Purpose: Despite comparable leave requirements among consultant surgeons, metropolitan hospitals rarely rely on locum consultants, while regional hospitals remain highly dependent on locum surgeons. This study examines patterns of locum consultant surgical service delivery and implications for workforce equity. Methodology: A retrospective service evaluation was undertaken 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: All locum surgical activity occurred exclusively in regional hospitals, with no locum placements undertaken in metropolitan centres during the study period. Locum surgeons provided continuous emergency surgical cover and, where continuity was established, delivered substantial elective and endoscopic services. In contrast to metropolitan Acute Surgical Unit models—where subspecialty services absorb complex cases—regional locum surgeons independently managed complex abdominal surgery, emergency endoscopy and cross-disciplinary procedural care. Conclusion: The dependence on locum surgeons in regional Australia reflects a structural workforce inequity rather than episodic staffing shortages. Addressing disparities in regional surgical access will require system-level workforce strategies that recognise the breadth, complexity and decision-making demands placed on regional locum consultant surgeons.