The Illawarra has lost 15 general practitioners in the past five years and the workforce is still shrinking.
Patients are waiting four weeks for a routine appointment at some clinics and the shortage is most dire in Shellharbour, where there is one GP for every 6600 people.
According to the Illawarra Division of General Practice, there are 230 GPs operating from Helensburgh to Gerringong, down from 245 in 2003.
Only five of the 18 suburbs surveyed by the Mercury meet the 1:1000 GP per head of population ratio considered ideal in metropolitan areas.
An audit to be conducted by the division next year is expected to show a regional GP workforce of less than 180 full-time equivalents.
"The Illawarra is an attractive lifestyle retirement destination, so we see a disproportionate amount of elderly patients and elderly patients have a disproportionate amount of health problems," division chief executive officer Andrew Dalley said.
"What I'm hearing is concern, particularly from elderly patients, that they're not able to get in to see their doctor."
The region misses out on both federal and state schemes designed to bolster GP workforces.
Illawarra suburbs are afforded none of the special classifications available under the Federal Government's rural, remote, regional and outer metropolitan classification system, which is intended to lure GPs away from suburbs with the most doctors.
Under the system, financial incentives are available in "outer metropolitan" Sutherland and in the Southern Highlands and the Shoalhaven, both of which have rural ratings.
"We're surrounded by areas that have significant incentives for GPs to move to them," Dr Dalley said. "We're too far outer to be outer, but we're not rural.
"There are very strong reasons for new doctors to move out of the Illawarra."
The State Government has grown increasingly frugal with its own GP workforce growth tool, the area of need classification.
The classification allows surgeries to recruit doctors from
overseas and is awarded on a practice-by-practice basis according to the GP to population ratio, the percentages of young and old residents, transport availability and other factors.
Of the nine Illawarra surgeries to apply for area of need status in the past two years, only two were successful.
Dr Dalley said other general practices had not bothered to apply, knowing the process took many months and cost up to $20,000 in recruitment fees and compulsory national advertising.
"Many of our practices will advertise (for GPs) overseas and particularly in the UK," Dr Dalley said.
"UK doctors will agree to come over to that practice, and then the area of need status is denied.
"The doctors don't then move to Coonabarabran or something.
"They're lost from the Australian system entirely."
Gwynneville GP Dr Jennifer Smiley spent $4500 on an application before it was refused last month.
She had secured an overseas candidate, who was already in the country, when she began the application process after receiving advice from NSW Health.
When the application was refused she had to fire the GP because they wouldn't be eligible for Medicare rebates without area of need status.
"I got not a single answer to national advertising and I must say that I felt rather ripped off that I'd been encouraged (by NSW Health) to proceed," she said.
"To waste money on this process was cruel.
"The only reason for the rejection was that I was in the 2500 postcode."
With 60 GPs for 33,480 patients, the 2500 postcode has, on paper, the highest number of doctors in the Illawarra, but Dr Smiley is one of only 46 solo family GPs operating in the area.
She has 3500 active patients on her books, many of whom come to her for ailments they wouldn't take to a medical centre, which focus on quick and uncomplicated consultations and are prominent in the Illawarra's best-served suburbs.
"(Patients) will often go to a large extended-hour corporate practice for simple things, coughs or colds or a medical certificate ... then they'll come to the person they consider to be really their GP ... for more difficult, longer consultations," Australian Medical Association (NSW) president Brian Morton said.
The number of Australian medical graduates will double to almost 3000 by 2012, according to a report by the Australian Institute of Health and Welfare.
Until then, an ageing GP workforce, an increase in the number of study years required to become a GP and the low pay compared with other specialties is expected to take its toll on already dwindling numbers.
Earlier this month, The Royal Australian College of General Practitioners launched a counselling support service for its members to help them cope with the high level of stress that has become a feature of a workforce in crisis.
"Our college recognised the heavy toll that current workforce shortages and other work pressures can take on GPs and the impact these demands place on their health and personal life," college president Dr Chris Mitchell said.
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