's rates.
Waitemata anaesthetist Dr Julian Fuller, in an email to all specialists at the DHB and obtained by the Weekend Herald, said: "This DHB does not need to pay vastly inflated rates of pay to a limited few proceduralists, in order to achieve higher throughputs.
"It is fundamentally unfair, and completely unethical in the current economic environment. It ignores the vast majority of Waitemata DHB senior medical officers who are each doing their best for their DHB.
"It totally devalues fellow [senior doctors] such as, to name a few, general physicians or psychiatrists, intensivists or emergency medicine specialists, who also work extremely hard long hours, but not doing something that is easily counted. In public medicine, all [senior doctors] should be fundamentally paid the same for their basic day-time work."
Senior doctors' union executive director Ian Powell said the split rates undermined the team-work that was critical to the safety of patients in a complex public hospital.
"How can you say electives deserve to be paid at a higher rate than emergency and acutes. It's ridiculous. The electives are generally the less complex. To try and break down remuneration just because it [elective surgery] happens to be the political flavour of the month is absurd."
DHB chairman Lester Levy said the pilot had worked very well.
The rates paid to orthopaedic surgeons were around 60 per cent of private-sector rates. The scheme had led to a number of surgeons opting to do less private-sector work in favour of doing most of their work on public patients.
Productivity was up by a third. Costs shrank 12 per cent for hips and 16 per cent for knees because of a 40 per cent reduction in patients' average length of stay in hospital, less time in theatre and fewer staff being involved in treatment.
Bringing previously out-sourced surgery in-house saved the DHB $3 million in the last financial year. Patient satisfaction was high and the transfer rate to North Shore Hospital was low.