27 April 2022

Saving general practice is down to us

Clinical

We won’t survive by clinging to Medicare, and we won’t be thrown a lifeline on 21 May.


The area I live in has been declared a disaster zone. Again. It has been a relentless series of disasters since the megafires of December 2019.  

Our existence is precarious: fires, pandemic, floods, and now landslides with the ground shifting underneath us after weeks of rain. 

While we lurch from one disaster to the next, many of the services provided to Australians have become completely overwhelmed or inadequate, having been stretched to capacity well before our states of emergency. Many of us are realising that the help we need might not be arriving. The ambulance, the fire brigade, or the rescue team might not even be dispatched before it is simply too late.

We have witnessed flood communities band together to organise and share resources, to hire a private helicopter or arrange for private boats to rescue the flood-stricken. Neighbours worked to clear the wreckage one house at a time in Lismore while Peter Dutton made speeches about the Army needing to clear roads first, as if a Defence Force response is premised on having roadworks completed beforehand. 

While many people stayed at home, general practitioners continued to work through the bushfires, the floods, and throughout the entirety of the pandemic. During this time, we have born the increased costs and personal risks. We have struggled and often failed to protect ourselves and our families. We have become sick and bedridden with no sick leave entitlements. We have endured successive government directives which failed to consider, consult, or support us at every step. 

When the RACGP president Professor Karen Price took the unprecedented and courageous step of calling for GPs to privately bill “as many people as they can” on 17 November, GPs knew the ground had indeed shifted.  

As a profession, we no longer expect an increase in Medicare rebates to cover the cost of general practice care. Given Medicare rebates have deliberately failed to keep pace with inflation under successive governments for decades, any expectation for the Medicare rebate to represent a fair fee has died. It is simply a fact GPs are not adequately remunerated if they provide health care under Medicare.

The need to be paid a fee commensurate to the service provided is not about individual health practitioners profiting from the sick, it is about ensuring there will be enough general practitioners to care for the sick at all.  

Medicare stopped providing a fair reward for the personal cost and effort shouldered by a general practitioner a long time ago. If we want to identify how long ago exactly, we need only look at the declining number of medical graduates choosing to enter general practice going back as far as the 1980s. When you consider that your local neurosurgeon and your local GP graduated with the same HECs debt for the same medical degree, it’s easy to understand how with rising costs that it doesn’t stack up to consider becoming a GP in the first place. 

To get a bigger picture of how dire the current situation is, we also need to ascertain how many GPs currently supplement their incomes by working elsewhere, or even, how many GPs have decided to abandon work as a GP altogether, often in spite of loving and honouring the work they trained to undertake. The specialty of general practice has become so undervalued and demoralised, that GPs are literally forfeiting the personal cost of years of training to simply cut their losses and go and work elsewhere. 

General practitioners need to receive fair recompense for the health care we provide. After years of withstanding the gradual undermining of the specialty by successive governments, we cannot expect general practice to survive on its current trajectory. Nor can we expect to be thrown a lifeline at the ballot box on 21 May.

Last week I finally shifted to billing patients directly for the healthcare I provide. A mother with chronic care needs and her teenaged child beside her asked “Why do you need to do that?”

“Because the government pays less than half of a fair fee,” I replied.

The child was shocked at my answer: “But that is just terrible.” 

Yes. It is. 

As the ground falls away from under us, we have no reason to expect anyone to come to our aid except ourselves. We need to set our own terms and our own fees, as any private business is required to do, in order to survive and grow; in order to ensure general practitioners can continue to provide excellent healthcare. 

