Call her Maya. Thirty-one, pregnant with her first child, referred to North Canberra Hospital's obstetrics unit in 2025. At her first three appointments she saw three different doctors, none of them the specialist meant to run the unit, because the clinical director's position had sat vacant since May with no active recruitment underway. In their place, the hospital flew in obstetricians at locum rates of up to $3,000 a day, against roughly $750 a day for the territory's own most senior permanent doctor in the same specialty; between June and September 2025 alone, twelve temporary O&G doctors cost the public system $673,450 (Canberra Times, reporting Canberra Health Services figures, October 2025). Maya's baby arrived safely. The unit that delivered her kept running on doctors flown in a week at a time, because the permanent workforce underneath them was not there.
Maya is a composite, built from a pattern in the territory's own spending and workforce figures rather than one patient's file. She could as easily be a family that has called a dozen GP practices without finding one still bulk billing, a patient waiting months to see a psychiatrist, or a nurse who has just worked her last shift in a Canberra public hospital. All four describe the same problem: the ACT, wealthier and better resourced per resident than almost any other Australian jurisdiction, cannot reliably staff its own health system, and the shortfall gets patched with the most expensive labour money can buy rather than fixed.
What the government did
Health workforce planning sits with the Health and Community Services Directorate and its delivery arm, Canberra Health Services (CHS), under the Barr Labor government's parliamentary agreement with the ACT Greens, running continuously since 2020. Its central workforce document is the ACT Health Workforce Strategy 2023-2032, a ten-year plan spanning eight strategic priorities (ACT Government, ACT Health Workforce Strategy 2023-2032, May 2023).
On nursing, the government has followed through with funded reform. Mandated minimum nurse- and midwife-to-patient ratios began rolling out in ACT public hospitals from 1 February 2022. The 2024-25 Budget, handed down 11 June 2024, committed $86 million over four years to recruit 137.2 additional full-time-equivalent nursing and midwifery staff to support the ratios, plus $21 million from the mid-year Budget Review for a $2,000 education boost and a $750 annual professional-development allowance per nurse. The final tranche, covering University of Canberra Hospital and sub-acute mental health services, commenced in February 2026 (ACT Government/CMTEDD media releases, June 2024 and February 2026).
On general practice, the government has leaned on incentives rather than direct control, since GPs are private operators. In 2023 it introduced a payroll tax exemption for bulk-billing practices, and its 2024 election platform added an $11 million fund for bulk-billing clinics, $100,000 in HECS-debt assistance for 30 medical students who commit to five years as an ACT GP, and $4 million for junior-doctor exposure to general practice (ACT Government/CMTEDD releases, 2023-24; RACGP and Canberra Times reporting on the 2024 election). CHS also cut its most expensive labour line: measures through 2024-25 replaced part of its reliance on agency staff with direct employment, saving in the order of $27 million over six months, roughly $21 million from reduced agency use (Canberra Health Services/ACT Budget reporting, 2024-25, approx.).
The strongest case
A small jurisdiction competing nationally, inside a country genuinely short of clinicians
Put the government's defence at its best, and three points hold up. First, the ACT is fighting the sharp edge of a national problem, not one of its own making. Roughly four in five health occupations nationally were assessed as being in shortage as of 2023 (national workforce shortage analysis, 2023, approx.), and fields such as psychiatry face structural undersupply regardless of jurisdiction: Commonwealth modelling projects a national shortfall of roughly 74 full-time-equivalent psychiatrists in 2025, widening to around 124 by 2030, with about 85% of the workforce already in metropolitan areas (Australian Government, Psychiatry Supply and Demand Compendium Report, November 2025, approx.). A territory of around 470,000 people, drawing from the same pool as every other Australian capital, competes at a structural disadvantage of scale no single ACT policy can fix alone.
