Doctors warn that the current funding regime for GPs is unsustainable and patients should expect to pay more to see a GP if they can find a doctor when they need one.
- Some doctors say they have to bill patients more because federal funding isn’t covering their rising costs
- Far fewer medical graduates become general practitioners
- A shortage of nurses means doctors have to do more paperwork and answer phones, leaving less time to talk to patients
They say the shortage of doctors and nurses is likely to worsen as many GPs feel burned out from their heavy workloads.
At her clinic in Campbellfield, in far north Melbourne, Umber Rind last month began charging patients a deductible for a consultation.
“We’re the only essential service that’s expected to discount everyone and we’d love to do it, but we just can’t do it anymore,” she said.
The clinic now charges patients $30.90 for a standard 15-minute consultation. You also receive a $39.10 rebate from the federal government per standard consultation. That rebate rose 1.6 percent in July after being frozen for more than a decade.
dr Rind said a 1.6 percent increase didn’t even come close to covering the other cost increases her practice had to deal with — such as nurses’ wages, rent and utility bills.
She said the decision to end bulk billing led to some difficult conversations with patients.
“I’m still going to charge for people who are at risk and things like that, but I think as general practitioners, we shouldn’t be the ones shouldering that burden,” she said.
dr Rind said she thinks the clinic could be less busy once it starts charging. But it is not.
“Our phones keep ringing, we have patients who come from far away, even from small rural towns,” she said.
The reason for this is the lack of doctors, especially in the metropolitan areas and in the countryside.
Challenges in finding nurses and doctors
In West Brunswick, closer to town, Deb Wilson co-owns another bustling practice.
She said her clinic advertised for a new nurse at the practice, but a nationwide shortage meant the position was vacant.
She said it means GPs have more paperwork and phone calls to do and less time to see patients.
“I think that’s the other thing about family doctors, the amount of work outside of the patient’s face-to-face time,” she said.
She called on governments to do more to address the root causes of disease, including poverty and lack of housing, which lead patients to eventually end up in hospital.
“We have a universal insurance system, but not a universal healthcare system.”
Her colleague John Stanton has been a GP for 47 years and is retiring soon. He fears that not enough young general practitioners will come.
“When I graduated in 1972, about 60 percent of medical graduates went into general medicine. Right now it’s about 16 percent,” he said.
“So there aren’t any younger people coming in to take the place of people like me who are close to retirement.
“Unfortunately, the GP practice is not seen as a point of contact for new doctors, it is not financially rewarding, it does not have the status of a specialist doctor working in a hospital.
“That’s very sad.”
It’s difficult to keep doctors in the outskirts
Alastair Stark co-owned his medical practice in Melton in the far west for 15 years before selling it last year.
He said making a mass-billed primary care practice financially viable in the outer suburbs was difficult.
“Melton is a great place, I love working in Melton, it’s very diverse but of course there are downsides,” he said.
He said that means there are many complex medical and physical health issues that are taking longer to treat. But often his patients cannot afford to pay a fee out of pocket.
“Spending that little bit more time with patients costs the practice more.”
He plans to continue working at the clinic but said the biggest challenge in the outskirts is recruiting and retaining staff.
“It doesn’t make sense to me that someone would come to Melton to work harder and get paid less – unfortunately that’s not a very attractive proposition for the younger doctors,” he said.
Psychological counseling takes more time
Shumaila Panhwar said about 80 per cent of the patients she saw in north Melbourne required mental health care, especially since the pandemic began. She said it’s hard to see these patients in just 15 minutes.
“It’s more complex because you can’t do cookie-cutter medicine with mental health, it’s not a sprained knee or gout,” she said.
She said more and more patients choose not to go to the hospital to avoid long waits, and she recently spent 45 minutes helping a patient with severe chest pain find an alternative treatment plan.
She said she often spends her lunch breaks checking on patients or dealing with compliance or paperwork.
“It’s very easy for others to get things back, and it all comes back to our laps,” she said.
Health minister ‘really committed’ to solving problems
Karen Price is President of the Royal Australian College of GPs (RACGP) and works at a clinic in Highett, south Melbourne.
She said Health Secretary Mark Butler was listening to GPs’ concerns.
“I am very pleased that we are listening to the minister, I think he is really committed,” she said.
“He knows it’s a nasty problem and we’re all working to solve it.”
She said the Medicare rebate needed to be removed urgently — and the AMA guidelines on the cost of a family doctor consultation specified what that rebate should be.
“They’re on the order of $80 or $90 [per consult] — but I’m not holding my breath,” she said.
She said she understands it is a difficult time for patients.
“Try to let the front desk staff know a little bit about what you’re suffering from so we can determine if we need to make an urgent appointment,” she said.
In a statement, Mr Butler said the health department would be investigating the status of the bulk billing.
“Our Medicare Strengthening Taskforce will find the best ways to increase affordability, improve access and better support patients with ongoing and chronic illnesses, supported by the $750 million Medicare fund,” he said.