Dr Karan is a GP in the Blue Mountains, NSW; she blogs at tekhnomed.org 

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ABDUL AHAD KHAN
Guest
27 days 7 hours ago
Post-Script : You will need to put up a Sign stating something like this : Our Dear Patients, As you know, for more than 10 years now, the Medicare Rebates have not risen – the Medicare Rebates have not kept pace with the Yearly Inflation of the Cost of Provision of the Highest Standard of Care that you are currently receiving. at this Surgery. Hence we are needing to charge a very small Amount of $ 3.00 per Consultation in addition to your Medicare Rebate. We can arrange to get your Medicare Subsidy directly into your Account the same day.… Read more »
ABDUL AHAD KHAN
Guest
27 days 7 hours ago
Dear Peter, I understand the Hesitation in abandoning Bulk-Billing. I too had similar Hesitations. I started with a small Amount of $ 3.00 per Consultation on top of the MC Rebate about 10 years back & I kept on increasing this Amount each year by $ 2.00 increments. Now I am charging $25.00 on top of the MC Subsidy . Your Secretary can use their Visa Card to debit your Fees & she will make Medicare deposit the Medicare Subsidy directly into the Patient’s Account the same day itself. Since the Patient does not have to pay you Cash from… Read more »
ABDUL AHAD KHAN
Guest
27 days 13 hours ago
I get the impression that GPs feel that the Govt. is responsible for our Plight. GPs need to wake up to the Fact that by choosing to Bulk-Bill ALL Patients, we GPs have to take the Full Blame. We GPs need to wake up to the Fact that the MC Rebate is only a Subsidy for our Patients to recover. We GPs need to wake up to the Fact that we are NOT Govt. Employees. We can continue to remain on our Hands & Knees & keep BEGGING for a ‘ PAYRISE ‘ from the Govt. of the Day, as… Read more »
Peter Bradley
Member
Peter Bradley
27 days 11 hours ago
Ahad, you are of course right, when you say… “We can continue to remain on our Hands & Knees & keep BEGGING for a ‘ PAY RISE ‘ from the Govt. of the Day, as we have been doing for years & years OR we can stand up with Dignity & charge a Proper Fees “. The trouble is there are many Drs practising in areas where if they try to do just that, their patients will all disappear – or a substantial number of them anyway – down to the local clinic that does not charge a fee. How… Read more »
Peter Bradley
Member
Peter Bradley
28 days 9 hours ago
Dr Karan has just summed up perfectly what the situation is for GP and GPs as of now. Under the present scenario, there is no alternative. Which is why I have championed the concept of GPs having a fully salaried position as the only practical alternative to that of the private, ‘charge ’em what it actually costs and devil take the hindmost, approach’. Because we just know there are going to be injustices under that system – some winners, but plenty of losers as well. It will not result in a level playing field. Ok, I’ve always been a lone… Read more »
David Dahm
Guest
27 days 19 hours ago
Peter, the Government does not like salaries anymore than doctors like being told what to do. They are afraid GP’s will see one to two patients and hour and have to quadruple their workforce and cover for 4 weeks leave. Fee for service is here to stay. I think GP’s need to decide are they in a private enterprise or not. If not join the local public hospital or get a job you are happy with. Even more radical GP’s start explaining your fees and offering value in the patients eyes so they are prepared to pay for it. It… Read more »
Peter Bradley
Member
Peter Bradley
27 days 16 hours ago
David, this part of your reply really gives me the shits..! They (govt) are afraid GP’s (on salary) will see one to two patients and hour and have to quadruple their workforce and cover for 4 weeks leave.” Ok, if that’s the case you’re in effect saying that everyone not on some kind of fee for service is a lazy bugger. Well, I don’t buy that – and I know it’s not true. Ok, some politicians might think that, especially if they are the type that judge others by themselves, but even most politicians do work hard. As do the… Read more »
Andrew P
Guest
23 days 12 hours ago

Peter, I think David is largely correct. Human nature dictates this, and the government knows it full well.
GPs should bill what their service is worth to those who can pay for it. For those who cannot, they can choose to discount their fee or bulk bill.
Having these conversations can be annoying initially but patients will chose to pay for a quality service they believe they need.

Glenn Rosendahl
Guest
Glenn Rosendahl
28 days 2 hours ago
Peter, I am still ‘in it’. It keeps my mind active. As much as I would like a salary, for myself and other GPs, it simply will not happen. The (ir)responsible paying agency (in this case, the politicians of the Federal government, simply will not pay the appropriate salary. Yes, they pay it to themselves, and pay it to public servants. It was at least 25 years ago, that having run to a ‘fee freeze’ of more than 5 years, the AMA got a highly reputed Australia wide accountancy firm to determine what the appropriate fee schedule should be –… Read more »
Peter Bradley
Member
Peter Bradley
27 days 15 hours ago
Glenn, in effect, what both you and David are saying, is that the govt thinks it cannot ever afford to pay Drs a decent crust to do their job, and that therefore the public must pay a percentage of that cost. Only they don’t have the political guts to come out and admit that, so they hide behind the massive bulk-billing numbers, misleading though they also are. That is why my model does not support free at point of care either. But for a different reason. Sure it would help cover costs, but mainly it would help ameliorate the over-use… Read more »
Peter Bradley
Member
Peter Bradley
27 days 15 hours ago

Glenn, please see my reply to David Dahm below. Same response – except of course, as I think you know already, in my model, the care would not automatically be free at point of service, but rather than the patients paying for the Dr directly, they would pay a user pays service fee towards costs. The latter could well be on a sort of sliding scale to reflect the socio-economic area the practice served.

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