"There is no simple quick fix for these issues, if there was we would have done that by now," she told an inquiry hearing on Friday.
The inquiry into emergency department delays previously heard about long wait times.
Doctor James Tadros told the inquiry on Wednesday conditions at his workplace were "Third World".
"Well they want to go and work in the Third World then," Health Minister Brad Hazzard told reporters on Thursday.
"Those doctors who spoke are very good in their own areas ... but it doesn't necessarily mean they're good at managing an entire health system."
Labor's health spokesman Ryan Park said the minister, a parliamentary veteran of more than three decades, was out of touch.
"At a time when we are out in the market meant to be trying to recruit nurses and health workers from overseas to boost our supplies here, he's telling frontline clinicians they can go overseas," Mr Park said on Friday.
Ms Pearce said the department was recruiting thousands of staff, however Dr Tadros' description was not accurate.
"NSW is not a Third World health system and resembles nothing like (one)," she said.
NSW Ambulance recently added close to 300 staff, on its way to recruiting more than 2000 new workers over four years, commissioner Dominic Morgan said.
Graduate-entry recruitment recently attracted more than 840 applications.
"We're in a very good spot in terms of meeting our targets," Dr Morgan said.
The Australian Medical Association (AMA) recommended making Mr Hazzard's job easier by increasing federal funding for state hospitals to a 50-50 split.
Elective surgery suspensions to preserve hospital capacity in the pandemic also led to thousands of people not receiving treatment in time.
"It has a significant detriment and drawdown on our ability to provide health care because many of those patients will now require more ongoing health care than they would have required otherwise," AMA NSW president Michael Bonning told the hearing.
Bureau of Health Information data showed a more than ninefold increase in the pandemic.
Patients waiting longer than clinically recommended for surgery at the end of June numbered 18,748, compared with 2037 in March 2020.
Ambulances being forced to queue outside emergency departments (ED) - also known as "ramping" - is the main focus of the inquiry but emergency department staff specialist Kendall Bein said the issue is systemic.
"Ambulance ramping is caused by no empty beds in the ED, and there are no empty beds in the ED because there are no empty beds on the wards," Dr Bein said.
He proposes giving individual hospitals and wards within them responsibility and authority to set their own quotas for how many beds they need available, among other resource management reforms.
"We need to trial something," he said.
"Let's get a hospital executive who's willing to give something a go … and actually be forgiven for when there are inevitably hiccups and slowdowns."
Those issues need to be looked at as new problems to solve, not immediate failures, Dr Bein said.
Pharmacists told the hearing on Friday they could help reduce the burden by solving medication-related issues in the emergency room without patients needing to be admitted.
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