Spending on temporary doctors and consultants to cover gaps on wards has rocketed, with the bill on course to rise to almost £60 million this year.
If the current trend continues, an extra £7.7m will be spent on medical locums this financial year – a 15% increase on 2011-12. This is despite spending watchdog Audit Scotland highlighting that hospitals were increasingly relying on locum doctors more than two years ago.
Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: "There are clear signs that the NHS is struggling to recruit into a number of the medical specialities in Scottish hospitals, with competition ratios for advertised posts down and a number of posts, at both consultant and trainee level, remaining vacant. This is likely to have led to an increase in the use of locum doctors."
He went on to warn changes on the frontline were putting staff off jobs and said it was vital doctors were given more support in order to protect patient care.
He said: "The NHS has been under increasing pressure in recent years due to a combination of factors including a decrease in acute medical beds, an increase in hospital admissions and a gradual erosion in the balance of the time doctors spend providing patient care and undergoing training.
"As a result, careers in hospital medicine have become less attractive, and we need to ensure doctors are better supported in order that patient care can be maintained and we can attract doctors into these positions."
The spike in spending on locums has come to light following a Scottish Labour request under freedom of information legislation. It shows health boards spent £48.4m on medical locums to provide hospital cover in 2010-11, £48.9m in 2011-12 and £28.3m in the first six months of the current financial year.
Labour health spokeswoman Jackie Baillie said: "Every hospital needs locum doctors to cover for sickness or other staffing pressures, but these figures show an upwards trend, with too many showing a greater reliance being placed on temporary staff, which suggests there is inadequate workforce planning.
"Reliance on locum doctors pushes up the wage bill. With the majority of health boards now running underlying deficits which are rolled from one year into the next, the last thing we need is to see greater pressure on the wages bill because managers haven't planned appropriately."
Among the health boards where spending has risen most steeply are NHS Lanarkshire, NHS Lothian, NHS Dumfries and Galloway and NHS Fife.
Dr Alan Robertson, a member of the BMA's Scottish Council, said: "There has been a lot of work undertaken by the Scottish Government, in partnership with the profession, to establish a national "medical bank" to help provide cover from within the NHS medical workforce
"These are still being implemented locally and it is therefore unlikely that the impact of the introduction of this medical bank will be felt until next year. However, in those areas where medical banks are well established, such as Greater Glasgow and Clyde, costs appear to be more stable."
A spokesman for the Scottish Government said it was committed to ensuring the health service was safe, reliable and sustainable, adding: "It is the responsibility of individual health boards to ensure they provide medical services to meet the reasonable needs of their population. The use of short- to medium-term medical locums to ensure service continuity during times of planned and unplanned staffing gaps will always be a part of this."
Careers in hospital medicine have become less attractive ... we need to ensure doctors are better supported