[The Conversation]

6 reasons why it’s so hard to see a GP​

The recently released Strengthening Medicare Taskforce report found more people are delaying care or attending emergency departments because they can’t get in to see a GP.

And it’s likely to get worse. General practice is shrinking rapidly, with estimates Australia will be 11,500 GPs short by 2032. This is one-third of the current GP workforce.

So why is it harder to access and afford GP care? Here are six key reasons why.

1) Patients are older and sicker​

The population is ageing, and more people with multiple chronic diseases – such as cancer, diabetes and heart disease – are living longer in the community. Rates of mental illness are also rising.

This not only increases GPs’ clinical workload, it also shifts a greater load of care coordination onto the GP. This decreases the number of patients a GP can see.

GPs have also been under increasing pressure from administrative and compliance activities for Medicare, as well as paperwork for the aged care, disability, social security, health and workplace sectors.

Patients have increasingly complex health issues, which take up more time. Shutterstock​

2) General practice is no longer financially viable​

GP clinics are less financially viable than they used to be. One survey of doctors found 48% of respondents said their practices were no longer financially sustainable. As a result, many are closing.

The Medicare rebate has increased much more slowly than inflation and was frozen from 2014 to 2020.

While this was a huge saving for the government, a low rebate meant the gap between the cost of care and the rebate had to be passed on to GPs and their patients.

A GP’s fee has to cover the costs of the whole practice. There are growing operating costs for insurance, rent, wages, information technology and consumables like gowns, gloves and single-use clinical equipment. When a GP bulk bills, their businesses absorb the gap between the cost of care and the Medicare rebate. The rebate is now so low (for example, the rebate for a 45 minute consultation for mental health is A$76), and costs are high, few GPs are able to afford to bulk bill patients. This means people on low incomes have trouble affording the care they need.

Women doctors in particular feel these cost pressures. Medicare rebates are lower per minute for long consultations and female GPs see more patients with mental ill-health and complex chronic disease requiring longer appointment times. This leaves women GPs earning at least 20% less than their male colleagues.

Women doctors spend more time with patients and earn less. Pexels Karolina Grabowska​

3) GPs, like other health workers, are becoming unwell​

The rate of physical and mental illness among GPs is rising. The causes are complex, and include the stress of increasing workloads, vicarious trauma (the cumulative effects of exposure to traumatic events and stories), administrative overload and financial worries.

The suicide rate for female doctors is more than twice the national average, and rates of depression are high. It can be difficult for doctors to access care, particularly if they work in rural practice.

Abuse and violence is also more common, with one survey finding at least 80% of GPs saw or experienced a form of violence at their place of work.

However, it is the moral distress of knowing how to help patients, but being unable to do so, that often damages their health the most.

Illness among GPs is rising. Shutterstock​

4) Fewer junior doctors are choosing general practice​

Around 40% of junior doctors used to choose general practice as a career. It is now 15%.

Junior doctors now carry more than A$100,000 in HECS debts, so it is understandable they may choose other specialties with similar lengths of training that will earn them double or triple the yearly income.

However, we suspect one of the key reasons junior doctors avoid general practice is the denigration of GPs. GPs are portrayed as greedy, unethical and incompetent.

We cannot attract young doctors to a profession that is constantly under public and political attack. Education Minister Jason Clare recognised this in teaching, saying “It’s also about respect. […] We need to stop bagging teachers and start giving them a wrap.” We need this for GPs too.

5) Rural GPs are leaving​

It has always been challenging to attract GPs to country practice. Rural practice often involves a wider scope of practice, personal isolation and increased workloads with less professional support.

Rural GPs often work long hours and have on call responsibilities. Jobs, schools and services for GP families can be difficult to access.

Despite a growing number of programs for educating and training rural doctors, the uneven distribution of GPs may be worsening.

6) Fewer overseas-trained doctors are arriving​

There is a global shortage of all health-care workers, which is expected to worsen. Supply of international medical graduates may drop as their options for work in other countries increases. Border closures during COVID have also reduced supply.

There is a global supply of doctors. Shutterstock​

International medical graduates make up more than 50% of the rural workforce. However recent changes mean these doctors can now work in urban locations, rather than the more isolated practices in rural areas. This may worsen GP shortages in rural communities.

International medical graduates have to fund their own training and assessment. This starts with becoming registered as a doctor in Australia and then involves training as a GP. The training is long, arduous and expensive, and doctors often need additional support. There is also an ethical question of recruiting health-care workers from countries that need their services more.

While the Strengthening Medicare Taskforce supports GP care, it doesn’t identify the specific changes required to improve accessibility and affordability and requires significant structural change.

It will be months before the recommendations of the report can be translated into policy, and it may be years before radical changes can be implemented. Without addressing the GP shortage in the meantime, there may be a much smaller workforce to strengthen.

This article was first published on The Conversation, and was written by Louise Stone, General practitioner; Associate Professor, ANU Medical School, Australian National University, Jennifer May, Betty Fyffe Chair of Rural Health Director of University of Newcastle Dept of Rural Health, University of Newcastle

 

[Ricci]

My GP bulk bills all pensioners and children, others have to pay. The surgery is expanding too, they have just taken on two new doctors bringing the total to five. The whole practice works damn hard for their money, the practice nurses are always on the go, the receptionists always have phones growing out of their ears and the doctors each have a constant stream of patients. I would happily pay $10 per visit direct to them and might suggest it next time I go, I feel they deserve it.

