More money can’t buy happiness for GPs

Job satisfaction and work-life balance have deteriorated for GPs despite a lift in hourly earnings

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The Medicare rebate freeze appears to have caused a dip in morale for GPs, even though hourly earnings for the profession rose at double the national average.

An ANZ-Melbourne Institute Health Sector Report shows job satisfaction and work-life balance plateaued then tapered off after the freeze was first introduced in 2013.

Job satisfaction fell by 1.5% over three years, while work-life balance dropped 1.2% over the same period – a decline that could lead to difficulties in retention and recruitment, the report warned.

“Though it is not possible to say that the fee freeze has caused the fall in job satisfaction, there appears to be an association,” the report said.

The findings come as little surprise to doctors’ groups, which warn that the downwards trend could be hard to reverse.

“Once morale is down it is really quite difficult to get it back up again,” RACGP President Dr Bastian Seidel said.

GPs were being “blamed, attacked and targeted all the time” by government and pushed to the periphery of health policy. “If you target the GP workforce … then don’t be surprised if the system falls apart,” Dr Seidel said.

AMA President Dr Michael Gannon said he was both unsurprised and saddened by the low level of job satisfaction.

“GPs often feel greatly aggrieved that it seems policy after policy from the government unfairly targets them even more than their fellow doctors,” he said.

Despite increased financial pressure, GP salaries have actually increased, the report said. Personal hourly earnings before tax rose 4% since 2013, which is double the rate of real wage growth in the economy.

Although hourly rates were up, Medicare revenue per GP fell around 2% per year in real terms.

GPs might be reducing practice costs or seeking other sources of revenue to maintain their salaries, the report said. But there was no evidence that GPs were reducing bulk-billing rates and charging higher out-of-pocket expenses.

Without an increase in government funding, GPs faced the tough choice of discontinuing unprofitable services to the community, Dr Seidel said.

“When I go to a nursing home I am not going to take my eftpos machine with me to ask for a co-payment,” he said. “It’s just not something I would consider doing.

“[GPs] have to consider whether we are still offering this service and the answer is most likely not. “So somebody else has to do it. And, of course, it is going to be even more expensive, in particular, when the patient ends up going to the emergency department or calling out the ambulance.”

Dr Gannon said the change in take-home earnings was not often what troubled doctors.

“If you talk to doctors across the system … you will rarely hear them talking about how much they are paid,” he said. “They will more talk about their ability to get the job done.”

If the government’s remuneration model squeezed funds from general practice clinics, GPs might move to communities with lower bulk-billing rates or stop providing services, he said.