26 April 2022

GP frustration could be approaching critical mass

AMA Political TheHill

With more and more GPs deciding to stop bulk-billing, it’s starting to get ‘really, really obvious’ that something is going wrong in the profession.

GPs stepping away from bulk-billing has been making mainstream headlines recently. But low Medicare rebates are an old problem, so why does it seem like more people are paying attention right now?

One program on “the death of bulk-billing” ran an infographic which compared the patient rebate for a 15-minute GP consult – currently $39.10 – with a plumber, who could make $85 in roughly the same amount of time.

“No disrespect to plumbers, but you can’t possibly have a viable, excellent universal health care system, when you fund it like that,” Australian Society of General Practice President Dr Chris Irwin told The Medical Republic.

According to Dr Irwin, the issue is just now getting more mainstream attention because the number of GPs declining to bulk-bill has reached a critical mass of sorts.

“Everything we can do to take the blinkers off patients [so they can] see the actual state of general practice funding is, I think, a good idea,” he said.

“I think the reason why it is getting traction in the mainstream media is because it’s really, really obvious now [how many practices cannot afford to bulk-bill].”

The Department of Health has, as recently as last month, claimed that about 88.7% of GP services were bulk-billed.

But ASGP places its estimates much lower, at around 65-70% of GP services.

Medicare billing expert Dr Margaret Faux has said there is reason to believe this number is even lower – she estimates that the true legal bulk-billing rate is probably around 30% across the whole health system rather than the 81.9% touted by the government.

“The average increase in the cost of providing medical care in terms of the medical equipment and the disposable items we use is going up by about 10% per annum, so it’s just a crunch [at the moment] and I think that we’ll see quite a large drop in bulk-billing over the next 12 months,” Dr Irwin said.

With the federal election now less than a month away, ASGP have come out with a patient-facing resource explaining the cost pressures on general practice. The poster also encourages patients to reach out to members of parliament to say they want Medicare freezes and cuts reversed.

“Both sides of politics seem more interested in manipulating the bulk-billing numbers to make it look like the majority of services are bulk-billed than actually solving the problem,” Dr Irwin said.

“I don’t think the Liberals or Labor have any real taste for significantly altering the Medicare landscape.”

Sydney GP Dr Imaan Joshi said she believed the reason that doctors abandoning bulk-billing rates are back in the headlines is because “people are just sick of it”.

“A colleague in a private-billing clinic saw her local member of parliament, who at the end of the consultation asked to be bulk-billed, ‘because bulk-billing is good for everyone,’” Dr Joshi said.

“Things like that just erode your sense of self-esteem.

“If you’re providing great value, why aren’t people willing to recognise it?”

Female GPs especially are feeling burnt out right now, according to Dr Joshi.

“I can tell you that so many women are leaving the profession – they don’t want to do anything that’s related to Medicare, or if they’re young enough, they’re thinking of switching to a different specialty training program,” she told TMR.

Female GPs, Dr Joshi said, tend to deal with more complex issues than their male counterparts as they do the bulk of women’s health and mental health consultations.

“Women [tend to] earn a lot less than our male colleagues do, because of the fact that we often work fewer hours than the men, because we have childminding duties at home, et cetera,” Dr Joshi said.

“I think it’s just starting to add up for a lot of us.”

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Peter Bradley
Peter Bradley
2 months 4 days ago

A more revealing and realistic figure as to the rate of bulk-billing would be to be able to separate out and list just the percentage of actual GP consults bulk-billed. That would be much more reflective of the reality of how many GPs are charging fees. Most imaging and pathology items are automatically bulk-billed, as are most care and mental health plans. The number of item 3, 23, 36, 44s, and equivalent non-VR (A2) items, etc BB’d would be very different from the claimed 85+%.

Dru Haywood
Dru Haywood
2 months 4 days ago

Comparing GP rebate to a plumber rebate is silly and does not help the discussion. Plumbers’ fees are for home visits. A totally different thing.

Elizabeth Grey
Elizabeth Grey
2 months 4 days ago

I’m sure a plumber would prefer to work from a centre if they could; and GP’s who do home visits are still not adequately renumerated compared to plumbers!

Joe Kosterich
2 months 5 days ago

The percentage of GP services direct billed and the percentage of patients who are direct billed is NOT the same.
Most GPs with direct bill EPC items in all patients. Most also direct bill pensioners and children who make up a disproportionate number of visits.
Thus the number of services direct billed may be 20% or more greater than number of patients direct billed.
The government likes to use the number of services figure as it makes them “look good”.