They do not accept the culture of disempowerment at the hospital is the main problem rather than a lack of money, they state in a letter to the Otago Daily Times.
But on Friday night Mr Ryall repeated his view the NHB report "makes it clear that money is not the issue ... the problems are long-standing and revolve around poor culture within the organisation".
The doctors' letter arrived soon after National Health Board deputy director Michael Hundleby and Southern District Health Board chief executive Brian Rousseu made a public attempt at reconciliation over the damning report issued a fortnight ago.
The pair, who issued the statement after a meeting in Dunedin on Friday, said they had agreed that spending any more time "debating the rights and wrongs of the body of the report would detract from focusing on agreeing and implementing those recommendations that would be beneficial to both the DHB and the community it serves".
The letter to the editor, sent by oncologist Associate Prof David Perez, the chairman of the general medical staff, said those senior doctors who spoke to the NHB review committee made it clear that both the issues of disempowerment and a lack of money were important.
The doctors said efforts had been made to empower staff in the past few years, but unfortunately clinical governance "has not flourished, partly because of financial restrictions".
This had led to significant disenchantment.
"Many ideas for improvement, including acquiring modern equipment, required investment but the district health board's prolonged deficit reduction strategy has not allowed for necessary development expenditure," they said.
Fortunately, a few promising initiatives had been supported, such as the recent establishment of a gastrointestinal diseases centre of excellence.
Despite the negative publicity and frustrations about inadequate resources, senior doctors at the hospital had maintained a culture of collegiality and the desire to deliver excellent standards of patient care.
This had been acknowledged in the NHB report which said the hospital functioned better than it should "with these impediments", Prof Perez wrote.
Prof Perez said the doctors supported many of the recommendations in the report and were keen to assist with their implementation.
"However, assertions that the problem is solely a poor culture within the organisation diverts attention from the more important issue, which is longstanding underinvestment in services and infrastructure at Dunedin Hospital."
The doctors who signed the letter were from a range of disciplines and included three professors.
Mr Ryall, in his brief email response to the letter, said the Southern DHB had received an extra $71 million in funding from this Government over the past three years, and a total of $785 million this year.
In the Hundleby-Rousseau joint statement, Mr Rousseau said while he agreed with many of the recommendations, "I am disappointed that the body of the report unfairly targets both clinical and non-clinical leadership of the DHB, who work tirelessly to improve services to our community".
Regarding the accuracy of the report, which has been called into question in some Otago Daily Times coverage, Mr Hundleby acknowledged the report "does contain some matters of fact over which we disagree" but he stood by the recommendations in the report which reflected information in the DHB's own reports.
Mr Rousseau was not prepared to comment further on the issues in the joint statement, nor on the doctors' letter.
Mr Hundleby could not be reached for comment.
It is not clear whether there has been any agreement to alter any factual matters in the report.
The report's recommendations will be discussed by Southern's hospitals' advisory committee in the public session of their meeting in Queenstown next week on Thursday.
Profs John Highton, Rob Walker and John McCall, Assoc Prof David Perez, and Andrew Bowers, Louise Bremmer, Michael Chin, Shaun Costello, Stephanie Farrand, Martyn Fields, James Fulton, Juan Garcia, David Gwynne-Jones, Lisa Horrell, Geoff Laney, Blair McLaren, Neil Morrison, Vic Du Plessis, Hilda Mangos, Ursula O'Sullivan, Ulla Reymann, Michael Schultz, Andre Smith, Mike Stiteley and Mathew Zacharias.
