The Waitemata District Health Board is so short of doctors it has had to consider stopping admission of acutely unwell patients to one of its main services.
A second service, also struggling to retain staff, has had to close the door to new acute patients twice in recent weeks, diverting
them to Auckland City Hospital.
And a third, the emergency care centre at Waitakere Hospital, has had to extend its nightly early-closing by three months.
Waitemata's problems are part of a national shortage of resident medical officers - house officers and registrars.
The Resident Doctors' Association says shortages of doctors put patients' lives at risk, but the DHB maintains its services, although under stress, are safe.
Shifts are covered by high-cost locums or permanent staff doing extra duties, or if staffing levels fall too low, a service is temporarily closed to new patients, as has happened with the acute gynaecology service at North Shore Hospital.
Association general secretary Deborah Powell said yesterday that Waitemata, serving more than 500,000 residents in north and west Auckland, was the health board worst-hit by the shortage of house officers and registrars (specialists-in-training).
The Auckland region had a vacancy rate of 26 per cent - 236 of the 900 positions were unfilled.
"The vacancy crisis is getting worse. They are acknowledging they have a crisis at Waitemata, which is something. DHBs are still refusing to address their retention crisis."
She said pay needed to rise and DHBs had to make it easier for doctors to work as permanent part-timers.
Waitemata says its vacancy rate for registrars in the adult general medicine service has hit 40 per cent .
"General medicine" provides non-surgical treatment for people with conditions including heart failure, pneumonia and stroke.
"Further resignations are expected, which would call into question the ability to admit acutely at both hospitals," board papers say.
"Temporary consolidation into a single acute site is considered an option of last resort, but may be unavoidable, given the high and increasing level of medical registrar vacancies."
If this occurred, Waitemata would admit acutely ill medical patients only to North Shore Hospital. Only once they had stabilised would they be transferred to Waitakere Hospital.
This would be a further down-grading of Waitakere Hospital, after its emergency care department's closing time for walk-in patients was changed in December from 10pm, to 6.30pm, because of a shortage of mid-grade doctors.
The board's general manager of adult health services, Andrew Potts, said that although closing Waitakere to acute medical admissions had been flagged to a board committee, "at this stage we don't expect we would have to invoke that contingency measure". Although two more registrars would leave this month, "there will be some more appointments".
The obstetrics and gynaecology department has no house officers and North Shore Hospital's acute gynaecology service has been closed twice in recent weeks when fill-in staff could not be found to ensure safe staffing levels.
Health Minister Tony Ryall said: "This is part of what we have inherited. There is real pressure in many parts of the country in the doctor workforce."
The Government was implementing medium-to-long-term solutions.
THE NUMBERS
Auckland region
* Requires 900 house officers and registrars
* Currently employs 664
* Staff shortfall 26 per cent.
Critical shortages
* Waitemata DHB adult medical registrars - 40 per cent shortfall
* Obstetrics and gynaecology house officers - 100 per cent shortfall
Waitakere's Hospital emergency department has cut its hours.
The Waitemata District Health Board is so short of doctors it has had to consider stopping admission of acutely unwell patients to one of its main services.
A second service, also struggling to retain staff, has had to close the door to new acute patients twice in recent weeks, diverting
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