Middlemore Hospital: Leaked letters reveal doctors warning need to stop teaching junior doctors

Senior doctors express concerns over "current crisis" at New Zealand's biggest hospital. Photo /Michael Craig

Senior doctors warn the situation at Middlemore Hospital is so dire they should stop teaching medical students and junior doctors as it's an unsafe environment, leaked letters reveal.

On Monday, a damning independent inquiry into the death of a "healthy" 50-year-old woman in June described the South Auckland Hospital as dysfunctional, overcrowded and unsafe.

Following that report, the Herald has been leaked two letters signed by 60 physicians, working in general medicine at Middlemore Hospital, alerting various health bodies they're at breaking point.

On October 7, the group of doctors sent a letter to the Royal Australasian College of Physicians (RACP) - which is the organisation responsible for training and educating physicians.

They expressed concerns over the "current crisis" at New Zealand's biggest hospital and the lack of action from management and Health New Zealand to address it.

"We believe the department is no longer able to provide a suitable training environment for both basic and advanced trainees and request urgent consideration by the college to revoking Middlemore Hospital's training accreditation in general medicine," the letter said.

Doctors said the hospital's general medicine service, which was chronically underfunded and understaffed, bore the brunt of the Covid pandemic and was now experiencing extreme consequences.

"We have given everything we have to provide care to our patients despite unprecedented staff shortages and the inevitable consequences of burnout, illness, and moral injury."

In the letter, doctors said there was significant erosion of their ability to provide high-quality clinical supervision to general medical trainees.

Junior doctors' access to protected teaching time is non-existent and outpatient clinics are regularly sacrificed due to acute service workload, the letter said.

There is widespread senior and junior doctor dissatisfaction with the situation which does not enable the next generation of physicians to receive satisfactory training, the letter said.

"Ultimately, this entire situation is bad for our trainees, SMOs and patients.

"We, the undersigned, therefore ask the Royal Australasian College of Physicians and relevant committees to urgently review to revoke Middlemore Hospital's General Medicine training accreditation," the letter said.

RACP was expected to visit Middlemore Hospital in two weeks as part of a periodic check to ensure the teaching environment was safe. The Herald understands this letter will be considered on that visit.

The Herald made several attempts to contact RACP for comment but did not get a response.

Association of Salaried Medical Specialists (ASMS)'s executive director Sarah Dalton. Photo/ Supplied

Association of Salaried Medical Specialists (ASMS)'s executive director Sarah Dalton said it was "highly unusual" for a group of senior doctors to come together and say please pull our accreditation.

"That's a bit like turkeys calling for Christmas ... it's a terrible space to be in and it speaks to their feelings that they are failing on their moral and professional obligations."

The senior doctors' union leader said the risk long-term of not teaching a cohort of doctors would be huge for New Zealand.

Dalton said at the heart of this was a collective forgetfulness that one of the core functions of our public hospitals is to teach and train.

"We have run them down so much in terms of staffing that teaching is next to impossible now.

"Middlemore is a really compelling case study for how bad it can get," Dalton said.

Earlier, on September 27, the group of doctors sent a separate letter to the interim executive leadership team of Te Whatu Ora Counties Manukau concerning inequal additional duty rates.

This leaked letter said senior doctors working in general medicine at Middlemore Hospital were paid significantly less for picking up extra shifts compared to those working the same roles at other Auckland hospitals.

If general medicine senior doctors worked extra shifts at Auckland City Hospital, they could get a minimum $182-$236 per hour. If they worked at Waitematā general medicine, they got at least $170-$200 per hour. But if they worked at Middlemore, it was likely to be closer to $150 an hour.

"We are one of the busiest general medicine departments in New Zealand," the letter said.

Senior doctors express concerns over "current crisis" at New Zealand's biggest hospital. Photo /Michael Craig

Dalton said appropriate remuneration wouldn't fix the problem but it would at least acknowledge the severe strain they are under and help make the profession more attractive to build workforce shortages.

In response to this letter, Te Whatu Ora Counties Manukau clinical leadership met with the general medicine leadership and agreed to back-pay additional duty rates worked over the winter period to match other hospitals.

However, one doctor told the Herald his team were worried this was a temporary fix and was not a long-term solution.

A Health New Zealand spokeswoman said the service was actively working to address workforce shortages and had employed six more junior doctors, with a
"business case" for 15 more being developed.

"In addition, a model of care review is in progress with a directive to ensure regional/national consistency," she said.

Monday's inquiry report expressed "serious concerns" about the degree of overcrowding in the ED, which it said was an indicator of significant systemic failures and "it is clear that this institution is struggling".

"The evidence provided to me strongly reflects an overcrowded ED, a hospital well over acceptable capacity and subsequent system dysfunction," the report said.

"This is an unsafe environment for both patients and staff and is not sustainable."