Being a rural GP might sound dreary but some Northland family doctors say their job is not as mundane as most think.
With a growing health staff shortage, rural GPs are more needed than ever to deliver services to the remote communities of Tai Tokerau.
For Dr Liam Watson becoming a rural GP in Northland is an exciting journey that began in the cold south in Invercargill and has brought him up to Dargaville.
Originally from the UK, Watson came to New Zealand in 2017 looking for a different work experience which landed him in Southland.
As part of his placement, Watson spent half his time at the local hospice and the other half travelling around southern communities including Te Anau, Queenstown and West Otago with other rural GPs to provide care.
"I got to experience the breadth of work [rural doctors] do," Watson said.
Performing X-rays and EKGs, managing fractures and dealing with acute patients are within the scope of work for rural GPs.
Watson explained that a difficult and vital part of their job was liaising with health teams in nearby cities to work out an appropriate health plan for a patient.
"People don't want to travel two or three hours to go to a hospital if they don't need to," he said.
What Watson learned quickly was that rural GPs are enthusiastic about their work and deeply connected to their community.
"It felt like the old sense of being a GP."
Following his stint in Invercargill and placement at the Christchurch Hospital ED, Watson and his partner, a nurse from Kaitāia, had planned to go back to the UK so that Watson could begin his speciality training to become a GP.
"But then Covid hit."
Instead, the couple decided to go to Northland "for a wee while".
After a work experience at the Whangārei Hospital paediatric department, Watson applied to do his GP training in Northland and started his three-year education at a Tikipunga practice.
He said typically GPs in training would have to work at least six months in practice in town and six months rurally.
So when his time in Whangārei came to an end, Watson switched to Dargaville – and stayed.
He is in his second year of speciality training now and loves the work experience.
Watson described Northland as an interesting and fulfilling place to work in, particularly thanks to Māori culture and te reo Māori.
"I like the variety of the work. We can see 20 different presentations in a day, which keeps you on your toes.
"One appointment can be a six-week baby check-up and the next one a patient in their 90s with signs of heart failure."
He sees far more than the little aches and pains one might expect a GP to deal with on a daily.
Since the practice Watson is working at is connected with the Dargaville Hospital he also gets to care for acute patients with minor injuries, heart attacks or bad pneumonia.
Day trips to Te Kōpuru, Pouto or Ruawai are also on the roster to bring medical care into remote Kaipara communities.
"People are here so appreciative, very welcoming and down to earth. They work really hard – farming, working at meat works and being out on a kūmara fields are labour-intensive jobs. These types of jobs lead to special presentations."
While Watson has to commute from Whangārei, driving through rolling hills and navigating logging trucks was better than being stuck in downtown traffic, he said.
He quotes the flexibility of working hours and room to specialise within the medical field as a perk of being a rural doctor. The job offered a good work-life balance, Watson said.
"However, the challenge is that we're so short of doctors."
Watson said the biggest worry was that many of his colleagues are nearing retirement age and there are not enough young doctors coming through who are willing to work rurally.
This would lead to longer wait times for patients.
Watson also criticised the lack of guidance after the first year of GP training.
"Hospital doctors get funding for years of training and supervision." Meanwhile, GP registrars are thrown in the deep end after their first year.
"It makes you feel undervalued," Watson said.
A significant pay gap between first-year GP registrars and those doing training in hospital specialities was another deterrent for doctors to join the rural workforce, he explained.
In the Bay of Islands, an established rural GP has teamed up with Ngāti Hine Health Trust to hire a sustainable number of doctors for Kawakawa and Moerewa – both of which have been short of GPs for years.
Dr Graeme Fenton, who has been practising for over 50 years, says he loves working in the Moerewa community.
"Moerewa doesn't have the best reputation but it is a very friendly place."
According to Fenton, the last time it was this desperate in terms of GP numbers was in the early Nineties when patients had to travel to Whangārei to see a doctor.
After a reprieve, it deteriorated again in the last five to six years, he said.
"The present situation is worse than we've seen in the last 50 years."
In 2021, there were 151 Northland GPs registered with the Medical Council of New Zealand; that makes up 133.7 full-time equivalent doctors because some GPs don't work a 40-hour week.
On average, there are 68.2 full-time equivalent doctors per 100,000 Northlanders, which is more than the national average of 65.8.
In other terms, one full-time equivalent doctor looks after 1466 patients in Northland, compared with 1520 patients nationwide.
However, for Northland's rural doctors those numbers can sway significantly.
Currently, there are three doctors or 2.75 full-time equivalent GPs covering Kawakawa and Moerewa.
Fenton reckons he and his colleagues are looking after about 1700 patients each.
Together with Ngāti Hine Health Trust, Fenton is hoping to find two to three GPs to join the trust's Mid North practice at the new, purpose-built facilities at the Bay of Islands Hospital in Kawakawa.
Ngāti Hine Health Trust CEO Geoff Milner said the health provider wasn't immune to the current challenges caused by health staff shortages and decided to do things "a bit different".
"We want to fly the flag that being a rural GP is a good thing," Milner said.
Milner was optimistic that domestic as well as international doctors would appreciate the rural lifestyle in the Bay of Islands.
He said the remuneration rates were "as good as it gets in Northland" and being employed under the trust would relieve doctors of the duties that come with running the clinic business.
Since the Māori health provider offers a range of services including social and housing services, Ngāti Hine doctors had a sense of belonging to the community, Milner said.