Guest Post: New Zealand’s Doctor Shortage Isn’t Real—It’s a Policy Failure

A guest post on Kiwiblog by Marley Joseph:

New Zealand’s public hospitals are facing a doctor shortage, yet Health New Zealand—the bureaucratic body overseeing our public health system—continues to artificially limit the number of hospital internship positions available to newly qualified doctors. Without these placements, graduates cannot gain full registration and are effectively locked out of the workforce. Meanwhile, instead of hiring more permanent staff, hospitals are forcing already overworked junior doctors to take on unsafe levels of extra shifts just to keep the system running. This isn’t a funding issue—it’s a case of government mismanagement and poor workforce planning that is burning out staff and driving talented doctors overseas.

Finishing medical school doesn’t make someone a practising doctor. After years of study, graduates must complete a two-year hospital internship (PGY1 & PGY2) before they can work independently. Health New Zealand controls how many internship positions are available each year, yet despite hospitals constantly reporting shortages, these placements haven’t kept pace with demand. In 2024, 563 new doctors were ready to start work, but 25 were left in limbo due to a cap on internship positions. Even worse, hospitals rarely advertise new PGY1 positions—openings only occur when an overworked junior doctor resigns. If there’s truly a shortage, why aren’t more permanent roles being created? Meanwhile, hospitals claim they can’t find enough staff.

With hospitals refusing to create permanent positions, the burden falls on existing junior doctors, who are forced to work extra shifts and take on additional responsibilities just to keep services running. Instead of hiring more staff, hospitals rely on a broken system—expecting junior doctors to not only do their own jobs but also cover the duties of missing colleagues. This means that during the day, a single doctor might be responsible for twice the number of patients because no one else is available. After hours, hospitals often don’t have enough staff on duty, so exhausted doctors are called back in from home or coerced to stay long past their scheduled shifts. Across four separate weeks in 2023 (Week 6 of each quarter), Auckland’s major hospitals spent nearly $2 million on 2,900 of these additional shifts, adding up to 17,500 hours of extra work. If that trend continued across the year, it suggests Auckland alone is short by around 110 full-time junior doctors (RMOs), costing taxpayers an estimated $26 million annually in temporary staffing fees. To put this into perspective, $26 million could fund the salaries of more than 300 full-time junior doctors each year, providing continuity of care and reducing burnout. Instead of investing in a permanent workforce, Health New Zealand is funnelling taxpayer dollars into a revolving door of emergency shift cover—an approach that neither fixes the crisis nor provides sustainable care for patients. And this is just Auckland—it doesn’t include rural or regional hospitals, where shortages are often even worse.

Nor does it account for the growing deficit of Senior Medical Officers (SMOs), meaning junior doctors are increasingly left to manage complex cases without proper supervision. While some may argue that a lack of supervisors limits the number of junior doctors that can be trained, the reality is that failing to expand these positions only worsens the SMO shortage long-term. A sustainable workforce starts by ensuring a steady pipeline of trained doctors who, with experience, can relieve the burden on senior staff—rather than forcing them to pick up the slack left by chronic understaffing. All that money goes toward patching holes rather than developing a stable workforce. If we continue down this path, costs will only balloon further, and the shortage will worsen. So why does Health New Zealand continue throwing millions at a short-term fix while refusing to create the permanent roles that would solve the problem?

If funding isn’t the problem, then why is Health New Zealand still refusing to expand training positions? Year after year, it chooses to fund emergency shifts instead of creating the permanent jobs hospitals desperately need. Rather than addressing the workforce crisis, policymakers seem more comfortable maintaining the status quo—even as the costs of inaction keep rising. Hospitals claim they can’t find enough doctors, yet bureaucratic red tape continues to block qualified graduates from entering the workforce. Meanwhile, private locum agencies thrive on these inefficiencies, profiting from a system designed to fail. It’s unclear whether this is the result of poor workforce planning, bureaucratic inertia, or a system that has become financially dependent on short-term staffing solutions. With multiple key Health NZ executives resigning in recent months, it seems even those in charge don’t have a clear strategy. But what is clear is that this crisis isn’t being fixed—and taxpayers, patients, and frontline doctors are paying the price.

