As Australia's shortage of general practitioners deepens, more than 6,000 patients from one town in regional New South Wales have been left scrambling to find a new doctor.
An exodus of eight experienced GPs from the New England city of Armidale in the past few months has caused a "workforce crisis".
Vicki Howell, a GP who is remaining in Armidale, told ABC's 7.30 the doctors had relocated for personal reasons or retired.
Recruiting replacement GPs has been a frustrating task.
"We didn't expect it to hit quite as hard as this," she said.
"If this can happen as a workforce crisis in a township like Armidale, this can happen in any rural town in Australia."
Dr Howell said her practice had been fielding daily calls from "people who are distressed, people who are angry, and people who are very worried about how they're going to access health care".
"At least 6,000 people, but probably thousands more, do not have access to an ongoing general practitioner for their health provision," she said.
Maria Cotter is one of them.
The mother of two has been a regular patient at West Armidale Medical Centre for more than 20 years.
Up until a month ago, she relied on her doctor, Maree Puxty, for extra support with her mental health after being diagnosed with complex post-traumatic stress disorder and major depression.
"Dr Puxty has extra training in mental health and that's been a lifesaver for me," she said.
"My GP has been there [for me] for a lot longer than any of the psychologists that I've had or been able to afford."
Although her mental health has improved considerably since being hospitalised for a breakdown in 2015, Ms Cotter says she does not know where she will turn if her situation worsens.
"I'm vulnerable, and I'm not the only one," she said.
Dr Puxty's practice, now owned by a charity, has moved primarily to telehealth while it tries to recruit staff. She is worried about how telehealth will impact her former patients who struggle with technology.
"We're quite concerned for people who have chronic disease, people who are financially vulnerable," Dr Puxty said.
She and her husband relocated last month to the coastal town of Lake Macquarie to be closer to family and to decrease their workload.
Dr Puxty said a "perfect storm" had made it virtually impossible to have a succession plan for new doctors.
One of the factors contributing to the problem is a change in policy by the federal government dictating whether international medical graduates are allowed to work as GPs.
"It meant that there were no international medical graduates who were interested in coming to Armidale, let alone even the smaller towns," she said.
"People are choosing to stay in the more coastal urban areas."
GP shortages the new norm
The Rural Doctors' Association of Australia (RDAA) said the situation in Armidale highlighted a growing issue across regional and rural Australia, with a workforce shortage of 11,000 GPs predicted by the end of the decade.
"GP shortages are becoming the norm, not the exception," RDAA chief executive Peta Rutherford told 7.30.
"When we're seeing vacancies in a community like Armidale, it is concerning because the implications for access are more far-reaching than just the immediate community."
Survey results from an upcoming report from the NSW Rural Doctors Network found 70 per cent of rural medical practices were actively seeking staff, while 40 per cent of rural GPs said they were planning to leave the profession within the next five years.
Another issue, according to some doctors, is the inability of GP practices to pay prospective employees as much as they could earn in hospitals working as locum doctors.
"Around two shifts [as a locum doctor] is the equivalent of working for two weeks as a GP registrar in community practice. We just can't compete with that," Dr Howell said.
Junior doctors can also see a drop in pay and loss of employment entitlements if they leave state-run hospitals to pursue general practice.
Dr Howell believes a pilot program to attract more GPs to rural areas, known as the single-employer model, could see promising results in Armidale.
That model was first trialled in the Murrumbidgee Local Health District in southern NSW in 2020 and will be expanded to Tasmania from July.
Nationals MP Adam Marshall, who represents Armidale in state parliament, announced last month his electorate had been approved as the next trial site for the program, which allows junior doctors to work in both state-run hospitals and privately run clinics but get paid by the state government or local health district.
The federal and state governments told 7.30 they were still negotiating the next sites for the rollout.
In a statement, Federal Health Minister Mark Butler said NSW had been invited to establish two new trials, while the NSW government wants to pursue a rollout across the state.
"I can't choose two out of the seven local health districts. We need to start it in all of them because I'd be robbing Peter to pay Paul," NSW Regional Health Minister Bronnie Taylor said.
For GP practices in Armidale to take part in the program at the start of next year, answers are needed soon.
"There is a lead time with getting this model and this project up and running," Dr Howell said.
"We're really keen to get rolling now but we need the details."
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