A regional NSW doctor and medical educator has slammed two decades of health policy as "systematic disinvestment" in bush medicine.
Director of the University of Newcastle's Tamworth-based Department of Rural Health, Jenny May, told a parliamentary inquiry that government ought to "be honest" if it is going to continue to slash local services.
"If our intent and our reality is a downgrade in those services, please can we majorly ramp-up retrieval services and just-in-time care and be honest and accountable to this trade-off to our communities," she said.
The NSW Parliament's Legislative upper house health outcomes and access to health and hospital services in rural, regional and remote New South Wales inquiry was kicked off by a series of scandals in Western Local Health District hospitals.
Scores of Tamworth and Gunnedah patients and medical professionals have slammed an overstretched, under-staffed rural healthcare system.
In its Gunnedah hearing, the inquiry heard that Tamworth hospital has three "ghost theatres", which could be used to deal with the current backlog to see a specialist, but instead lie dormant.
The inquiry returned after a three-month hiatus on Friday, hearing from a number of medical experts involved in rural healthcare education via videolink.
Professor May told the inquiry that rural medicine faces an "escalating challenge" driven by over 20 years of cuts, and a "focus on specialism over generalism".
"I've observed the gradual loss and ongoing loss of localised capacity, with increasing reliance on locums, on fly-in-fly-out services and rescue and retrieval," she said.
"It is the result of multiple, small, unconnected decisions over 20 plus years."
She said the problem was much more severe in smaller communities like Gunnedah, than in rural centres like Tamworth.
Efforts to train rural people to work in their own communities could not fill the gap, even if doubled or trebled, she said.
"Currently 30 per cent of medical students in NSW are of rural origin. Of those 30 per cent of them currently go rural. You can see our net return is 10 per cent. Now what you need is a workforce of at least 30 or 40 per cent, probably, to get population and geographic equity," she said.
She said it was vital to expose metropolitan students to a positive rural setting for months, not just a two-week "medical tourism" placement.
The theme of dozens of submissions read by the Leader was simple: there's not enough rural doctors, not enough nurses and things are getting worse, not better.
ABC journalist Jamelle Wells and Nine journalist Liz Hayes both lost fathers after what they condemned as poor treatment at Dubbo, Cobar and Manning hospitals.
Both gave evidence to the inquiry on Friday.
"I feel like we've let our country families down. I feel they are second- class Australian citizens when it comes to health," Ms Hayes told the inquiry.
Liverpool Plains farmer and rural advocate Fiona Simson was among scores of other high-profile Australians to use the inquiry to demand change, in her submission. Many other submissions were anonymous.
The Gunnedah Community Roundtable called on the government to allow psychologists and social workers to develop and implement mental health care plans, not just doctors, to reduce their workload.
They said the health system should establish formal GP clinics within rural hospitals, allow nurses to perform a broader range of duties and require early-career doctors to work in rural areas.