YARRAM'S current health care crisis has turned the spotlight on Victoria's chronic regional and rural GP shortage and the need for bipartisan government support.
Yarram District Health Service has been left without a full time GP service because both doctors are away on leave, with one scheduled to return in early September and the other on unplanned leave until Monday, August 26.
A registrar on a GP training program has also recently resigned.
While a locum was recently secured for four days until August 16, the service is still seeking ongoing replacements, and patients are having to travel up to an hour out of town or face long waiting lists to get into other services.
Local health care activist group Chrissy Inc posted on Facebook that while the staff had done a good job in trying to deal with the problem, management should have provided earlier notice of what was happening.
"Letting people know would not only have allowed for better planning re medical appointments and urgent care, it would probably also reduce the consequential stress on the poor nurses who I'm sure are having a pretty horrid time," a spokeswoman said.
She said the hospital serviced a fragile aged community and a medical clinic "servicing some 3000 patients", and essentially had no permanent doctors.
Like many small, rural towns, Yarram has long struggled to find and retain doctors, who are often drawn to larger cities where services are better.
In 2016, a doctor shortage led the YDHS to advise the Yarram community that "there are limited medical services available and a visit to a medical service in the Latrobe Valley, Sale or Foster, or even an ambulance trip to another hospital may be necessary at times".
YDHS chief executive, Bernadette Wardle, who was appointed in June, said Yarram District Health Service was continuing to explore all options to keep the service open from August 19 until one of the GPs returns on August 26.
She said patients could make appointments this week with the locum doctor, or wait until the service's GPs return.
Ms Wardle also advised patients to phone other clinics in nearby towns, as well as the part time GP service in King St, Yarram.
"We again apologise and thank our community for their patience," she said.
The Rural Doctors Association of Australia said the situation in Yarram was part of a broader issue affecting regional and rural areas.
Rural communities rate amongst Victoria's unhealthiest and most poorly serviced in terms of medical care, with higher rates of obesity, lower rates of physical activity, heart disease, stroke, cancer, osteoporosis, arthritis and anxiety or depression.
The association's chief executive, Peta Rutherford, said an expansion of government programs to support rural doctor placements was essential to address the continuing decline in rural doctor numbers across most of Australia.
"Australia is now producing enough medical graduates to meet the health needs of the population, but we continue to see a major disparity in access to health services between rural and remote Australia and the major centres," she said.
Dr Rutherford said the RDAA had long advocated for the establishment of a national rural generalist pathway to deliver more of the next generation of doctors into rural medicine, and welcomed federal government funding for the pathway's initial rollout in this year's federal budget.
The pathway is about training the next generation of rural doctors with the skills required to meet the needs of their local community, while also supporting and guiding them on their journey into rural medicine.
"Providing an increased number of rural clinical placements - so medical students, interns, junior doctors and registrars can sample rural practice first-hand - is essential to get more of the next generation of doctors interested in rural medicine as a career," Dr Rutherford said.
Dr Rutherford said patient safety and sustainable lifestyle considerations also meant that the next generation of rural doctors could not be expected to work 24/7, 365 days a year as their predecessors did.
"With these changes in attitude and policy, health workforce planners and policy makers need to recognise that when a senior rural doctor retires, it is likely they will need to be replaced with two or three doctors to meet both the expectations of the local doctor workforce and the needs of the community," she said.
"We continue to advocate for an expansion of rural clinical placements, financial incentives and appropriate support mechanisms to entice and retain doctors in the bush."
The RDAA believes rural general practice needs to be made more viable financially, and is calling on federal and state governments to look at better supporting practice infrastructure and accommodation for GPs in smaller rural towns to attract them to difficult-to-fill positions.
"Governments also need to take on more responsibility for organising and paying for locum support, to enable rural doctors to take much-needed holiday and study leave and reduce burnout," Dr Rutherford said.
Importantly, some of the biggest success stories in recruiting new doctors to rural communities have occurred when the local general practice, hospital and community have worked together to 'smooth the path' in getting a rural doctor to their town.
In a submission to a senate inquiry last year into regional inequality in Australia, the Rural Doctors Association of Australia said people living in rural and remote areas were experiencing significantly poorer health outcomes than those who lived in metropolitan areas, and that "inequitable allocation of health funding and resources exacerbates inequality in these areas".
The submission stated that people in regional or rural areas "have rational expectations about what constitutes reasonable access to health care", and that state and federal regional development policies "must recognise that the good health and wellbeing of rural and remote Australians is essential to personal, community and national social and economic growth".
It said governments must also acknowledge that the provision of health services was critical to underpin development outside capital cities, and deliver those services.
State health minister Jenny Mikakos said the state government in 2018/19 had allocated more than $10 million dollars to support the development, recruitment and retention of a general practice workforce for rural and regional Victoria.
She said primary health care was a federal responsibility, but the federal government had "failed to address the challenge".
Federal health minister Greg Hunt did not respond to the Gippsland Times' requests for comment before deadline.