The message that doctors need to deliver a profit as well as healthcare has always been a hard one to sell, but that could be about to change.
A GP corporate umbrella group has called for a louder voice when advocating for business sustainability, and has put its hand up for the role.
The call comes as mainstream media coverage of the crisis in bulk billing has accelerated over the past week, while the group cited the absence of a pure business focus in doctor groups as one of its drivers.
The Primary Care Business Council (PCBC), which comprises representatives from seven of Australia’s largest GP corporates, is calling for rapid changes to be made to the rules that govern the supply of GPs, particularly ones that relate to immigration, and increases to MBS funding.
The group has developed over the past 18 months.
“We genuinely felt there was a need for a voice from people who actually operate the day-to-day medical centre structures, particularly with the change of government,” PCBC director Dr Peter Stratmann told The Medical Republic.
“Of course, there are representative groups – those include large groups like the AMA and RACGP – but our presence and knowledge is quite different.
“I don’t think [those groups] stand for practice viability – they can’t because they have too many agendas. We would like to see ourselves as another reference point with deep and valid industry data just about viability, funding, financing and strength, and I think that’s how we’re being received by state and federal governments.
“That message needs to stand above all the range of issues and the interests of the larger groups, which can include education and training and a whole lot of other community-type issues,” Dr Stratmann said.
The PCBC sets particular store by its access to data, which it draws from members who receive over 23,000,000 patient visits every year at almost 500 GP practices across inner city, metropolitan, rural and remote locations. They support 5000 GPs and provide contracted services to more than 20 per cent of the Australian GP workforce.
“A group of us met with [Health Minister] Mark Butler recently and that wouldn’t have happened if he didn’t recognise we had some specific information and close-to-the-ground industry feedback that could supplement the voices and the information coming from the AMA , the colleges and other groups.”
One RACGP representative takes the group’s point about the need for a stronger voice on sustainability.
“There has been a gap in our advocacy space for some organisations,” said Dr Emil Djakic, chair of the RACGP’s business sustainability working group. “The corporates, of course, have a very big slice of the general practice market and the college’s position is that we’re here to serve all members as best we can.
“So, I think an advocacy group for that section, to collectively talk about the business environment they’re operating in, is something I would say we’d welcome.”
RACGP president Adjunct Professor Karen Price drew heavily on PCBC data in a statement yesterday highlighting the crisis in bulk billing, while AMA and RACGP representatives also fronted news media to address the question.
The growing media attention wasn’t lost on Dr Stratmann.
“Suddenly, government and the community have realised that GPs can’t just sit there and do their job, work harder, be paid in relative terms less, and keep the system going. So the crisis has become real. The world only changes when disaster is almost upon us, and so now is this time. That’s why we’re here,” he said.
“We can, with the stroke of a pen, make it easier for overseas doctors to come here, we can continue to work on the DPA type restrictions, for sure. And we can make changes to practice funding quite quickly.
“I don’t think everything has to become corporatised. I think it’s possible for smaller practices to do well, but the support structures need to be cleaner and simpler because ultimately the mission of the operational side is simply to facilitate doctors seeing their patients efficiently,” Dr Stratmann said.
Dr Djakic, while not wishing to criticise the traditional GP model, said that type of practice was no longer the norm.
“We have to compare that [model] with every other business operating in our community, like the corner shop, or the small family-run supermarket and so forth,” he said.
“Things have changed and systems have got more complicated, business skills need to be at a higher level. So naturally, we’ve seen these corporate opportunities exist.”
Nor should corporate practices automatically be dismissed, despite criticism that they offer inferior continuity of care, data or management or access to the same doctor.
“Yes, [that continuity] is an absolute given in a solo practice, but there is also a deficiency in the solo practice around sustainability when it comes to being on call 24 hours a day or working seven days a week.”
But what if the traditional GP practice were to effectively die out, replaced by the corporates – albeit with good standards, governance and regulatory structure?
“Look, I can’t help feeling like that would be sad to see,” Dr Djakic said, “but the data is happily telling us that people are finding the business environment very, very unattractive. I think that’s very sad.”
In rural and remote practices, the challenge when it comes to corporates could be the lack of them, according to rural generalist and AMA (NSW) vice-president, Dr Rachel Christmas.
“We’ve heard about corporates who are choosing to sell out of small towns or not even look at towns any more,” she said. “It used to be that if you had a group practice in a town and you were looking to sell because you were retiring, there’d be some corporate willing to swoop in and pick up the pieces.
“That’s not happening any more.
“These corporate businesses are geared towards economies of scale and clever practices, where they’re looking at saving money and billing appropriately. If they are still saying it’s not viable, you know that there’s a problem.”
