Thousands of senior hospital doctors and dentists have walked off the job today for the third time over stalled pay talks.
Te Whatu Ora/ Health New Zealand said today's action meant 250 patient procedures and specialist appointments would be postponed.
Last week, the health agency said it had put a fair deal on the table, but the Association of Salaried Medical Specialists argued the increase on offer of $15,000 to $26,000 failed to keep up with inflation.
In Auckland, senior doctors and dentists gathered for four hours in the Auckland Domain to protest for better work conditions.
Emergency physician at Middlemore Hospital Sylvia Boys said the sector had had enough.
"We are over the progressive rundown of our public hospital system.
"There are not enough of us. There are not enough resources, and we spend every day apologising to patients rather than treating their needs and watching patients deteriorate, when we can't provide what they need," Boys said.
"It is utterly demoralising."
More health specialists were moving to Australia seeking better salaries, leaving the health sector in New Zealand crumbling, Boys said.
"We all know that salaries both in the private [sector] and in Australia are so much higher.
"We are progressively losing our colleagues and all the new doctors that we're training into specialists are progressively going overseas," he said.
Oral medicine specialist at Auckland Hospital Hadleigh Clark said health specialists inside hospitals were the ambulance at the bottom of the cliff.
"We definitely do have a crisis on our hands here. If we do not retain our senior doctors and dentists, it's just going to spell disaster for our healthcare system," Clark said.
"I have literally just said good-bye to two of my paediatric dental colleagues who head overseas and actually, it's not just about pay, it's about working conditions and that's why we're all out here today."
He said free dental care policies presented by the Green and Labour parties would not solve the crises inside hospitals.
"It is good that we are talking about free dental care, but we need to get those services inside the hospitals back on track first, by making sure that we're paying our doctors and dentists properly and that we're actually funding services to make them safe."
Professionals distressed and despondent - psychiatrist
Working in the Waitematā area, psychiatrist Andrew Turbott said professionals were not being replaced as fast as they were leaving the workforce.
"I joined the team last year and since I joined 10 people have left, but the trouble is that they're not being replaced in the numbers that they're leaving, so we're gradually eroding away.
"Hospital health professionals are distressed and despondent," Turbott said.
Forensic psychiatrist Yvette Kelly said wait lists to get hospital care increased almost 400 percent over recent months.
"We are used to have wait lists of maybe five or six people in our hospital. Now they're going into the 20, sometimes up to 30.
"We have a system where we red-flag people that have been waiting too long. It's been so bad that we've now got a black-flag system, which I'd never personally seen before," Kelly said.
Patients inside jail with critical mental health issues were waiting up to three months to see a specialist, she said.
"We are talking about severely mentally unwell people sitting in prison for three months waiting for a mental health bed.
"And when I say severely mentally unwell, I'm talking hearing voices, I'm talking trying to kill themselves or smearing faeces on the wall, because they can't even string a sentence together."
Kelly said low salaries and the high cost of living were driving away health professionals.
"I worked in Australia as a junior doctor, and I knew I was taking a $100,000 pay cut to move back to New Zealand as a senior medical officer."
Anaesthetist Vincent Fong went to the protest to support his colleagues.
He said getting a pathology test done in Auckland was taking up to three weeks, due to a lack of specialists.
"There are not enough pathologists in Auckland, and the reason is because Auckland is too expensive to live and their salaries don't match up, which is a shocker really.
"If you want people to work to the fullest and be enthusiastic about working in the public system, you've just got to reward them," Fong said.
Te Whatu Ora 'disrespectful and insulting' - Association
Association of Salaried Medical Specialists president Julian Vyas said without better work conditions, the recruitment of new health professionals would prove difficult.
"We need 1700 doctors across the board - GP trainees and specialists - and Te Whatu Ora does not have a plan for increasing recruitment.
"Our members look across the ditch and see increased pay rates, less risk or burnout, and the fact that in Australia they wouldn't need to make difficult decisions, such as which patient gets the resources available," Vyas said.
Health professionals want more than verbal recognition from Te Whatu Ora.
"People want something to change and those that are responsible for that change don't appear to have done anything more than simply say "oh, we value you".
"But in reality, they treat professionals in ways that I think is disrespectful and insulting," Vyas said.
The government's initiative of training more doctors would not guarantee a better workforce.
"Those new students would take 15 years to come through to be specialists like these people here today and it is quite likely they're going to say, 'well, I've done my training, but I can earn twice as much over there'.
"So, we might be training people for further exodus."
'Doing all we can' - Te Whatu Ora
Through a statement, Te Whatu Ora interim national chief medical officer Nick Baker thanked patients and staff for their understanding during today's strike.
"We acknowledge these events can be disruptive and may cause anxiety but want to ensure the public that patient safety is our utmost priority.
"Emergency departments remained open during the strike and care was maintained for patients. Our bookings teams are working to reschedule the approximate 250 planned care procedures and outpatient appointments that had to be deferred."
Baker said the health agency was doing all it could to resolve the dispute and reach a settlement.
"Te Whatu Ora remains committed to doing all we can to resolve the dispute with the Association of Salaried Medical Specialists.
"We made an application to the Employment Relations Authority yesterday for facilitated bargaining, to help the parties reach a settlement."