Mental health still a key issue for GPs

RACGP's Health of the Nation Report finds 90% of GPs are satisfied at work but mandatory reporting is stopping some seeking help

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A quarter of GPs say their workload is getting heavier, enough to affect their quality of care, and more than 40% say they have delayed seeking care for their own health problems, according to the RACGP’s third annual Health of the Nation Report.

Medicare rebates remain at the top of GPs’ list of priorities for the government to address, followed by mental health – still by far the commonest kind of presentation GPs face – and obesity. These issues are linked, since mental health and obesity require longer consultations that are undervalued by Medicare, which is structured to favour shorter, more straightforward appointments.

The report uses mainly data from the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal survey of doctors conducted by Melbourne and Monash universities and a survey of more than 1100 GPs taken in May.

This year, the report’s issue in focus is GPs’ own health. Citing beyondblue, it says doctors “are known to experience higher levels of mental distress than the general population”, and warns that mandatory reporting laws now in effect everywhere except Western Australia are contributing to doctors not seeking help.

Of the 41% who reported delaying seeing a doctor, 8% gave “fear of being reported to regulatory bodies” as a reason.

The report says a doctor must report a colleague “if they ‘reasonably’ believe that patient safety is at risk. This includes if a colleague seeks their help – as a patient – for a physical or mental impairment.” The RACGP wants treating doctors exempt from reporting their doctor-patients.

Sample survey responses included: “There is always the fear of being reported if there is ANY crack in the surface. I do not want to put a colleague (or myself!) in that type of position.”

AHPRA’s draft guidelines on mandatory notifications, under consultation until November 6, say an impaired practitioner must be reported “only if you believe there is a substantial risk of harm” to patients, which is “a very high threshold … This allows practitioner-patients to seek and have treatment for conditions without fearing mandatory notification.”

No notification needs to be made if the practitioner is being treated, or has undertaken other steps, such as a break from practice.

But college President Harry Nespolon said the fear was a fact, regardless of the guidelines.

“Unfortunately, there is a bit of a trust deficit between what is said [by AHPRA] and what is done,” he told The Medical Republic. “If you’re an unwell doctor, especially if you’re depressed, you’re likely to see just the risk of mandatory reporting as a real problem, and so you’re very unlikely to go and seek care if you think that you’re going to get reported.

“We’re going to have to wait and see what actually happens. But the West Australian version is that we don’t have any reports of patients being harmed because the doctor hasn’t been reported.”

He said doctors should have the same rights to confidentiality as any other Australian patient, and that if one didn’t want to stop practising or did represent a risk then they would be reported without the chilling legal compulsion.

“We might have first-class doctors in Australia, but when it comes to being a patient, we are second-class citizens,” he said.

Most of the doctors who delayed seeking healthcare (84%) said that was because it was difficult to find the time.

While 51% said their workload was manageable, 24% ticked the box saying “My workload is excessive and can sometimes prevent me from providing high-quality care”. Nineteen per cent chose “My workload is excessive but never prevents me from providing high-quality care”.

Ninety per cent of GPs were moderately or very satisfied with their work, “taking everything into consideration”, though 25% were moderately or very dissatisfied with their remuneration.

The average GP earns just over half what other specialists earn, and the disparity is increasing, the report says, which is probably contributing to the decline in the proportion of medical graduates choosing general practice: for every new GP, there are almost 10 new other specialists.

While the number of GP registrars grew by around 13% per year in 2011-16, there was zero growth in 2017 and 2018, even though the overall number of medical graduates is still going up.

While the bulk-billing of services – not patients – has been trending upwards, the proportion of GPs who bulk-bill all their patients is rapidly falling. Only 18% said this year that they bulk-billed 100% of patients, down from 23% last year and 29% in 2017.

In Aboriginal-Controlled Community Health Organisations the figure is 90%, but that’s down from 98% last year.