In the small Victorian border town of Casterton, the departure of a local doctor has increased pressure on an already overwhelmed health system.
The Casterton Coleraine Medical Centre has announced it will cease its visiting medical service within three months following the departure of clinic physician Brian Coulson.
Dr Coulson's departure from the clinic comes at a time when the health service is grappling to secure a long-term general practitioner and follows on the heels of the departure in May of GP Linda Thompson.
The region's two townships, 120 aged care beds, and small hospital covering an area of 6,000 square kilometres is being propped up by the private medical practice.
The announcement means the town's hospital, which services about 4,000 residents, will need a replacement GP to admit patients and visit nursing homes across the region.
The Casterton Coleraine Medical Centre continues to rely on locums to fill medic gaps.
Casterton Memorial Hospital chief executive Owen Stephens told the ABC it was a difficult situation.
"It's left us thinking, what will we do from here?" he said.
"As all other rural areas have been experiencing, it's very difficult to attract staff and when it comes to GPs it's even more difficult.
"We certainly are concerned as to what and whom we may be able to attract, but we'll be working our hardest to ensure the continuation of services to the hospital.
"What we will continue to do is provide any specific emergency care that we can from our organisation and also be on the lookout for any general practitioner who may wish to join the area."
'The system is broken'
Husband and wife team Brian and Coralie Coulson arrived in Coleraine in 1981 to start work at the Coleraine Medical Clinic.
In the 40 ensuing years, the couple set up a clinic in Casterton, saw doctors from all over the world through their clinic, and trained GP registrars across the country.
But an inability to attract doctors to the bush has led to difficulties with medical staffing in the region and across rural Australia.
Medical services are calling for "serious" intervention from the state and federal governments.
"It's been pretty successful until the last decade; a lot of things have not been run well from a policy perspective in general practice," practice manager Coralie Coulson said.
"Gradually there's been a decline in the attractiveness of going out into regional or rural areas where you take on this kind of double-whammy of community general practice plus managing the small rural hospitals.
"The pandemic blew the whole thing open. We've now got to this ridiculous stage where it's just my husband, Brian, and locums or telehealth from Melbourne.
"We've had to say it's an unsafe workload and we can't do it. The model isn't working."
Staff shortages rife across hospitals
The region's medical services have gathered for crisis meetings to address the impending gap that will be left by Dr Coulson's departure.
But the chief medical officer at Western District Health Service in Hamilton, Dale Ford, said everyone else was dealing with their own staffing shortfalls.
Hamilton is currently five doctors short.
Dr Ford said the problem stemmed from a range of issues including the lack of training opportunities in regional areas, the under-recruitment of general practitioners, low pay for trainee GPs, and lack of overseas workers due to COVID-19.
"If we look at the number of people who are training in general practice, there are about 2,000 spaces per year and this year we've only had about 1,300 of those filled," Dr Ford said.
"For Casterton and Coleraine there are well-trained rural nurses and telehealth services, but none of it's going to take away the real need to have a well-trained GP to be present in those areas at least two or three days a week."
Similar to Casterton and Coleraine, the Hamilton Base Hospital also did not employ GPs directly.
"We're short as well for almost the same reasons," Dr Ford said.
"Over the past couple of years we've lost a lot of doctors during the pandemic who have now been able to go and work in Melbourne and Geelong, and that has left Hamilton short as well."
Surrounding hospitals in Mount Gambier, Portland, and Warrnambool told the ABC they would not be filling the gap for Casterton.
Mr Stephens implored any available general practitioner to consider taking up the role.
"Casterton is a great community. We've got great facilities and organisations and we'd love to hear from any general practitioners who might like to support us," he said.
The Casterton Coleraine Medical Centre and Casterton's Riverview Family Health will continue to provide care through their private practices.
The Victorian Health Department was contacted by the ABC for comment.
