Outsourcing more elective surgeries will limit training opportunities for future surgeons, the Health Minister has been warned.

Health New Zealand aimed to perform more than 30,000 elective surgeries in the 15 months to June 2026 in a bid to reduce waitlists, including by outsourcing thousands of more straightforward cases to private hospitals.

Documents obtained by RNZ under the OIA show Health Minister Simeon Brown was told in March that outsourcing more elective operations to private hospitals will worsen training opportunities.

"That's because outsourced procedures are usually of lower complexity, which often makes them suitable for training," Health NZ wrote in a briefing.

Some doctors agree with the ministry's warning.

Hawke's Bay head and neck surgeon Christopher Kennel, who worked in both the public and private sector, said his trainees were already missing out on learning, because the public sector only had the capacity to deal with the most severe cases.

Outsourcing would only make it worse, he said.

"The registrars are already having a biased training towards more complex cases. I don't know how people who go through training here are going to be prepared to function privately because they're not going to have the background to do common, but less urgent cases, because the public system is under-resourced."

To mitigate this, Health NZ was exploring more national agreements to train more doctors in private hospitals, starting with radiology and pathology. Health NZ said significant work was under way to get an agreement for obstetrics and gynaecology, while briefing papers said otorhinolaryngology (ear, nose and throat) and plastic surgery could also be targeted.

Health NZ was also considering making training a requirement of private hospitals' outsourcing contracts.

This raised ethical and practical questions, Dr Kennel said.

"If trainees are helping me earn money privately, then who's paying them?

"Is it fair for the public side to pay them to operate with me privately when registrars could be seeing public patients in clinic instead?

"The other thing is that on any given day when I'm operating privately, I might do a public contract case, and I might treat a privately insured patient. How does the registrar know how to schedule their day? Because if they're going to be with me for like 2 hours of a public contract case, what do they do when I'm operating on just a privately insured patient?"

Auckland radiologist and Auckland University Faculty of Medicine associate professor Colleen Bergin said she wants to see details and assurances on how robust training systems in private hospitals would be.

"There are systems in place in the public hospital, there's a structure. Everyone on that day is involved in teaching those students. But moving to a private system, there's no details on that kind of process."

Orthopedics was the only surgical speciality currently allowed to train doctors in private hospitals nationally, as much of its work was ACC related and done privately. Health New Zealand said it also had training agreements with some specialities at a local level.

New Zealand Orthopedics Association chief executive Andrea Pettett said the 16-month-old scheme was "working extremely well" and a "win-win".

"All parties are very happy with the system. Our trainees are employed by the public hospital and they are released for one or two private runs. They go to the private hospital often with the public surgeon. And it's entirely up to the private surgeon whether they want to train them."

She saw no issue with publicly-paid trainees working in private hospitals, as private surgeons were also giving up their time to teach.

"Obviously in a perfect environment, our public hospitals would be better placed if they could do the full suite of acute and elective surgery, but they can't. So this is a pragmatic way to ensure that New Zealanders get access to elective surgery."

Speciality Trainees of New Zealand president Jordan Tewhaiti-Smith, an obstetrics and gynaecology registrar, was involved in setting up a training agreement between private hospitals and the Royal Australasian College of Obstetrics and Gynaecology.

He expected a deal to be announced soon but there were some details that still needed to be worked through.

"It's making sure we are medico-legally protected in those spaces because public registrars aren't employed by the private sector, so that's a grey area."

Ultimately, allowing private hospitals to train public doctors was a "needs-must" situation, he said.

"These are people that are going to be the future specialists of tomorrow and the people that are operating on you in 5-6 years time. If they aren't trained to a good standard because we've dropped the ball in the public sector then it comes at a cost to everyone.

"Some people might snub their noses at the fact that we're supporting the private sector by outsourcing all these cases, but actually it's a much bigger lens that I think we should look through."

The Royal Australasian College of Surgeons said it was speaking to private hospitals about training future surgeons, but ideally all training would happen in an appropriately resourced public health care system.

In a statement, Health NZ said a pre-requisite of any agreement is that training in private hospitals would not compromise the public system.

"We are working with the private sector towards common expectations for how medico-legal, quality and financial issues are managed, as well as with professional medical colleges and unions to build consensus," Health NZ Clinical Lead Planned Care Derek Sherwood said.

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