Purpose: Locum consultant surgeons in regional hospitals are frequently required to manage a broader scope of practice than their metropolitan counterparts. The complexity and decision-making burden of this role remain poorly quantified. Methodology: A retrospective service evaluation was conducted using a prospectively maintained consultant logbook documenting all operative and endoscopic procedures performed during locum appointments between March and December 2025 across regional hospitals in Queensland, New South Wales, Victoria and South Australia. Results: The locum role encompassed emergency surgery, elective general surgery, breast surgery, skin surgery, urology-adjacent procedures and gastrointestinal endoscopy. Procedures ranged from minor operations such as vasectomy, carpal tunnel decompression and abscess drainage to complex abdominal surgery including laparotomy, bowel resection and emergency colectomy. Endoscopic management of gastrointestinal bleeding and food bolus obstruction—often managed by gastroenterology services in metropolitan centres—was routinely performed by the locum surgeon. Conclusion: Locum consultant surgeons in regional Australia are required to maintain a wide scope of practice and high-level decision-making across multiple domains. Workforce planning should recognise the advanced skill set required to safely deliver regional surgical services.