Annette Pham thought she had recruited two doctors to work in her GP clinics, but a policy change in Canberra resulted in both of them pulling out almost overnight.
Ms Pham and her husband own four GP clinics on the New South Wales south coast, all within a few hours' drive from Sydney and on some of Australia's best beaches.
"We had two that pulled out officially after signing contracts," she said.
"Then we've had probably a further three that looked at our practice, they looked at other practices and they inevitably decided in the end that they would stay in the city."
It comes after the Distribution Priority Areas policy, which puts limits on where International Medical Graduates (IMGs) are allowed to work as GPs, was changed.
More than 52 per cent of Australia's GPs have trained overseas, so any policy that affects where they work will have a big impact on communities.
The federal Health Department classifies parts of Australia into categories of remoteness rated between one and seven.
Under the old policy, doctors who gained their training overseas either had to work in a small rural town for 10 years or in a remote location for five years, to work as a GP.
In January, the previous Coalition government eased those requirements, expanding "priority" status to include large regional towns such as Dubbo, Shepparton, Mount Gambier, or Gladstone.
Then in July, Labor went further, opening it up to include some towns within an hour's drive of a capital city and even classifying the outer suburbs of Sydney and Melbourne as priority areas, a policy it took to the May election.
"While we lose candidates, those people who are out even further, places like Coonamble, Brewarrina, and Burke, they're in a lot more of a difficult situation, because the doctors no longer need to go out there," Ms Pham said.
"They can stay in the city."
Change 'to keep voters happy'
Michael Livingstone came to Australia as an IMG, eventually buying a GP clinic in the small town of Ravensthorpe, six hours' drive south-east of Perth.
Ravensthorpe has the top rating of seven for remoteness.
Dr Livingstone is a policy-maker's dream, an IMG who decided to set up his life in a small, remote town.
But it came at a cost.
His wife gave up a lucrative marketing job to move to the town, which dropped the family's income.
She now manages the GP clinic, and their daughter is enrolled in the local school.
Dr Livingstone lamented the increasing reliance on telehealth for rural parts of Australia, arguing that governments were moving to that and emergency medical retrievals to consider remote parts of the country serviced.
"I could up sticks now, move to some private practice in the city and live that life, but who would replace me?" he said.
"If you can't set a precedent for someone or you can't show a government that this can be done, then no-one will."
Dr Livingstone said he was trying to recruit IMGs to work in his clinic but was competing against clinics in Perth.
"Very hard, nightmarish level," he said.
"It's killed recruitment for those jobs."
He said there was a clear link between the policy change and politics.
"We have to deal with a model that rewards sending doctors to bigger centres and keeping voters in bigger centres happy, than going rurally and keeping the smaller number of voters happy," he said.
Doctor shortage 'crisis'
No rural health group actually liked the Distribution Priority Areas policy as they were generally uncomfortable with forcing doctors to live somewhere they may not want to.
But all conceded it was an effective, if blunt, tool to look after rural Australia.
Rural Doctors' Association of Australia (RDAA) chief executive Peta Rutherford said the organisation was getting reports the policy was going to have an impact on rural communities before it had even been implemented.
"This is not a crisis that's coming, it's a crisis we're in now, certainly for rural communities," she said.
Federal Health Minister Mark Butler said the policy change had so far not caused a stampede of doctors from the bush to the cities.
"In that first three-month period of the new DPA arrangements there was no difference whatsoever between what happened this year and two years ago under the former government's regime," he said.
When pressed on Ms Pham's situation, where recruited doctors pulling out would not show up on Health Department data, the minister insisted he was not aware of any large-scale issues.
"All I can go by is the data provided to me by the department," he said.
"Can I say there's generally a background situation though, whether it's rural or metro Australia, of real pressure on general practice.
"We're seeing that in all communities across Australia right now where the impact of six years of Medicare freezes by the former government is really starting to bite."
Editor's note 06/02/23: Since publishing this story, the ABC has learned there is a second GP in the Ravensthorpe area. The story has been amended to remove a reference to there being one.
