Patients of some rural health practices are waiting up to six weeks for routine appointments because of staff shortages, a rural GP says.
Another says rural practices often feel "one resignation away from collapse" and the solution lies in training rural people for health careers.
That is where one rural health career promotion programme is hoping to make a difference by inspiring young people to pursue careers in the sector.
Rural Health Network medical director and Bay of Plenty rural GP Dr Jo Scott-Jones said in some areas staff shortages had led to five or six-week delays in getting a routine appointment.
"I think the shortage of providers has yet to have its full impact," Scott-Jones said.
"It is a little like climate change in that efforts we make now to recruit and train more people will take years to have any palpable impact."
Scott-Jones said staff shortages had already caused significant changes.
"[In some areas] the only way to provide services is to use a combination of telehealth medical care supported by in-person nurse or medical care assistant service.
"Patients in those places with acute medical needs have had to be redirected to hospital emergency departments, which is far from ideal."
Hauora Taiwhenua Rural Health Network chief executive Dr Grant Davidson said the country needed to train more health workers and encourage them into rural jobs.
Davidson said about a third of New Zealand's 194 rural practices had vacancies for GPs at any given time.
"Many of our understaffed rural practices are being run by dedicated health professionals who are working overtime, after hours, and sometimes for days and weeks on end."
He said the shortages extended beyond GPs and nurses to all forms of allied health, including practice managers, physiotherapists, health coaches, pharmacists, kaiawhina and others.
"In the next 10 years about 50 per cent of our GPs are set to retire," Davidson said.
"While we currently rely on international doctors to fill the gaps in our rural workforce, the long-term solution is to train more doctors, nurses and other health professionals here in New Zealand and prepare and encourage them to work in our rural areas.
"To do this we need a strategy to attract, train and retain these workers in rural areas."
Ōpōtiki resident and Te Kaha Medical Centre GP Dr Emily Gill said rural medicine was not about the number of patients but the number of services.
"We are the emergency service. We provide palliative care and school care. We deliver babies. We're even the pharmacy."
Gill said rural healthcare was in some ways the "canary in the coal mine", as problems in the wider health system were often exposed and accentuated in a rural setting.
"I do think our patients are disproportionately affected by the waitlists. We often see people who are still in pain and referrals can disappear."
Gill said the difficulty lay in communicating in places where there was no mobile reception and often slower mail services.
Te Kaha medical centre GP Dr Rachel Thomson said the situation was "an equity issue".
In her view: "Rural communities are entitled to the same services as urban areas but that does not happen."
Thomson described the rural health workforce as "small" and "fragile" with practices finding it difficult to cover absences and fill vacant positions.
"Any rural practice feels one resignation away from collapse."
Thomson said it was easy for people to get burnt out and if there were more staff they could offer more services.
Both Gill and Thomson said their practice was in some ways protected from the worst effects of understaffing because of their funding model and their function as, essentially, a rural hospital extension.
However, both agreed the workforce was under pressure.
"It's relentless," Gill said.
"The shortage is everywhere."
Thomson said the solution was for rural areas to "grow our own" workforce.
"Start with a rural person and you're more likely to get a rural health worker."
Te Whatu Ora Hauora a Toi Bay of Plenty chief medical officer Dr Luke Bradford said staff shortages in the rural health sector were "longstanding" but had recently been "exacerbated".
"We've always struggled to keep consistent staff numbers in rural health and that is because often the smaller places need smaller teams but will work harder."
Green Cross Health regional business manager for the Bay of Plenty Philippa Fox said
there were staff shortages in general practice nationwide.
"This is felt more strongly in rural areas. The shortages puts ongoing pressure on teams while recruitment takes place,
"It can be hard to attract people to rural health locations, including Whakatāne, which means recruitment times are lengthy and it often means there is an enrolment waitlist for new patients because there are not enough GPs for the enrolled population."
The Medical Council of New Zealand's report on the New Zealand Medical Workforce in 2021 did not include numbers on the urban/rural distribution of doctors and it was reviewing its estimation methodology.
However, the council's 2019 report stated 11.6 per cent of the country's doctors worked in rural areas.
"Almost three-quarters of doctors are in main urban areas compared with 61.2 per cent of the population.
"One-quarter of people live in rural areas, but these areas only make up 11.6 percent of doctors."
One programme is hoping to change the situation for the better by inspiring young people to pursue careers in rural health.
More than 10 high schools in the wider Bay of Plenty signed up for the Rural Health Careers Promotion Programme visits.
Tokoroa School careers adviser, physical education and health teacher Tairi Ford said she knew many students interested in health careers.
"The students really loved it. The visiting tertiary students spoke about a whole range of career pathways with health.
"It opened my students' eyes to more options. They came out of it knowing there's more to health work than what they think there is."
Dania Haddawi, a second-year physiology and psychology student at the University of Auckland, said being part of the programme opened her eyes to the challenges faced by rural health professionals.
"I've always wanted to come back and work in rural health," Haddawi said.
"Visiting the schools and rural health centres has solidified that idea for me."
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The programme appealed because she was from a rural community and "wanted to give back".
"A couple of the kids have told us they've been inspired to go into health careers," Haddawi said.
Throughout the process, Haddawi found herself learning just as much, if not more than the high school students she presented to.
"It's taught me how not one size fits all and you really have to come to rural health with a community-centred approach."
A Te Whatu Ora Health New Zealand spokesperson said an interim New Zealand Health Plan Te Pae Tata would be released soon.
"The plan sets out changes to be made in the next two years to transform the health system," the spokesperson said.
"Accessible rural healthcare is identified as a priority under the plan."
The spokesperson said a health workforce pipeline, development of telehealth services for rural areas and programmes for recruiting and retaining health workers were also were also underway.
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