Australia's most populous state is accused of abandoning mental health patients by failing to meet pay demands to retain psychiatrists.
The NSW government has conceded some 200 psychiatrists have resigned - about half the workforce - due to pay negotiations stalling and the growing pressure of staff shortages.
Health Minister Ryan Park admitted the mass resignation will have an impact across the system, not just on mental health patients.
However, the government will not agree to the 25 per cent pay increase demand which Mr Park says adds up to an extra $90,000 on each salary.
Mr Park said the government simply cannot afford to pay the healthcare professionals so much.
"To have a wage increase of 25 per cent on an individual who's earning multiple hundreds of thousands of dollars a year is substantial for any government of any political persuasion, and that is simply not possible," he said.
He has begged the state's psychiatrists to reconsider their resignations or any who are yet to hand in their notices to think again.
"Please don't do this, remain at the table, don't do this to patients, don't do this to the healthcare system that I know you love and support, don't do this to your colleagues who I know you value and trust," he told reporters.
A health union said the government has refused to budge in pay negotiations that would help address the growing staff shortages, where one in three psychiatrist positions remains unfilled.
“Instead of dealing with the underlying problem of staff retention and attraction, the Minister for Health seems happy to throw mental health patients, the psychiatry workforce, and doctors in training in NSW under the bus," said Ian Lisser, acting executive director of the Australian Salaried Medical Officers Federation (ASMOF) NSW, the doctors' union.
The union said psychiatrists do not want to resign but have been left with little choice when the government cannot match a salary given in other states.
"(Psychiatrists) have been working in a crumbling system for months, they have been telling Ryan Park the situation is untenable, and now they have been backed into the corner," Mr Lisser said.
As negotiations falter, NSW Health secretary Susan Pearce said the department has been putting contingencies in place for the mass resignation.
This includes engaging with private providers, speaking with the Health Direct service, looking at the Mental Health Line capacity and adjusting workforce models across the state.
However, Ms Pearce remains concerned that 200 resignations will significantly impact the state.
"Despite the plans that we have in place it is very difficult to overnight replace 200 psychiatrists," she said.
The pay dispute is expected to be negotiated in the Industrial Relations Commission next week.
