A staggering bill of almost £229m was racked up in just three years paying for locum doctors to help prop up Northern Ireland's broken health service, it has emerged.
Cash-strapped health chiefs paid out the eye-watering sum between the start of April 2016 and the end of March 2019, according to official figures.
The statistics have revealed that the financial cost of the doctor shortage here rose steadily over the three years, from £68.6m in 2016/17 to £86.7m in 2018/19.
At the same time, the most recent statistics show there were 180 vacant medical posts at the end of last year.
However, a leading doctor has said the figure is likely to be much higher as it only includes posts where health trusts are actively recruiting.
Dr Tom Black, chair of the British Medical Association in Northern Ireland, said: "It's difficult to estimate the number of real vacancies.
"The reality is there is a significant number of vacancies throughout all grades in Northern Ireland, which puts pressure on the system and obviously everyone is working as hard as they can to fill those vacancies, although it isn't easy.
"There can be a number of reasons why a trust isn't recruiting for a post; it could be because they have tried before and haven't filled it.
"They know there is no one going to apply for it, so they take the view there isn't any point trying to recruit.
"That means that vacancy isn't included in these figures."
According to the information, which was released by Health Minister Robin Swann, the Belfast Trust paid out the most money for locum doctors over the three-year period, accruing a bill of £59.7m.
The Western Trust paid out £54.4m, while the Northern Trust amassed a £46.3m bill.
At the same time, the Southern Trust paid £40.2m for locum doctors over the three years, while the South Eastern Trust paid £28.3m.
Dr Black said there are a number of reasons why health trusts are experiencing significant challenges in appointing doctors.
He said moving ahead with transformation of the health service will help address the situation, which is currently being exacerbated by the threat hanging over a range of services.
Rumours are swirling that a number of services have been earmarked for closure as part of ongoing plans to overhaul the local health service.
"Doctors don't want to uproot their families and have to buy a new house and have their children move schools if a job isn't sustainable," he explained. "If a doctor has reassurance that a service is going to remain open then they are more likely to make the move, so I think decisions on the transformation agenda would be helpful."
Dr Black said issues with attracting doctors to take up jobs can also make it even more difficult to encourage others to apply for a role on a team.
"Rota gaps, which happen when there aren't enough staff, mean that any staff on the team have to work longer hours, and perhaps unsociable hours, more often," he said.
"If a doctor knows that is the case, they are more likely to apply for a job in a different trust where there are fewer rota gaps and a better work life balance."
At the same time, rota gaps have been blamed for a number of high-profile service closures in recent years, including the shutting of the emergency department at Belfast City Hospital.
Dr Black said it is vital that health bosses work to address the shortage of doctors in Northern Ireland.
"Locum doctors work just as hard as staff but very often they don't know local conditions or ways of working," he said.
"You find in general practice that maybe a third of patients seen by a locum doctor contact the surgery again because they want things fully sorted.
"Having a rota that is fully staffed instead of filled with locums does improve efficiency and effectiveness."
The Department of Health was contacted for comment.