The punishment keeps coming from every angle. Without a good-faith commitment to fix this crisis, the profession will be gone.
After practising for over a quarter of a century, I continue to work hard at maintaining the caring ideology and naivety regarding some institutions charged with maintaining standards and quality in general practice.
Take, for instance, continuing professional development, and the nonsensical dance we do at the end of each year, finding points for colleagues, having spent the year disillusioned, disengaged, and disinterested in the absolute necessity of learning development and peer review.
We once had to achieve so many points every three years to maintain registration. The board mysteriously changed the requirements to yearly. I still don’t understand what the rationale was. Personally, I don’t see the point in a pseudo-mandated facilitation of learning.
I don’t need to be told what to do to be safe, as I take the responsibility of being a general practitioner seriously and would not present to the office if I or the trusted network around me thought my professional development was lacking.
So for the past two years I did this little personal experiment. In 2023, I spent the year logging the professional development that I participated in over the year, but only those learning items that I shared with other practitioners or completed in the company of peers. In 2023, I ended up with 500+ CPD points.
In 2024, I thought I’d do the opposite and just record what I did for the first four weeks of the year and then switch off. I made sure I had 50 points by the end of January. But by the time December came around, I had 200+ points.
So in 2025, I’m not going to log any points and just see what happens at the end of the year.
I mention this because the premise of the CPD is to somehow guarantee that doctors are keeping up with the ever-progressing information in the medical world. But I get frustrated that every year, at the end of December and now going through January and February, I get asked to assist colleagues who do not have points to reach the minimum requirements to maintain registration for many reasons, sometimes just because they’re disorganised.
We play this silly game, tracking down or undergoing point-cramming just to satisfy requirements for registration that, in reality, aren’t really being met. What is the point?
I see other decisions being made about the profession, such as the requirement now that my colleagues over 70 will need to undergo compulsory examinations in order to continue to work.
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Again, does this truly have any bearing or positive outcome on the quality of our GPs and the safety of our patients? Because without this guarantee, like the CPD program, it’s more than likely going to be another pointless, time-consuming exercise.
I’m particularly concerned about this as I work in the southwest of Sydney, where just under 15% of the entire GP workforce are already over 70 years of age, and we have a further 7.5% of the workforce aged 65 to 69.
This means that nearly a quarter of the workforce of GPs in southwest Sydney will come up for mandated medical examinations in the next few years – the GPs who manage about 300,000 residents will be subject to compulsory examinations and the prospect of sudden ending of careers.
Has there been any forethought into what’s going to happen to these patients? Because the doctors that I talk to in that age group locally are already contemplating early retirement to avoid the indignity of the unknown assessments and the personal stress and anguish associated with contemplating an unknown future.
Making life harder for GPs in these ways is an extraordinarily ill-conceived move given the already extreme pressure general practice is under – a problem that the pre-election $8.5/$9 billion promises to boost bulk billing will do nothing to alleviate.
Certainly, any funding boost to general practice and primary care in Australia is welcome; however, one easily tires when the fine print shows this is just another Band-Aid and not a significant structural solution to an increasingly outdated healthcare system.
Universal healthcare in Australia no longer exists. Health in Australia has become a discretionary spend, thanks to the cost-of-living crisis and the Medicare freeze. The only way to keep my doors open is to privately bill a proportion of our patients every day.
A minor increase in billing incentives, while leaving the rebate unchanged, seems aimed at incentivising the six-minute medicine merry-go-round, which all evidence shows is bad for patient health, bad for taxpayers, bad for the public health system, and bad for the working GPs and their communities.
For me to keep the doors open under this bulk-billing regime, I’d have to see 10 patients an hour, compared to three patients an hour privately charged with a gap fee, which is unfortunately ever-increasing.
Mandating that GPs cannot access the maximum Medicare rebate for their patients, like every other specialty, unless they sign up to commit to permanent pure bulk billing, will do nothing except further dissuade graduates from a career in general practice and exacerbate our professional crisis.
A recent discussion with Australian Medical Students Association regarding the package highlighted their fear that increasing GP training placements is simply an attempt by the government to force them into doing GP training when they don’t want to. They would prefer an increase in specialist training so they could pursue a career in any specialty other than general practice.
Those brave enough to actually want to work in general practice will not want to work in areas of need without a Medicare rebate that can cover the cost of running a practice.
If you were able to get paid more, see fewer patients, and see healthier patients because you’re working in an affluent area, why on earth would you move to an area where the patients cannot afford gaps and have worse health, education, financial independence, employment, etc, so that your remuneration is actually lower for doing more and longer work?
So far, the Band-Aid solution is a lose-lose-lose step. The rebate has not increased to cover the cost of running a practice. There is a disincentive for graduates to want to do general practice. There is a disincentive for GPs to work in areas of need.
We have a health minister who’s promising that nine out of 10 GP visits will be free, even though he has no control over this and is obviously promising something he cannot fulfill. He’s also speaking about 5000 practices being financially better off. Of course they will if they continue to see 10 patients per hour, which is bad medicine.
Three out of four doctors in my practice book only two patients per hour, as they are committed to providing quality comprehensive continuous medical care. We are working in an Australian Bureau of Statistics level one area of socioeconomic deprivation and need but still have to charge an increasing gap fee to keep the doors open and care for our chronically and comorbidly unwell patient community.
Unfortunately, the fees cause delays in presentation, fragmented care, suffering and poor health outcomes.
In the forthcoming budget we need either: 1) an urgent restructure of the time-based tiers for practice to reflect an even distribution of healthcare, incentivising chronic, complex, longer, and mental health consultations, which is required by our complex patient cohort, or 2) a commitment to increasing the current rebates to the levels required to maintain viability and provide quality care.
Both major parties are averse to fighting an election based on healthcare and will likely agree to support whichever leader shows the integrity and vision to fix the problem once and for all.
We need permanent indexation of Medicare rebates or even an independent price-fixing authority that can reflect the increases in providing care in the future so that Medicare never again becomes an inadequate funding mechanism for high-quality general practice care.
Now is the opportunity for a political leader to create their legacy moment. I’m afraid, though, that all we will get is mediocrity, and a continuation in the erosion of quality general practice at the cost of the nation’s health.
Dr Kenneth McCroary is a GP in Campbelltown, a lecturer at Western Sydney University and University of NSW, director and clinical co-chair of SWS PHN Aged Care & Mental Health, and chair of AMA NSW’s Council of General Practice.