Second, where the government holds a direct lever, it has funded it properly rather than merely announcing it: the nurse and midwife ratio rollout is a genuine, multi-year commitment, backed by new money in successive Budgets and phased with a formal evaluation built in. Third, it has begun weaning the system off its costliest habit — cutting agency and locum spending by tens of millions in a single year — and a GP registrar intake that grew from 23 to 40 funded places in a single year shows the pipeline responding to policy support.
The evidence
Against that steelman, the ACT's own data show a jurisdiction losing ground on almost every measure that matters to a patient trying to get seen.
The GP shortage and the bulk-billing collapse
General practice is the clearest case. RACGP's Health of the Nation survey put ACT supply at 91 full-time-equivalent GPs per 100,000 people in 2023, against a national average around 113 and above 118 in New South Wales, Victoria and Queensland (approx.) — the worst-supplied capital city in the country, with roughly 23% fewer GPs per person than any other Australian capital (RACGP, Health of the Nation, 2024-25 editions, approx.). GP registrar training, the pipeline replacing retiring GPs, filled under half its funded places for years running — just 23 registrars, 44% of funded spots, in 2025 — before a stronger 2026 intake of 40 lifted the fill rate to around 80%, still leaving the College warning the territory is "definitely not oversubscribed" (Dr Rebekah Hoffman, RACGP, quoted in Canberra Times, 2026).
Bulk billing has followed the workforce down. AIHW data put the ACT's annual GP bulk-billing rate at only around 53% for the twelve months to October 2024 (approx.), against a national rate near 78% over the same period — a gap of roughly 25 percentage points, the widest of any state or territory, predating the November 2025 national incentive expansion (AIHW, bulk-billing analysis, approx.). Cleanbill's independent 2026 Blue Report, a nationwide audit of practice billing policies, found the ACT had the lowest share of practices that always bulk bill of any jurisdiction, in the low double digits (approx.), against 51.9% in New South Wales and 43.6% in Victoria, alongside the second-highest average out-of-pocket gap fee of any state or territory at around $57.96 (approx.), behind only Tasmania (Cleanbill, Blue Report 2026, independent secondary source, clearly labelled).
Nursing, specialists and the workplace culture that drives staff out
The nursing ratios now rolling out exist because the alternative, running wards short, had already produced years of self-reported strain. A 2021 internal culture survey of 3,852 CHS staff, roughly half the workforce, found about one in eight intended to leave within two years, with only 39% rating workload as fair and separation above 19% in mental health, justice health and alcohol and drug services (CHS workforce survey, obtained under freedom of information, November 2021, approx.). A follow-up survey in November 2023 found self-reported bullying and harassment down 18% on the earlier baseline, but most nursing and midwifery staff opted out entirely, a sign their union read as unrebuilt trust, and mental health nurses and midwives kept recording the highest resignation numbers of any nursing group (Canberra Times/ANMF reporting on CHS culture surveys, 2021 and 2023). Occupational violence compounds the exit risk: the ACT Ambulance Service alone logged more than 190 occupational-violence incidents in a recent financial year, over one every two days (Region Canberra, reporting ASMOF ACT and ACT Ambulance Service figures, approx.).
The specialist gap shows up most starkly in obstetrics but is not confined to it: the territory has separately recorded a persistent, multi-year shortage of psychiatrists across mental health, justice health and alcohol and drug services (Canberra Times reporting, approx.), consistent with the national maldistribution described in the steelman above. Facing that gap, CHS became the only ACT directorate offering retention bonus payments in recent years: in 2024-25 it spent close to $4.96 million on incentive payments to 95 employees, mostly clinical staff, averaging about $52,000 each on top of base salary (approx.), which its own union cites as evidence base pay, not just vacancies, is driving people out (Canberra Times reporting on CHS incentive payments and the ASMOF Fair Work Commission dispute, 2025-26, approx.).
Paying a locum four times a senior doctor's day rate is not a workforce strategy. It is the price of not having one.
