I’m among the doctors our system rejects. This is why regional healthcare is dying

A gastroenterologist based in Port Macquarie, New South Wales, has been dismissed from his role after years of working in a region facing chronic shortages of specialist medical staff. His termination came amid systemic issues within the local healthcare system, which he claims has led to deteriorating standards of care and the collapse of critical services. The doctor, who served as head of gastroenterology at Port Macquarie Base Hospital for nearly 15 years, described receiving an email in March 2025 stating that the district was unable to fund additional specialist appointments. This decision, he argues, reflects broader failures in regional healthcare infrastructure and management. The doctor's concerns date back to 2019, when the district’s medical services director informed him that there was no capacity to hire a fourth gastroenterologist. At the time, three specialists were struggling to maintain coverage, leaving one week per month without adequate support. By April 2020, the hospital’s general manager acknowledged this as a risk to patient safety, though no action was taken to address the gap. Despite these warnings, the fourth gastroenterologist was never hired, and the situation remained unresolved for years. In November 2024, the Royal Australasian College of Physicians conducted a survey of the hospital’s gastroenterology department. The findings revealed that the public service relied on three visiting specialists whose combined work amounted to just 0.6 of a full-time position. This level of staffing, according to the college, was insufficient to properly supervise a trainee. The college issued a formal warning in June 2025, noting that if one of the existing supervisors left the public system, the hospital would fail to meet accreditation standards. However, the district proceeded with plans to terminate the doctor’s contract under a revised staffing model in December 2025. He was formally notified of his impending dismissal in January 2026, with three months' notice. His contract ended in April 2026, following the lapse of the hospital’s accreditation. The doctor criticized the lack of investment in the region’s healthcare system, pointing out that the district had cut approximately 160 positions in a recent ministry review. While the college focuses on ensuring hospitals meet accreditation criteria, he argued that financial constraints alone should not determine the quality of care. The doctor also highlighted the difficulty of attracting and retaining specialists in regional areas. In 2017, he successfully recruited a highly qualified hepatobiliary interventional endoscopist, who had trained in both Australia and Canada. The specialist worked in Port Macquarie for eight years without a public hospital contract, providing essential services such as endoscopic ultrasound, which is crucial for diagnosing pancreatic cancer. However, due to the lack of public funding, this service was only available to private patients, forcing public patients to travel nearly three hours for treatment. The specialist eventually left for a major city in mid-2025, taking the endoscopic ultrasound service with him. The doctor expressed frustration with the administrative challenges faced by medical professionals in the region. When he raised concerns about a dismissive comment made by an executive regarding a recruit’s vaccination status, he was instructed to avoid “public feedback” to his manager. The term “public feedback” referred to sending a response to all recipients of an email, highlighting the restrictive communication policies within the organization. Since early 2025, the doctor’s attempts to contact the district’s chief executive have gone unanswered. Even his termination letter included instructions not to discuss the matter publicly. He described the article itself as an unscheduled exit interview, emphasizing the impact of his departure on the community. The loss includes the training program that would have developed future specialists, the endoscopic ultrasound service that enabled early detection of pancreatic cancer, and the early cancer surgeries performed by the former head of department. The consequences of these losses remain uncertain, but they underscore the fragility of the regional healthcare system.