GP oversupply driving budget blow out?

Doctors have criticised claims that GPs will maintain high bulk-billing rates even if the rebate freeze is extended

Doctors have criticised a recent report that claims an “oversupply” of GPs will maintain high bulk-billing rates even if the Medicare rebate freeze is extended

The report, by The Australian Population Research Institute, said the number of GPs per 100,000 population climbed 24% between 2004-5 and 2014-15, while Medicare outlays on GP items more than doubled to $6.8 billion.

Co-authors Dr Mike Moynihan and economist Bob Birrell cast doubt on warnings from the AMA and the RACGP that the prolonged freeze on MBS indexation could force GPs to abandon bulk billing.

“There are so many GPs seeking patients that few could risk charging a co-payment,” the authors write.

“If they did, patients would go round the corner to a competitor that does bulk bill.”

The authors called for a cut in the recruitment of overseas-trained doctors, a freeze on medical student intakes and a halt in granting provider numbers in areas with an abundance of doctors.

The ratio of doctors to Australia’s population was already high and on course to get higher, they claimed.

“This is the main reason why the share of GP consultations that are bulk-billed has increased from 68% in 2003 to 84% in 2014. It is also the main reason why … the number of services per patient has steadily increased across Australia since 2003.”

Dr Moynihan, a former president of the Rural Doctors Association of Victoria, told TMR the recruitment of overseas trained doctors was the main factor driving the increase in GP numbers.

“These doctors are flowing out [of rural and regional areas] into capital cities and as they flow out they are replaced,” he said. “We are getting a very rapid increase in workforce.”

The number of overseas trained doctors had more than doubled in a decade to 13,209 in 2014-15, according to the report.

Further, the report criticised the AMA and the RACGP for supporting policies aimed at increasing the GP workforce.

“Organised medicine is part of the problem,” the authors said. “One might think the AMA and the RACGP would put their members’ interests first by curbing the flood of new competitors into their market.”

AMA President Dr Michael Gannon said the argument about GP numbers was “slightly false”, applying only to densely populated areas in capital cities.

Dr Gannon argued that investment in general practitioners kept patients out of hospitals and emergency departments.

“A quality primary care sector reduces costs in more expensive hospital care,” he said.

Dr Evan Ackermann, chair of the RACGP’s National Standing Committee – Quality, said the report’s use of raw statistics was misleading.

“Quoting the raw bulk-billing rate in isolation as an indicator of affordability of general practice care is mischievous,” he wrote in a recent article in the MJA.

“It misrepresents the true costs of seeing a private GP and is being used to justify a political agenda.”

According to Dr Ackermann, many organisations have been dipping into Medicare funding over the past decade.

“Medicare has broadened MBS access to several non-government and state government organisations, which now include: the Royal Flying Doctor Service, Aboriginal medical services, bulk-billing clinics in public hospitals […] women’s health centres and refugee health centres,” he said.