The critique
The steelman's national-shortage framing is real, but it cannot explain why the ACT sits at the bottom of the country rather than merely below the middle. Sydney, Melbourne and Brisbane draw from the same national and international labour pool and face the same training bottlenecks, and are not smaller or less financially capable than Canberra, yet the ACT runs roughly a quarter behind every one of them on GPs per person and records the widest bulk-billing gap to the national rate of any jurisdiction. A city that ranks among the wealthiest in the country on average income should not also be the hardest place in Australia to find a doctor who will treat you for free.
Second, the pattern across two independent workplace-culture reviews, eight years apart, is recommendations made, only partly implemented, and then rediscovered. A 2018-19 review into workplace culture at ACT public health services made 20 recommendations after finding troubling levels of bullying; a further inquiry, chaired by Michael Walsh PSM and drawing on 259 consultations, tabled in the Legislative Assembly on 10 June 2026, made 49 more, again flagging clinicians who lack confidence that raising a safety concern will be acted on (ACT Legislative Assembly, Inquiry into ACT Health System Data, Demand and Processes, Final Report, 10 June 2026). That most of the 2023 survey's own nursing and midwifery cohort declined to take part is itself evidence trust, once lost, is not rebuilt by a policy document alone.
Third, the response increasingly relies on the most expensive fix available rather than the cheapest. Paying a locum obstetrician up to four times a senior permanent doctor's rate, and running a clinical directorship on fly-in rotations for the better part of a year with no active recruitment, is not a strategy; it is triage. Retention bonuses follow the same logic: paying 95 staff an extra $52,000 each on average, while a linked pay dispute heads to the Fair Work Commission, treats a symptom already priced at close to $5 million a year rather than fixing the pay structure its own union blames.
Finally, the cross-border dynamic now cuts against the ACT. The territory has long paid above New South Wales rates to recruit staff out of border towns; a state-wide NSW nurses' and midwives' pay rise, legislated after the 2023 election and still flowing through as backpay into 2026, narrows that gap just as NSW border communities already supply close to a fifth of ACT hospital admissions with no matching contribution to its workforce (NSW Government pay announcements, 2023-2026; ACT Government cross-border health data, 2023-24).
What they got right
Credit belongs in specific places. The nurse and midwife ratio program is real, funded across multiple Budget cycles, phased sensibly, and — on the territory's own reporting — is giving ward staff safer, more predictable workloads where fully implemented. Cutting agency and locum reliance by tens of millions in 2024-25, even as obstetrics still needed emergency locum cover, shows real fiscal discipline rather than simply throwing money at the problem. And a GP registrar intake that grew from 23 to 40 places filled in a single year is a genuine, if overdue, response to years of RACGP warnings — though one strong intake year does not yet prove the pipeline is fixed while GPs per person remain the lowest of any Australian capital.
The risk to the future
A workforce shortfall that compounds with every year of population growth
The ACT's population keeps growing faster than most of the country, and every additional resident needs a GP, a nurse and, eventually, a specialist the territory does not yet have enough of. If bulk billing keeps recovering nationally under the November 2025 universal incentive while the ACT's own GP-per-person gap stays the widest in the country, Canberra risks becoming the one capital where a national fix does not translate into local access, because the binding constraint is doctors on the ground, not the price a patient pays to see one. If the pattern from two culture reviews eight years apart repeats a third time, the government will keep funding nurse and midwife ratios with one hand while losing the staff who fill them with the other, and locum and bonus spending will keep growing as a permanent cost rather than shrinking as a temporary bridge.
The clearest warning sign is obstetrics: a clinical directorship left vacant for the better part of a year with no active recruitment, on a service delivering thousands of babies annually, is the kind of gap that either gets filled properly or becomes normal. If the ACT cannot show, within the next Budget cycle, that its 2026 GP registrar surge and completed ratio rollout are translating into fewer vacancies and a narrowing bulk-billing gap, not just more funded positions on paper, the territory's health workforce risks settling into permanent, expensive triage, in a city wealthy enough that it should not need one.