Key Points:

A plan to cut 200 resident doctor positions in Auckland means some services will close because senior staff will struggle to take up the slack, critics say.

Auckland's three regional district health boards - which have been struggling to fill the resident positions - want to reduce the jobs by up to 20 per cent and rely on senior doctors and senior nurses to fill the gaps.

According to a document leaked to the Herald, an average turnover of 38 per cent and 160 vacancies means the region needs to recruit 500 resident doctors to achieve full staffing throughout the region this year. While some will come from medical school, not all the positions will be able to be filled.

"The board accepts 500 new starts is not an achievable target. Therefore, the recommendation to reduce positions by 10 per cent to 20 per cent must be implemented sooner rather than later," said the author of the document.

"The board is aware that the reduction in numbers will be extremely difficult to achieve."

In a statement from the three DHBs, Counties Manukau chief medical officer Dr Don Mackie said workforce numbers would not change because senior nurses, doctors and locums were already filling the gaps.

"We want to make sure the paperwork matches the reality," he said.

But in another leaked document the boards' human resources managers admit clinical work now done by the residents will need to be taken up by senior doctors and nurses. In the medium to long term several alternatives, such as physician assistants, will need to be implemented.

The Resident Doctors Association has described the plan as "bureaucratic lunacy".

General secretary Dr Deborah Powell said the problem wasn't a lack of residents to fill the jobs, there were 400 doctors working as locums in Auckland. The problem was that none of them wanted to work as residents because of the pay and conditions the hospitals offered.

"They just can't retain people ... that's their fundamental problem. They are bad employers. We [residents] start on $25 an hour. As a locum we will earn at least four times that.

"But there's a multitude of other problems as well."

Dr Powell said the problem was only in Auckland and the board's inability to fill the positions had already ended some services.

"It's not that these vacancies don't need a doctor in them, they do. To say 'we are going to disestablish the position' isn't going to solve the problem."

Getting rid of the vacant positions, rather than finding solutions to fill them, could cause more closures.

Health Minister Tony Ryall has decided not to intervene, saying it is up to the DHBs to resolve the issue.

But Labour Party deputy leader Annette King said that wasn't good enough, especially given Mr Ryall while in Opposition consistently called for the Government to intervene in DHB issues. "He's the minister, he said a minister should take responsibility - what's he going to do?"