Junior doctors are being encouraged to "dob in" their bosses if senior clinicians refuse to come into work to assist while on-call overnight.
The New Zealand Resident Doctors Association (NZRDA) told the Herald it was aware of this "dangerous behaviour", citing cases where one or two junior doctors - some only a year out of medical school - were left running the emergency department unsupervised.
One of the biggest problems was junior doctors were often hesitant to report it because they feared for their career.
A junior doctor who worked at Wairarapa Hospital - and asked not to be named - said he often worried about someone dying under his watch because he didn't have the necessary experience . He was aware of "horror stories" of working the ED night shift alone.
"I would frequently be thinking, 'What's going to come through those doors that I'm not going to be equipped to deal with'."
Casey* said he knew situations where junior doctors working the ED night shift had called their senior on-call boss and specifically said "I want you to come in" and the boss refused.
"The important thing to stress here is that emergency medicine is a speciality of its own so to be staffing doctors that do not have that training is dangerous and unsafe," he said.
National Chief Medical Office chair Ken Clark said the national standard was a senior doctor must be available to assist a junior doctor over the phone immediately and if on-call and be able to come in within 10 to 15 minutes.
Wairarapa DHB spokeswoman Anna Cardno said a senior doctor may, on hearing the RMO's [junior doctor] description of a patient case, determine that their presence was not required and would advise the RMO accordingly.
"If an SMO [senior doctor] determines that the situation described is within the RMO's own ability and scope of practice, and does not require senior clinical presence, they may choose not to come into the hospital and instead opt to provide appropriate support by phone," Cardno said.
NZRDA national secretary Deborah Powell said the problem was junior doctors had less experience -
"If you don't know, how do you know to call for help."
She said there was immense pressure on junior doctors to see, treat and discharge. Patients could be sent home when an inexperienced doctor did not realise something more serious was happening. These issues were particularly bad in smaller hospitals.
"When we hear about it we take it up as an urgent matter with DHBs and they usually respond quickly, but it requires the RMO to dob in their supervisor who may be responsible for signing them off as competent at the end of the run," Powell said.
"Without someone immediately available to review the patient these mistakes can happen and this is a concern, not just to NZRDA but every junior doctor working in ED, none of whom want to make such a mistake."
Senior doctor Yoojin Na, who left Whanganui DHB on Friday to move back to the US, said it was common for junior doctors straight out of medical school to work the ED night shift without any on-site supervision.
"An overwhelmed and rushed junior doctor may miss a potentially life-threatening, time-sensitive diagnosis. It's difficult to think critically when one is constantly bombarded, which is sometimes what happens overnight," Na said.
She feared it was just a matter of time before a patient died as a result.
Whanganui DHB introduced the Government's new Schedule 10 safer staffing rosters late last month. This meant RDAs worked no more than 10 consecutive days and four consecutive night shifts.
However, Na said there were still issues that had not been addressed.
"We now have two RMOs overnight most nights but not always. However, even when there are two, if there is a c-section or delivery, the second RMO gets called away leaving only one RMO by themself."
While Whanganui DHB confirmed the number of RMOs had increased, Na said management refused to employ more SMOs to train them.
"This has been hugely disappointing, as yes it's great to have more junior doctors but training them adds to our workload and how could we be expected to manage that on top of our already hectic schedules."
Whanganui DHB chief medical officer Frank Rawlinson said the board did not agree that there was a insufficient number of SMOs to support the junior doctors.
"RMO numbers were increased in ED overnight as much as staffing allowed in the three months leading up to the implementation of the new rosters.
"These RMOs are supported by an ED consultant who is on-duty till midnight and on-call till 7.30am, as well as on-call consultants from all other specialities."
The situation comes amid concerns for a "serious shortage of senior doctors" nationwide.
Unions - NZRDA, Association of Salaried Medical Specialists (ASMS) and New Zealand Medical Association (NZMA) - have urged the Health Minister David Clark for an accord on the issue.
Clark said he would keep working with both the ASMS and DHBs to improve workforce sustainability .
"While, I'm not yet convinced that an accord would be the silver bullet if all parties came to me with a solution of course I would support it," Clark said.