Lloyd Nash’s job has taken him to some of the world’s most far-flung places, with work commutes on planes, ships and four-wheel-drives.

As a general and acute care physician, Dr Nash has worked in Antarctica, the Pacific and in remote Indigenous communities.

He has treated conditions many doctors only get to see in textbooks, while also getting a taste of adventure.

“You’re working to the top of your scope, seeing interesting patients and having an impact,” Dr Nash told AAP.

Dr Nash, who now heads the department of medicine at Albany Hospital in WA, is something of a rarity as one of a limited number of physicians working outside a city.

Specialists and trainees are largely concentrated in metro areas, according to a Royal Australasian College of Physicians report released on Wednesday night.

More than 90 per cent are metro-based in Victoria, NSW, SA and WA, while in Queensland it’s 82 per cent, according to the research.

The city-country divide is the result of complex policies that siphon specialists back to the cities for their final years of training, the report said.

By the time physicians do that training they’re more likely to have children, partners and mortgages, making it harder to uproot to the regions.

The research urged broad reforms, including national workforce planning and more support to retain rural physicians, such as providing housing and childcare support.

Dr Nash is also the co-director of the WA Rural Physician Training Pathway, a program anchoring trainees in rural areas, with rotations in the city.

It accepts doctors with an existing rural connection and allows them to receive networked training and remote supervision.

The model is in high demand, Dr Nash said.

“Word gets out very quickly that these are great places to live, work, and train,” he said.

Medical workforce shortages underpin health gaps in remote areas, where people are 1.5 times more likely to die early compared with city peers.

Annabel Martin, a nephrologist and head of Charles Sturt University’s rural clinical school in Albury, has seen patients forego specialist care because travel to the city is not feasible.

While the clinical school embeds students in regional communities, many may be forced to go back to the city for sub-specialist training, Dr Martin said.

Medical colleges could assist by reducing barriers for regional hospitals to get training accreditation and recognising the value of remote supervision.

But rural Australia remains largely invisible to policymakers, Dr Martin told AAP.

“We have a lot of metro people speaking on behalf of rural, regional and remote health.”

Torre, a mother who moved from Melbourne to regional Victoria, is one of the patients left behind.

She has waited years to a see a neurologist for debilitating migraines.

A Melbourne specialist will finally see her in October.

“Despite the difficulties of getting in to see rural specialists and GPs … I feel genuinely cared for by them,” she said.

“It’s not lack of quality, it’s a lack of access and availability.”

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