Registrar doctors were warned to consider applying for positions at other hospitals after the Australian and New Zealand College of Anaesthetists (ANZCA) found John Hunter Hospital was not meeting the recommended number of qualified supervisors - one of the key requirements for training accreditation.

ANZCA visited the hospital's anaesthesia department as part of the routine accreditation process late last year, and conducted a follow up visit about a month ago.

Several sources, who spoke to the Newcastle Herald on condition of anonymity, said the college had initially granted a 12-month "provisional registration" to the hospital to give the health district time to address the shortfall of senior specialists. But warnings to increase senior staff numbers "had been ignored", and staffing problems had become "worse, not better".

One source said there were concerns that trainee anaesthetists were often left to conduct complex surgeries by themselves.

Another source said that following the college's recent follow up inspection, registrars were advised to apply for different hospitals in 2020 as John Hunter would "not be accredited".

"I don't think it was really a patient safety issue," one source said. "While the more senior registrars were being left to do complex cases on their own, they are at the top of their game. They are highly capable, and they can handle anything. But it was impacting on their training and morale. The registrars felt they were missing out on their teaching time, and the college brought it to the attention of the health district in their report last year.

"The college came back to do their inspection a few weeks ago, and nothing had changed. The staffing problems had gotten worse, not better."

A spokesperson said ANZCA required all hospitals providing specialist anaesthesia training in Australia and New Zealand to meet "rigorous" accreditation standards.

Accreditation visits were to ensure trainee anaesthetists received the "best training possible" to deliver a high standard of patient care.

"Part of this process involves interviewing staff and trainees about a broad range of issues," an ANZCA spokesperson said. "One of the key requirements for training accreditation is the provision of the correct number of qualified training supervisors and assessors, roles that are filled by senior specialist anaesthetists."

During its visits to John Hunter Hospital, the college had identified issues regarding supervision and "associated flow on effects" that were impacting on training.

"The college and the hospital's management have been involved in ongoing constructive discussions to ensure that the anaesthesia department continues to appropriately resource senior staffing levels," she said. "This is to guarantee the senior specialist anaesthetists at John Hunter Hospital can continue to meet the ANZCA standards for training and supervising junior doctors training to become specialist anaesthetists."

To date, the college has not removed training accreditation from any hospital.

"Our approach is to assist hospitals to meet the requirements where possible."

ANZCA has now extended the hospital's accreditation from the end of 2019 to the end of 2020 after John Hunter agreed to recruit six additional senior anaesthetists.

"Registrars were kept informed about the process and advised to consider all options."

The hospital's director of medical services, Professor Michael Hensley, said they would remain accredited to deliver training in 2020.

"ANZCA requested the hospital increase senior medical staffing to ensure continued adequate supervision of trainees," he said.

"John Hunter Hospital has already begun recruitment for these additional positions, as well as filling short-term vacancies.

"As the only tertiary referral teaching hospital in Northern NSW, John Hunter Hospital takes its training and supervision obligations very seriously. The hospital works with all relevant colleges to ensure we provide an appropriate training and working environment for staff, while providing excellent care for patients."

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