Some come and go, many stay for decades, and they all fill gaps left by their peers who went through the domestic system.

As the federal government continues to spruik new measures to attract Aussie doctors to regional areas – including a $95 million Murray Darling Medical School network – the rural doctor shortage is worsening in many places.

Residents in Greater Hume Shire had access to just one GP over the holiday period who had the ability to treat emergency cases in a hospital.

There are six GPs working in clinics in Holbrook, Henty and Culcairn, but only at the latter does Dr Jan Reddy have visiting medical officer privileges (VMO), meaning he can see patients at the local emergency department.

Family circumstances have meant the two other VMOs in the shire – who were based in Holbrook and Henty – have moved away or are no longer in the area full-time.

Residents in those areas have confirmed to The Border Mail that patients have had to travel to be assessed by Dr Reddy, or vice-versa.

Greater Hume general manager Steven Pinnuck said for doctors to become VMOs, they had to undertake a training program, which required them to spend time at an accredited hospital without pay.

“The local health district manages VMO accreditation, and to get that you have to have emergency department experience in Australia,” he said.

“Most overseas-trained doctors haven’t got that experience, as opposed to Australian-trained doctors who get it as part of their medical training, so they have to get into a training program.

“The federal government is telling us they’re training more doctors than ever before, and that there’s doctors for everybody – but that’s not the experience in our towns and it’s not the experience across most of rural Australia.”

Further, the training GPs have to undertake to become a VMO in the Greater Hume area can largely not be done at Albury hospital, as it is not part of the Murrumbidgee Local Health District.

Acting director of medical services Kathleen Atkinson said MLHD was aware of the issue in Greater Hume and was working with all the relevant parties toward a solution.

“There is a statewide and countrywide shortage of doctors in these smaller rural areas, and many of the vacancies are taken by doctors who come from overseas,” she said.

“Many of them are fantastic GPs, but not all of them have additional training required to safely manage emergencies.

“We are very conscious of patient safety and making certain we have the right people working in the right place.”

Dr Atkinson said there was financial support available through the federal government for GPs to take part in training, and not every GP wanted to obtain VMO accreditation.

“The distance you are from a larger hospital changes how many people (VMOs) you need,” she said.

“We don’t ever like to see people working in isolation, because that puts incredible stress on them.

“Overall, there has been a drop in people applying for GP training over 2016, 2017 and 2018, and in particular rural GP training.

“This is something people have been working on for a long time, focusing on ensuring we train Australian doctors to work in rural areas.”

The Hume Medical Centre in Holbrook, established by Lukumar Pathumanabhan in 2014, is one of many clinics with a job opening for a GP.

Dr Pathumanabhan said he was yet to fill the vacancy left by his VMO Delakshe Sentheeran, who returned to Sydney with her family last month after four years at the clinic.

“In the city, there is an oversupply of doctors, but they are not coming to rural towns,” he said.

“If you want fully-qualified doctors, there needs to be something to attract them.

“There are no houses for rent in Holbrook, and even in the hospitals they don’t have quarters for somebody to come and work.

“There could be an incentive like a house that the council owned for doctors.

“Also, in bigger towns with busier hospitals you get a fixed payment (as a VMO), but the payment is fee-for-service here – you get a small payment for being on call, and you might have one payment for the whole night.

“The income isn’t guaranteed.”

Dr Pathumanabhan said it was becoming more difficult to recruit overseas-trained doctors due to red tape, and said there needed to be a more streamlined process for them to gain further training in Australia.

“Dr Lakshmanan had been operating a clinic for 43 years and he had restrictions put on him, so I approached him while I was in Tumbarumba about opening the Holbrook clinic,” he said.

“Things have been changing and more restrictions are being put in place, at the medical level, at the immigration level, and at the local hospital level.”

There are fears a new federal government measure favouring GPs who seek to become more qualified will further exacerbate the doctor shortage in rural areas.

In October, representatives from 20 regional NSW councils met in Albury ahead of the local government conference to discuss their concerns with the Stronger Rural Health Strategy, which came into effect in November.

It reduced the Medicare rebate eligible rural GPs could claim from 100 per cent to 80 per cent, unless they were on an approved pathway for general practice college training. 

Rural and Remote Medical Services chief executive Shane Hatton, who is working with New England’s Gwydir Council to promote the issue, described the policy as “madness”.

“The Commonwealth is effectively asking new non-vocationally registered GPs working in rural and remote bulk-billing practises to work for 20 per cent less,” he said.

“And they’re asking patients who are required to pay an out-of-pocket fee to see those GPs, to pay 20 per cent more than they currently are.

“This policy measure defies logic, particularly when the wait time for a doctor to get onto an approved GP training program can be up to two years in rural and remote locations.”

Dr Pathumanabhan was worried what impact the changes might have in the future.

“If I was recruiting anyone new, (the rebate) will be 80 per cent, for providing the same service,” he said.

Most patients would prefer to be seen by a GP who has the highest possible qualifications – but the reality is these medical professionals aren’t taking up postings in regional areas.

Gwydir Council states there are 277 GP vacancies across remote NSW, an increase from 231 in 2016.

Dr Reddy, who was contacted for comment, has been contemplating retirement for a number of years but is reluctant to finish up without finding a suitable replacement.

Culcairn’s David Gilmore said GPs like Dr Reddy, who has received an OAM, were dedicated community people.

“He’s contributed so much over the 40 years – my dad was in Kiltearn House (aged care facility) for the last couple years of his life and I couldn’t have asked for any better care,” he said.

“We are very lucky when a lot of towns are struggling, and I think we will too when he decides to retire.

“We know the person that will replace him isn’t going to be someone who does what Dr Reddy does.”

Greater Hume Council is seeking a meeting with Minister for Regional Services Bridget McKenzie to discuss the issue.

Mr Pinnuck recently wrote to Senator McKenzie about the Stronger Rural Health Strategy.

“We don’t believe she adequately answered our questions … we have sought a meeting with Senator McKenzie through Farrer MP Sussan Ley,” he said.

A spokesman for the Senator said Australia-wide, doctor services per person had increased nearly 50 per cent from 2005 to 2015.

“While the Rural Other Medical Practitioner program provided incentive for doctors to work in specific areas, access to the higher rebate created a disincentive to achieve specialist qualifications,” he said. 

“Grandfathering arrangements will allow current participants to continue to access the higher rebates until June 30, 2023.” 

Gwydir Council will table a petition in parliament in February in part calling for the ROMPs program to be reinstated.