Following nearly three years of pandemic conditions that have put healthcare systems under unprecedented pressure month after month, depleting resources, burning out staff, and pushing services to the brink (and often beyond), it's unsurprising that health is a key issue, but the issues with regional health run deeper and stretch back further than COVID-19.

Former Portland District Health chief executive Christine Giles said recruiting and retaining doctors had always been a challenge, but was getting harder and harder. She said more money needed to be spent to lure top talent from the city as well as training more medical professionals who wanted to stay and work in the regions.

"I'd be looking closely at the enterprise bargaining agreements and how we remunerate the workforce, because the remuneration for country doctors just isn't competitive," Ms Giles said.

Both Labor and the Liberals have engaged in a health funding arms race in recent months, but the hundreds of millions in pledged funding has gone almost entirely to metropolitan Melbourne and mainly into capital works projects.

"They're announcing money for shiny new buildings, but there will be nobody to staff them," Ms Giles said. "I'm not seeing any commitment to staffing."

She said the neglect of regional areas was nothing new. "The rural health workforce is woefully underresourced... What we really need is a recruitment drive for senior doctors, but that means looking at rates of pay and conditions, but it also means looking at the housing problems, which are making it even harder to bring people out."

Deakin University rural health professor James Dunbar said the staffing issues in regional areas quickly became a "vicious cycle".

Speaking about the emerging crisis in general practice, Professor Dunbar said a lack of new doctors coming into the country system had a knock-on effect for staff already working in regional areas.

"You have the existing GPs in places like Warrnambool, Hamilton and Portland getting disillusioned and burnt out because their colleagues are leaving and there's nobody to replace them, so we are at risk of losing them too," he said.

Professor Dunbar said one of the keys to solving the problem was to improve remuneration. "If you want doctors and nurses to change their behaviour you have to offer them something, you can't just hit them with a stick," he said.

Portland District Health had well-documented staffing problems in early 2022 when it had to shut down its birthing services, forcing one woman to give birth on the side of the road en route to Warrnambool.

Warrnambool Base Hospital has not been immune, shuttering its urology services when the region's only urologist left the hospital over an ongoing contractual dispute. South West Healthcare has also been forced to recruit doctors from Sri Lanka to bolster a strained emergency department.

The Victorian Department of Health said a long-awaited $384 million renovation would start in before mid-2023 and was "on track to be completed in late 2026".

The Standard asked SWH what was being done to ensure the hospital could maintain its workforce ahead of the expansion and whether it had sought additional funding from the state government, but it declined to comment.

But Ms Giles said funding was only one half of the equation. She said a key factor in the poor state of regional healthcare was a "drive to centralisation" under which decision-making was all done by the department, with poor or cursory engagement.

"When government policy is being written it's all being done by bureaucrats in Melbourne who don't understand rural health... The people in charge aren't listening to the clinicians, they're not asking what they need," she said.

Professor Dunbar agreed. "The government should be asking the people on the front line, asking them what tools they need to do their job," he said.

"Only in the clinical microsystem, an ED team for example, is quality and safety built, so they're the people who need to be asked."

He said that didn't fit the government's approach, which was to come up with a policy at a department level and feed it down. A top-down approach.

"Top down fails in the face of complexity and healthcare is about as complex as it gets," he said. "There's no reason you can't set up safe and capable services in regional areas."

Ms Giles said the push towards centralisation was hollowing out the capacity of smaller medical services like Portland and Hamilton. "The urgent care system across rural Victoria has been failing for a decade".

"What we've done is move towards a model that says it's only safe to have specialist services in metro areas with super specialised doctors," she said.

"Now it's got to the point where people are going to Geelong or Melbourne to get their appendix out or kidney stones removed, which is really unnecessary."

Ms Giles said it also meant rural doctors were losing skills for procedures they were no longer being asked to perform. "So for example you now have 15,000 people sitting out in Portland who don't have access to much any more," she said.

Ms Giles said the rural health system could only be fixed if the regions had real decision-making power.

"We need a rural health minister and a rural health sub-department with regional directors that is staffed and funded appropriately," she said. "Our healthcare needs to be in our own hands, so that we can get what we need."

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