New Zealand Orthopaedic Association president Simon Hadlow said the organisation’s major concern was the lack of public-sector jobs available for young specialists.
This comes as the health system seeks to outsource an estimated 357 orthopaedic procedures annually in Southern, where new data shows Dunedin Hospital patients are routinely waiting longer then government targets.
Mr Hadlow said while he was happy with the trainee pipeline, if the health system did not fund more jobs it risked specialists choosing to work in countries such as Australia and Canada rather than New Zealand.
The association was pushing Health New Zealand Te Whatu Ora (HNZ) for an increase in full-time equivalent (FTE) roles, and a working group had been formed aimed at widening the provision of spinal surgery.
Resources such as theatres and other health staff also needed to be in place — it was not simply a question of the number of orthopaedic surgeons.
"Certainly we could do with more in the public hospitals.
"I know at the moment that people that are in the public hospitals have barely enough resources to do what they need to do."
Orthopaedics tended to be outsourced more than other areas because it was by and large a discretionary type of surgery, dealing with joint arthritis and spinal conditions rather than cancers and life-and-death situations.
Hospitals were straining to deal with acute, or unplanned, services, he said.
One factor was the knock-on effect of the GP shortage and the deterioration of primary care, causing people whose diabetes or heart conditions had not been properly managed to need hospital care.
Only 12% of public hospital beds were available for for elective surgery, compared with full availability in the private sector.
"It’s important not just to look at orthopaedics in isolation but look at the the other pressures which are on the whole health system — that stems right back to primary care."
Southern group director of operations Hamish Brown said Dunedin Hospital had 10.8 FTE orthopaedic surgeons, although it was budgeted to have 8.7 FTE.
"We are currently over our FTE due to succession planning for the service", he said.
Despite this, in many instances patients were not being seen within the government’s target timeframes.
There were 1191 people on the hospital’s waiting list for orthopaedic surgery, Mr Brown said.
While government targets state treatment should be provided within four months of being waitlisted, a majority of 705 people had already waited longer than this.
The median waiting time for orthopaedic surgery was 164 days, or more than five months.
People were also routinely waiting longer than the four-month target for a first specialist assessment after referral.
For the 698 people waiting for their first orthopaedic assessment, the median waiting time was 177 days, or almost six months.
Mr Brown said HNZ sympathised with patients facing health challenges waiting for elective surgery.
"We encourage anyone with concerns or changes in their condition to reach out to their GP or referring team in the first instance.
"The waiting list is reviewed frequently, and we are outsourcing some planned care.
"Outsourcing is on a case-by-case basis.
"This includes meeting the criteria for outsourcing including the patient’s medical history, the patient’s location, length of time on the waiting list and availability of services."
HNZ is seeking to outsource surgeries to the private sector, as reported by the ODT last week.
Its request for proposals stated the heath system did "not have the capacity to provide all the surgical services needed to meet the current demand".
The plan estimates thousands of procedures would be outsourced annually, encompassing 11 regions and multiple specialties.
Orthopaedics topped the list both in Southern, where 357 procedures would be outsourced, and overall, with a total of 2950 procedures set to be outsourced.