This workforce crisis isn’t just affecting local graduates—it’s also trapping foreign-trained doctors in limbo. New Zealand recently doubled the number of exam slots for internationally trained doctors (NZREX) from 90 to 180 per year, promising a pathway for them to work in our health system. But there’s a catch — Health New Zealand hasn’t expanded the number of internship placements they need to become fully registered. The result? We have built a system that is failing from both ends—turning away new Kiwi doctors while simultaneously inviting foreign-trained doctors to New Zealand with no clear path to employment. EInstead of solving the workforce crisis, we are actively worsening it. Many of doctors who have passed every required exam but remain unable to work—just like many Kiwi graduates. Instead of strengthening our health system, this failure has created a bottleneck where both locally and internationally trained doctors are being shut out while hospitals continue to struggle with staff shortages. It’s a baffling contradiction—our healthcare system is crying out for doctors, yet government inaction is keeping them on the sidelines.

This crisis isn’t just about numbers—it’s about real people, both doctors and patients. When hospitals don’t have enough staff, doctors are forced to work back-to-back shifts with little rest. Fatigue leads to mistakes, slower response times, and missed diagnoses. Patients wait longer for care, and avoidable complications become more common. Hospitals are meant to be places of healing, but instead, they are running on desperation. Junior doctors, instead of learning and developing under proper supervision, are being stretched to their limits, covering chronic staff shortages with little support. Every resignation due to burnout forces remaining staff to work even harder, pushing more doctors to leave. It’s a vicious cycle that only gets worse with time.

Meanwhile, New Zealand-trained doctors, unable to secure placements at home, are heading overseas for better opportunities. These are doctors taxpayers have invested in, but instead of serving our communities, they are now treating patients in Australia, countries that recognise their value. If we keep losing doctors faster than we replace them, New Zealand’s healthcare system will be permanently crippled.

The solution is simple: let trained doctors work. Instead of wasting millions each year on emergency shift cover, that money should be redirected towards permanent positions that build a stable workforce. Expanding junior doctor placements isn’t just the right thing to do—it’s the most cost-effective and practical way to fix the shortage. Every dollar spent on short-term fixes could instead be used to train and retain doctors who will stay in New Zealand long-term. Likewise, if we are inviting more foreign-trained doctors to sit NZREX, we must guarantee a clear pathway to full registration. Otherwise, we’re just inflating numbers on paper while hospitals remain critically understaffed. The bottleneck isn’t a lack of qualified doctors—it’s Health New Zealand’s refusal to provide them with the final step they need to work. We already have the doctors. We already have the funding. If there were truly no capacity to train more junior doctors, hospitals wouldn’t be spending millions on emergency shift cover year after year. The system has found a way to fund reactive, short-term fixes—so why can’t it fund proactive, long-term solutions? The only thing missing is the political will to remove the barriers keeping them from serving our communities. If Health New Zealand continues down this path, the crisis will only escalate—more burnout, more resignations, and more Kiwi doctors choosing to leave for better opportunities overseas.New Zealand invests heavily in training doctors, expecting them to serve our communities. Yet Health New Zealand is actively blocking them from doing so—wasting taxpayer money on short-term fixes while letting homegrown talent walk out the door. Patients wait longer, doctors burn out, and our hospitals become increasingly reliant on expensive, unsustainable stopgaps. This is a manufactured crisis. We don’t have a doctor shortage—we have a policy failure. The solution is staring us in the face: expand the number of internship placements, give new graduates a clear pathway into the workforce, and stop throwing millions at temporary fixes. If Health New Zealand can afford to spend $26 million per year patching holes in Auckland alone, it can afford to train and retain the doctors we already have. The longer this inaction continues, the greater the damage will be. More doctors will leave, patient care will suffer, and the system will spiral deeper into crisis. Health New Zealand must be held accountable for these failures—and it’s time for the government to step in and demand urgent reform. If we genuinely want to fix our hospitals, we must stop blocking the very people who can save them.

Marley Jospeh graduated MBChB in 2022.