GPs shifting to private fees post-covid

A survey of over 1,000 GPs suggests at least 10% have moved from bulk billing to mixed or from mixed to private.

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A survey of over 1,000 GPs suggests that at least one in 10 practices has changed its billing model since the start of the covid pandemic. 

A further 6.6% of respondents to the survey by GP education provider Healthed were thinking about switching their billing model.

Of those who had overhauled their billing model or were considering it, around half were going from 100% bulk billing to mixed billing, while the other half were moving from mixed to private billing.

Most GPs (83% or 909 of 1,104 surveyed) did not make a change to their billing model.

Of those GPs that had changed their billing model, 21% said it was triggered by cuts to Medicare, 32% said it was due to rising costs and 19% said covid-related costs were the greatest concern.

Around half of the GPs that made a change to their billing switched over last year between July and December.

A quarter made the leap in the first half of this year, and another quarter have moved since July.

The survey had some limitations as not all GPs answered every question, and some appeared to interpret the follow-up question “Which switch did your practice make?” as including future plans for a change in billing as well as past changes. If that answer were taken on its face, the proportion who had changed their billing was just over 20%.

The GPs included in the survey were mostly from capital or major cities in NSW, Victoria and Queensland.

Of those surveyed, 41% worked in clinics with 1-5 GPs, 31% worked in clinics with 5-10 GPs, 16% worked in clinics with 10+ GPs, and 12% were solo practitioners.

The Medical Republic recently reported on the issue of GPs giving up on bulk billing due to covid-related financial pressures, covering three case studies in detail.

An estimate of what proportion of GPs have switched from bulk billing to mixed billing has not been available prior to HealthEd’s survey, as far as we are aware. Neither the RACGP nor the Department of Health could provide this data.

To collect more data on this topic, The Medical Republic posted an anonymous survey on its website in mid-July asking healthcare professionals working in general practice whether their clinic had changed its billing model recently and why.

This survey had received 85 responses as of 11 August (including 77 GPs, five practice managers, two receptionists/admin and one nurse).

It is possible that some of these individuals worked at the same practice as we did not collect data on practice name. It is also possible that some respondents answered the HealthEd survey and The Medical Republic survey.

With those limitations in mind, we can report that 36 survey respondents (42%) said their practice had changed its billing model recently, 31 said they were thinking about it and 18 said they had not changed their billing model recently.

Thirty-one respondents said they had switched from 100% bulk billing to mixed billing and 21 said they had switched from mixed billing to primarily private billing.

Of those that made a switch, 14 did so in July-December 2020, 19 did so in January-July 2021 and 23 made the change after July 2021.

In most cases, it was a mix of various factors that triggered practice to think about giving up on a particular billing model.

Overall, 42 respondents cited Medicare cuts as the trigger, 56 blamed rising costs, and 26 pointed to covid-related costs.

The comments section of the survey provided some insight into the strength of emotion felt by some GPs and practice managers experiencing financial pressures.

“GPs have become the charity donors of the medical profession during covid-19 times,” wrote one GP who had not changed their billing model recently.

Another GP, who had switched from mixed billing to primarily private billing, said: “Many patients who claim to be poor spend a lot of money on non-essentials, such as takeaway food, coffees, restaurant meals and non-essential food items … without batting an eyelid … Yet the same patients claim they cannot afford to see the GP and are entitled and expect to be bulk-billed for every GP visit.”

A GP who had switched from bulk-billing to mixed billing earlier this year said it was “completely financially unsustainable to continue fully bulk-billing to maintain my 15 min appointments”.

“[It’s] impossible to provide quality care with 10-minute appointments that would be needed for bulk-billing to continue,” the GP said.

Another GP who had moved from mixed to private billing in July this year, said, “GPs are undervalued. Have you rung for a plumber to come and look at your problems? There is a standard ‘call out’ fee (150 AUSD) ‘before’ he charges you for work done. Totals are always over 350 AUSD.”

A practice manager at a 10+ GP clinic who was looking to give up on 100% bulk-billing said, “There’s no bulk-billing pokies! And don’t get me started on the naturopath! There are no qualms in shelling out $300+ supplements from the naturopath with no rebate but $80 for a GP consultation with a $39.10 rebate – get the hell out! That’s crazy talk!

“We don’t want a parent to have to make a difficult choice about whether or not their child needs medical attention or even put off vaccination because it will cost them money, but there will be no medical care for anyone if we can’t afford to keep the lights on!”

You can download the TMR survey results here.