Kaitaia GP Cecil Williams hasn't retired. He has burnt out. And last week he warned that if something didn't change soon, he would not be the only one.
Dr Williams, who began his career in his native South Africa, and worked as a physician anaesthetist at Kaitaia Hospital in 1995-96 before establishing a general practice in 1998, said the town's health services had become dysfunctional.
"We have a big problem here," he said, "and I don't have a silver bullet. A lot of things have to change, and that has to start with everyone sitting down together, looking at what's wrong and what has to happen to fix it."
The problems included a lack of co-operation between GPs and Kaitaia Hospital doctors. With no proper triage system in place, those needing attention after hours (5pm to 8am, and weekends) had to see a GP first. That cost that many couldn't afford, or were reluctant to pay, and often resulted in them being referred to the hospital for treatment or procedures that a GP could not provide.
Hospital doctors' refusal to take over after 10pm added to the GPs' workload, and delayed the provision of the required level of care.
"The hospital doctors are adamant. They have threatened to resign rather than adopt the system that works well elsewhere (including in the Mid North), which would collapse the hospital system," dr Williams said.
"A lot of of people just aren't coping. We're working unsustainable hours, and the stress that generates just continues to build. More and more is being demanded of GPs. We have been talking about it for years, but it has never been resolved."
The ramifications of that included that Kaitaia was no longer seen as a desirable place for GPs to work. Many were now locums, who would stay for six months, 12 months, "if we're lucky two years," while those who were permanent were nearing retirement age.
It was also having an effect on the hospital staff, which had already lost many of its senior nurses, and where people were not "queuing" to work.
"The workload is definitely one reason why doctors don't want to come here," he said.
"The patients are losing out too. They don't have the long-term relationship with a doctor that they used to have. There is no continuity of care. That's not good for the doctor, and it certainly isn't good for the patient.
"I have tried to cope with this for a long time, but it reached the point where it was affecting my health. That's not good for me, my family or my patients. I had to do something to sort myself out, and I won't be the only one who has to make that decision.
"I feel guilty about not being able to care for my patients, but I had to do something to rehabilitate myself. The advice I'm getting now is not to return to the situation that put be under unendurable stress, so I don't know what's going to happen, unless something changes.
"As long as people continue to do their job there will be no urgency or commitment to change the system, but one day it will collapse, because it's going to become more and more difficult to find people who want to work here.
"Hospital doctors and GPs must start working as a team. After-hours care has been a grey area for years — both say it is up to the other provide that service. That has to be resolved.
"Why would we continue with a system that isn't practical and doesn't work? I left my practice three months ago, and nothing has been done, or will be done."
Stress levels were exacerbated by extraordinarily burdensome bureaucracy, he added. Once he wrote three or four sentences after a consultation; now he was expected to write an essay. One hour of consultations generated an hour of paperwork, which made an eight-hour day impossible.
"We need to find solutions," Dr Williams said.
"We need to make the system better for everyone, so we can provide the best care and so people will want to come and work here.
"Locums might be a short-term solution, but won't fix anything long-term. They are concealing the underlying problem, for the time being."
He very much wanted to continue his career, but his only options currently were to work as a locum or to leave Kaitaia.
"At the moment people are just surviving. It's very sad," he said.
"And of course it's my wife who bears the brunt of my frustration and anger. It's not her fault. That's why I quit.
"I tried to cope the best I could, but I've reached the stage were I just can't do it any more."