27 April 2022
Saving general practice is down to us
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