The wasteful duplication of expertise and training has been identified as a threat to the medical workforce in a review of the health system.
The Simpson review, released yesterday, identified three ways the proposed overhaul would be enabled, which all demand better long-term planning: workforce development; buildings and facilities; and data and digital systems.
The training of doctors in the 17 medical specialisations, that come under 15 medical colleges, is not providing enough specialists across the range.
Some colleges, such as emergency medicine, have no problem recruiting junior doctors while others are constantly short of numbers, including for GPs and in public health which tracks pandemics.
The system was distorted by competition for DHB subsidies and a siloed funding system, according to professor of medicine Des Gorman, who led the government's Health Workforce unit up until it was made a Health Ministry directorate last year.
The training system had resisted all attempts at reform, with his team encountering opposition from the ministry, DHBs, and the colleges themselves, Gorman said.
He said he has no confidence the review will deliver "the sort of meaningful change that we so desperately need".
The implementation of reform is what he doesn't have faith in.
"When they (health reforms) work is when they start off with a bi-partisan approach."
The Simpson review perceives the risks but does not offer a recommendation.
"Our system will not be sustainable unless we change models of care and use the workforce differently," it said.
"While the review does not recommend immediate changes to workforce regulatory structures it notes that there are large numbers of different bodies involved in workforce training and regulation.
"Unless they work effectively together to promote and achieve relevant workforce plans then, in future, some tighter oversight may be required.
"The New Zealand system is too small to duplicate expertise and effort unnecessarily."
Council of Medical Colleges chair John Bonning said it was vital to get an "overarching" plan and coordination of training.
"The bottom line is it's what the community needs and that's what we need to talk about ... how many people we need and where we need them in the country," Dr Bonning said.
"They are quite separate areas of medicine so I don't think there's too many colleges per se," he said.
"We don't need fewer colleges. We need better coordination between the colleges and the Health Workforce Directorate."
Dr Bonning said the colleges would be happy to negotiate for funding if, for instance, the funding system was reformed to put the onus of all health practitioners, including nurses and such, to justify investment in their training from the same pot of money, an investment approach that Prof Gorman has advocated.
"It certainly needs to be nationally coordinated and if that's based around a funding model, then certainly," Dr Bonning said.
However, there were some wild cards.
"There's possibly been a little bit more of a free-for-all in terms of how many people will specialise," he said.
"And it's been driven by some market forces as well, as more and more people go into private practice."
New Zealand was one of the largest importers and exporters of doctors per capita in the world.
Specialists would keep coming here, or returning here, if the health system improved, he said.
"It's more about the quality of our healthcare system and the care we can provide, and the resources and avoidance of burnout ... than it is about salaries.
"But salaries do have something to say about it, given that the the salaries in Australia are significantly more than the salaries in New Zealand for specialists."
Association of Salaried Medical Specialists executive director Sarah Dalton said the new centralised agencies, Health NZ and the Māori Health Authority, were welcome, as was the push for longer-term workforce planning which she said has been "sadly lacking".
However she had doubts that having having fewer DHBs would necessarily improve the quality of clinically-led decison-making "if the doctors and dentists are further away from the decision-makers".
"[Doctors] are pleased about the centre picking up responsibility for key things like major assets, health IT, workforce planning, and I think our members will be pleased that the review panel have said there's an important place for unions to play and that the tripartite relationship already in place need to be reinvigorated."
Dalton said current staffing would not allow for the suggestion that hospitals should work extended hours.