A new report is critical of the Government's health goals, warning of a potential crisis over a lack of medical specialists.
The Association of Salaried Medical Specialists (ASMS) says the gap between the number of specialists entering the workforce and the number needed grows bigger each year, while retention of workers is getting harder.
In the next five years, nearly a fifth of the specialist workforce could be lost as doctors drop off from age 55.
The report says New Zealand is effectively becoming a medical training ground for other countries. Employing overseas-trained specialists is essential to running the health service, although there is a high turnover rate of those workers.
The ASMS warns that if New Zealand continues on its current path, it will continue to lose many specialists overseas and be heavily reliant on internationally-trained doctors and locums.
Some services will not be clinically or financially viable, and the health system's ability to meet future needs will be seriously limited.
It says clinical leadership can achieve what successive Government's have failed to do and improve hospitals across all services, "not just the selected few targeted by the Government".
While Health Minister Tony Ryall called retaining more specialists his "number one priority" in October 2010, there has been no improvement so far, the report says.
Specialist numbers have increased but not at a great enough rate, the report says, calling for greater engagement and involvement of specialists in health decision-making, and development of clinical leadership.