Mount Isa Hospital (MIH) is a remote hospital in far North Queensland that serves as the main public referral centre within the North-West Hospital and Health Service. It has departments for emergency and general medicine, general surgery, obstetrics and gynaecology, and general paediatrics. However, there are no further specialty services on-site, nor an on-site intensivist. The nearest subspecialty services are at Townsville University Hospital, 900 km away. MIH faces significant challenges in running its operating theatre efficiently due to a shortage of staff. In 2024, there were 10,752 delays, with key causes being patients not ready (1,628), elective cases overrunning (1,439), and emergency priorities (1,397). Surgeon unavailability accounted for 1,331 delays, reflecting the heavy workload on general surgeons managing diverse cases and adapting to last-minute changes. From the general surgeon's perspective, the workload in remote hospitals is uniquely challenging. They care for all types of surgical patients, from trauma cases to gastrointestinal and oncological surgeries, without the specialised support typically found in metropolitan hospitals. This heavy workload and insufficient anesthetists and theatre nurses lead to stress, burnout, delays, and compromised patient care. Addressing these challenges requires systemic solutions, including improved recruitment and retention strategies, better allocation of resources, and innovative models such as telemedicine and subspecialty outreach programs. A comprehensive approach is essential to support the diverse roles of general surgeons, reduce staff shortages, and enhance service delivery. Strengthening these systems will improve surgical efficiency, sustainability, and equitable healthcare access in remote regions.