District Health Boards are rejecting claims they run a top-heavy leadership and are preoccupied with targets they set.
In a paper delivered at an Australian Medical Association meeting in Canberra on Thursday, the Association of Salaried Medical Specialists, a union representing senior hospital doctors, has targeted the Auckland, Waitemata and Southern DHBs.
Executive director Ian Powell said poor leadership and a preoccupation with targets within the DHBs is causing problems.
He said leadership styles at the DHBs could be described as autocratic and the way they operate puts the public at risk.
Auckland and Waitemata DHB chairman Lester Levy said Mr Powell's comments are out of date as the organisation has already made changes to structure and management.
Dr Levy said the organisation's priority is to the patients before anything or anyone else - including medical practitioners.
Southern DHB chairman Joe Butterfield rejected Mr Powell's claim that the merging of the Otago and Southland DHBs has not worked.
"Of course there are tensions and there are difficulties, but that's to be expected, but on the whole the benefits that were foreseen in the merger are occurring."
Mr Butterfield said leadership within the organisation is strong and he does not accept Mr Powell's criticism that it is top-heavy.