Table 4. Summary of qualitative responses.

Theme	Examples
Poor staffing, management and resourcing	“Ongoing worsening shortage of staff - worst at the junior level, that is greatly impacting all hospitals, all departments and all current doctors… It impacts morale and is causing burnout.”“Chronic understaffing - causes difficulties within teams and for transferring care to community, with patients not being picked up.”“Overworked with inadequate staffing, even when all staff are present. Frequent vacancies with no relievers to cover night shifts, sickness, or leave.”“Under-resourced almost universally. The healthcare system is in complete disarray, and the whole system seems broken.”“Same mistakes being made in the health system in NZ as were made in Ireland 10–15 years ago.”“If the working conditions [continue to] deteriorate to a level approaching those in (Ireland/the UK), many doctors from the UK and Ireland will leave despite being permanent residents/citizens as there is no longer an incentive to stay. Australia is a realistic and attractive alternative.”“Management is entirely incompetent, changes almost monthly and is oblivious to the realities of [resident doctor] work.”“The medical registrar night shifts at our large, tertiary hospital are quite distressing to cover due to the extremely long wait that most of the patients have had in our ED by the time they are seen, and also the shortage of nurses to monitor them/commence treatment while they are in the waiting room.”
Inadequate support	“I feel that some of the lack of support comes from the SMOs* being burnt out.”“Unsupportive environment. Department runs by service manager who also managing other bigger departments hence the needs of my department is sacrificed.”“I feel poorly supported. Work is busy but would be manageable if better supported.”“Not having enough SMOs* in the department puts a lot of extra stress on [registrars] and takes away from our training opportunities. Te Whatu Ora really needs to focus on filling SMO* roles to maintain trainee health and encourage trainees to return as consultants.”
Inadequate remuneration	“Far too little pay… taking into account the training required and the nature of the work… it seems ridiculous that a doctor would struggle to pay for ordinary day-to-day expenses and yet here we are.”“I feel like my life is 99% work, hardly anything otherwise, yet financially struggling to meet day-to-day expenses, mortgage, childcare…”“I feel completely undervalued as my remuneration is a joke…Why would anyone return to the public health care system [as a consultant] under these conditions instead of working overseas or exclusively in private?”“Grossly underpaid for the hours done… it’s absolute madness & soul destroying.”“Working in Australia really opened my eyes to the pay discrepancy here.”“Income hasn't kept up with cost of living.”“The current hourly pay rates just make what is asked of us not worth it. Am seriously considering other careers.”
Difficulty getting on to surgical training	“I feel like my life is on hold until I get onto training and work feels like an extended job interview for the last 4 years.”“Stress about trying to get onto SET† training.”“I have previously experienced burnout as a junior registrar … Not having job security or guidance was a massive factor, as was the pressure of effectively having a multi-year job interview process [for surgical training] with little feedback and support.”
Balancing workload, family and examinations	“Training program not sympathetic to family needs and no good job prospects at the end of training. Makes me regret choosing medicine.”“Just feel like there’s too much to keep on top of. Working 60 hour weeks, studying 20 hour weeks for exams.”“Working full time and studying for specialty exams is verging on impossible.”“Currently studying for part 2 exams and feeling slightly resentful that my Australian counterparts work significantly fewer hours and have significantly more time for self-care and study while being paid more.”“I feel very undervalued in general… I also feel angry at the significant time (hundreds of hours!) I spend out of work studying for exams.”
Service provision over education and training	“Busier each day with limited learning/training opportunities due to service provision.”“95% service provision with no protected time for learning.”“Interest in junior registrars careers is very low and the focus is on service provision.”“(Specialty) training in [location] is about service provision, not about training registrars.”“No time for project work, no time to attend teaching.”“We have only had a handful of the weekly teaching sessions we are meant to have due to the high clinical workload and short staffing.”

^*SMO refers to a Senior Medical Officer or Consultant Physician or Surgeon. This is equivalent to the term ‘Attending Physician’ in the United StatesUSA.

^†SET Training refers to any of the nine surgical training programsprogrammes overseen by the Royal Australasian College of Surgeons, the training body for surgeons in Australia and New Zealand.