Country doctors earning $2500 a day

One of New Zealand's most remote and cash-strapped health boards is paying fill-in surgeons up to $2500 a day - a pay bonanza that beats some of our highest earners.

Like many health services in provincial parts of the North Island, the South Island's West Coast District Health Board has difficulty attracting and retaining specialists.

But the West Coast is understood to have offered some of the highest rates to lure locum surgeons.

The chief executive of the small and financially-troubled West Coast board, David Meates, said last night that to attract surgeons, it had to occasionally pay $2000 to $2500 a day.

This was in addition to travel and accommodation costs.

Mostly the doctors came from New Zealand, but some came from overseas.

Locums usually command a premium above permanent staff rates because they are filling gaps - but $2500 a day equates to $650,000 a year.

This is similar to the salary of the highest paid medical employee at the Auckland District Health Board and far above the base rate - before allowances - of $195,441 paid to specialists on the top rate of the senior doctors' national collective agreement.

The West Coast board's financial position became so dire this year that the Government gave it $6 million in deficit support.

The managing director of the MedRecruit agency, Sam Hazledine, said $2500 a day was at the upper end of locum rates.

A typical specialist's rate was $1000 a day, but that was "less than half they would expect to make in Australia".

Mr Meates, who is also chief executive of the Canterbury DHB, expected greater collaboration planned between his two boards would reduce the reliance on locums.

The West Coast board spent more than $9 million on locums in the 2008/9 year. It has a long-standing arrangement with a South African anaesthesia service to provide locum anaesthetists.

Many commentators have expressed concerns about New Zealand's heavy reliance on locums.

Health Minister Tony Ryall said the high West Coast rates were "indicative of the major challenges we inherited, particularly in an area like the West Coast ...

"That's why so much focus is going into training and retaining medical staff, like the [extra] medical school places and the voluntary bonding scheme.

"We have an estimated 300-plus more doctors in the public health service since the election."

The head of the Government's Health Workforce NZ agency, Professor Des Gorman, said the solutions to high locum use included improving co-operation between metropolitan and regional hospitals, and fostering the role of the medical generalist in the regions.

Green Party health spokesman Kevin Hague, a former chief executive of the West Coast DHB, said South Island boards' progress towards greater collaboration on clinical services was "glacial".

The senior doctors' union, the Association of Salaried Medical Specialists, says New Zealand is nearly 10 per cent short of specialists, needing a further 638. To match Australia's number of specialists per capita, New Zealand would need at least 1100 more.

ASMS executive director Ian Powell said New Zealand's over-dependence on locums was costly.

"It's not that they aren't good doctors; they generally are. But it's not the same for patients' continuity of care, and they are not going to be so involved in hospital-wide activities."

He said a trend was for senior doctors to do locum shifts in positions normally filled by resident medical officers after the hospitals had been unable to find a willing RMO.

This appears to be linked to caps imposed by district health boards in March on rates paid to locum RMOs (house officers and registrars) at between $45 and $100 an hour.

HOW IT COMPARES

$2500 a day is $650,000 a year and compares with:
* All Black captain Richie McCaw: About $2300 a day (About $600,000 a year).
* Chief Justice Dame Sian Elias: $1584 a day (Annual salary $412,000).
* Prime Minister John Key: $1511 a day (Annual salary $393,000).
* The average wage: $192 a day ($49,875 a year).
* The minimum wage: $102 a day ($26,520 a year).
All daily rates are calculated on a five-day working week.