"UNCERTAINTY" was the word on everybody's lips when 700 country doctors met in Sydney for the biggest rural health conference of the year.
Doubts over funding cuts, the disbandment of established public health bodies and the persistent city-rural divide were key topics on the opening day of the Rural Medicine Australia conference.
One point of discussion was the treatment of itinerant fruit pickers who roamed the countryside and often had a limited grasp of English.
But one of the industry's biggest challenges is to stop country GPs becoming the "migrant fruit pickers" of the health industry - showing up for a season and heading back home.
Rural Doctors Association of Australia president Dr Ian Kamerman said sweeping changes to the national health system had done little to fix the problem, with rural clinics finding themselves in a state of limbo.
The body responsible for GP training will soon be disbanded and its responsibilities transferred to the federal health system.
"What's causing a whole lot of stress is you have no control about decisions being made about you," Dr Kamerman said.
"You're running a medical practice and you have no way to predict your workforce or your workload.
"At the moment, I think there's no plan other than to remove the body that was running GP training and to put all the regional training provider (openings) out to tender.
"No doubt, we will find out more in the fullness of time."
Inequality of equality
KEYNOTE speaker Dr Carole Reeve is a senior lecturer at the Centre for Remote Health in Alice Springs.
She spoke on the "inequality of equality" between city and rural patients.
"It's not that we need equal care. We need equitable care which is fair," she said.
"A lot of resources have been put into rural and regional areas, but in terms of health outcomes there is still a big difference."
The average life expectancy for people born between 2009 and 2011 in northern Sydney is 84.6 years.
That lifespan falls to just 76 years in some rural and remote parts of the country - a figure on par with Ecuador.
The North Coast has the fourth-worst life expectancy for any region in New South Wales at 81 years.
"Our average outcome is one of the best in the world, but when you look closer there are bigger issues," Dr Reeve said.
Dr Reeve said funnelling money into the health system was not the only answer and that addressing "modifiable risk factors" should be a priority.
"These are the circumstances in which people live, work and play," she said.
"If you look at people's housing, there are associations with chronic lung disease.
"Homeless people have a very high rate of using emergency departments.
"It's important to take social circumstances into account, because if you just send them back to the same conditions it will happen again."
Issues raised at the three-day conference will be used to form policies to inform and lobby government.