The association is pushing the government to accept its rural rescue package in the next budget, which includes loadings of up to 50 per cent for specialist doctors working in very remote areas, in order to plug huge workforce gaps. Otherwise, it says, the government's guarantee of national standards of care would not be met.

The rescue package includes an ''isolation'' loading, from 3 per cent for large regional centres to 8 per cent for rural towns and up to 25 per cent for doctors in very remote areas.

These loadings would be double for specialists.

The figures indicate the magnitude of compensation the government must pay to buffer rural and regional hospitals under its proposed activity-based model - by which hospitals are paid per procedure.

The association's rescue package is costed at $350 million a year to address a shortage of 1800 doctors in rural and regional Australia, a third of them in NSW.

The president of the NSW branch of the association, Ian Kamerman, said the state's rural hospitals were continually being downgraded. If Mr Rudd's reforms did not address workforce shortages, there would be ''widespread hospital closures''.

''There's nothing in there that says how they are going to encourage health professionals to the bush and my worry is that [the reforms are] about money and not services,'' Dr Kamerman said. ''The biggest cost for a small hospital is opening the doors, not doing the procedures.''

Tilak Dissanayake is the only doctor at the 20-bed Coolah Hospital, north of Mudgee, which has just nine acute care beds. He said the reforms must respect existing state-based remuneration packages which cover around-the-clock work.

''It's 24/7, I'm always running up and down to the hospital,'' he said. ''I almost have never had a sit-down lunch for the last nine years.