As more than 3500 NSW public hospital doctors down tools in a bid to improve working conditions and pay, surgeries, appointments and cancer treatments have been cancelled.
The first strike by NSW doctors in 27 years has highlighted the discrepancy in pay between the state and Australia's other jurisdictions with doctors routinely moving to Victoria and Queensland for better conditions.
Western NSW kidney specialist Zainab Wajih has joined the strike and said conditions are even worse in the regions than they are in metropolitan areas, with patients paying the price.
A lack of specialists and other supports has forced doctors to back their own skills and manage complex cases themselves, Dr Wajih said.
"I could be earning the same amount of money in Sydney with similar conditions in Sydney, but I choose to stay here because we need more specialists in this area," she said.
"We need to have a budget that allows for more specialists in this area and incentives for people to work in rural and regional towns, whether that's better work hours, whether that's more support from the admin staff or management, or whether that's more pay."
Western NSW psychiatry registrar Nathan Blake said a "vicious cycle of burnout" was driving worse care to patients.
Acknowledging his current conditions were reasonable, Dr Blake said he had worked 16-hour shifts in a previous role and understood the doctors' anger.
"You're trying to give all you can to the patients we've all given so much of our lives for (but) it can be really, really difficult to even begin to articulate how challenging that can be when you can't go to the bathroom because you've got so much to do," he said.
Earlier, Australian Catholic University academic Xavier Symons said a stretched workforce would not take the decision to strike lightly or without it being driven by a deep sense of ethics.
More than 3800 surgeries, appointments and cancer treatments were cancelled on Tuesday in the fight over staggering workloads and lagging workplace conditions.
Dr Symons said the sense of duty towards patients has caused doctors to suffer "moral injuries" as they feel disempowered to do their jobs.
"With increasing bureaucracy and increasing kind of systematisation of healthcare ... what you've seen, is that health professionals feel like they can't really do the best by their patients," he told AAP.
Dr Symons, director of the Plunkett Centre for Health Ethics at ACU, said medicine was not like other professions, where you can leave work in the office.
"The issue with burnout is not so much that doctors aren't responsible enough, it's that they're too responsible ... they can't switch off," he said.
Doctors from more than 30 NSW hospitals went on strike on Tuesday, demanding a 30 per cent salary increase and guaranteed breaks.
The walkout is ongoing until late Thursday.
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