Senior doctors say a doctor shortage means they lack the time to contribute to improvements in public hospitals.
The union representing senior doctors has released findings of a survey it conducted of its members working for district health boards.
The survey asked doctors whether they have time, on top of their normal duties, for other clinical leadership work focussed on improving care and reducing wastage.
Ian Powell of the Association of Salaried Medical Specialists says 1500 doctors replied, a 43 percent response rate.
He says the average grade for having doctors in positions of wider clinical leadership is an E.
"Now that's not good, over half the DHBs get a grade of an E, no one gets an A and one gets a B - not a good situation."
He says just 37% said they had time for the extra role.
Lakes DHB in Rotorua got the highest score at B minus, followed by Tairawhiti and Nelson-Marlborough on Cs, with all others receiving a D or E grade.