 

[Colette 3799]

My GP bulk bills all pensioners and children, others have to pay. The surgery is expanding too, they have just taken on two new doctors bringing the total to five. The whole practice works damn hard for their money, the practice nurses are always on the go, the receptionists always have phones growing out of their ears and the doctors each have a constant stream of patients. I would happily pay $10 per visit direct to them and might suggest it next time I go, I feel they deserve it.

We’re very lucky too. Our surgery bulk bills certain patients too. It’s usually easy to get an appointment. I booked one today for next Tuesday but I could have got one tomorrow if I needed it.

 

[Judy_mcloughlin15]

where is the pratice you go to

My GP bulk bills all pensioners and children, others have to pay. The surgery is expanding too, they have just taken on two new doctors bringing the total to five. The whole practice works damn hard for their money, the practice nurses are always on the go, the receptionists always have phones growing out of their ears and the doctors each have a constant stream of patients. I would happily pay $10 per visit direct to them and might suggest it next time I go, I feel they deserve it.

 

[Judy_mcloughlin15]

We’re very lucky too. Our surgery bulk bills certain patients too. It’s usually easy to get an appointment. I booked one today for next Tuesday but I could have got one

 

[Judy_mcloughlin15]

Where is your doctors located at

 

[Judy_mcloughlin15]

Where is your doctors located at

 

[Ricci]

Where is your doctors located at

South Coast NSW

 

[Trina G]

My clinic no longer bulk bills. I’m a part pensioner plus some super. I don’t have a problem paying the gap but my last visit was a “long consult” and I had to pay $100 up front. Why can’t they get a system in where you only have to pay the gap fee. A lot of people in these financially difficult times might not have enough to pay the up front fee. I can only hope there will be something in the budget for Medicare as the previous govt almost destroyed it.

 

[Gsr]

The surgery I attend bulk bills pensioners, health care card holders. They are very approachable about their fees, they allow patients to be bulk billed if they don’t have the money on the day and they really need to see a dr. Most of the drs working there own big mansions, drive posh cars, send their kids to private schools, so they don’t seem to be struggling to make ends meet. The amount of patients the practice see in a day with bookings usually only ten minutes apart should be enough to cover the costs of the practice.

 

[Kimrus]

The surgery I attend bulk bills pensioners, health care card holders. They are very approachable about their fees, they allow patients to be bulk billed if they don’t have the money on the day and they really need to see a dr. Most of the drs working there own big mansions, drive posh cars, send their kids to private schools, so they don’t seem to be struggling to make ends meet. The amount of patients the practice see in a day with bookings usually only ten minutes apart should be enough to cover the costs of the practice.

That is crap. If those gps have the luxury of a mansion then it must have occurred via another source of income or prior to 1974 when Whitlam introduced Medicare. If the drs are working in a corporate practice they only get a percentage of their earnings. Those that are the sole owners of their practice have enormous expenditure including their rents. There definitely is a huge more drs that are needed. My husband was a gp but had to retire when he became sick with COVID and 12mths down the track is still having problems. He never wanted to retire prior to this. He loved his patients was still doing home visits until he got sick at age of 77. He now has the early stages of dementia caused by COVID. A once very active man now can’t remember simple tasks.
It is sad to loose so many gps now either through retirement, illness and other situations whereby it may have been an overseas recruit that finds Australia’s healthcare lacking with bureaucratic b…s
Some of the female gps think they are primadonas and maybe nice to their patients but the other side of them is abusive to staff etc. Yes have seen this first hand and will demand their patients are charged very long consults for patients having a Pap smear or breast examination and this way they get better income

Honestly I wouldn’t believe all the media crap

 

[Jest]

6 reasons why it’s so hard to see a GP​

The recently released Strengthening Medicare Taskforce report found more people are delaying care or attending emergency departments because they can’t get in to see a GP.

And it’s likely to get worse. General practice is shrinking rapidly, with estimates Australia will be 11,500 GPs short by 2032. This is one-third of the current GP workforce.

So why is it harder to access and afford GP care? Here are six key reasons why.

1) Patients are older and sicker​

The population is ageing, and more people with multiple chronic diseases – such as cancer, diabetes and heart disease – are living longer in the community. Rates of mental illness are also rising.

This not only increases GPs’ clinical workload, it also shifts a greater load of care coordination onto the GP. This decreases the number of patients a GP can see.

GPs have also been under increasing pressure from administrative and compliance activities for Medicare, as well as paperwork for the aged care, disability, social security, health and workplace sectors.

View attachment 13845
Patients have increasingly complex health issues, which take up more time. Shutterstock​

2) General practice is no longer financially viable​

GP clinics are less financially viable than they used to be. One survey of doctors found 48% of respondents said their practices were no longer financially sustainable. As a result, many are closing.

The Medicare rebate has increased much more slowly than inflation and was frozen from 2014 to 2020.

While this was a huge saving for the government, a low rebate meant the gap between the cost of care and the rebate had to be passed on to GPs and their patients.

A GP’s fee has to cover the costs of the whole practice. There are growing operating costs for insurance, rent, wages, information technology and consumables like gowns, gloves and single-use clinical equipment. When a GP bulk bills, their businesses absorb the gap between the cost of care and the Medicare rebate. The rebate is now so low (for example, the rebate for a 45 minute consultation for mental health is A$76), and costs are high, few GPs are able to afford to bulk bill patients. This means people on low incomes have trouble affording the care they need.

Women doctors in particular feel these cost pressures. Medicare rebates are lower per minute for long consultations and female GPs see more patients with mental ill-health and complex chronic disease requiring longer appointment times. This leaves women GPs earning at least 20% less than their male colleagues.

View attachment 13846
Women doctors spend more time with patients and earn less. Pexels Karolina Grabowska​

3) GPs, like other health workers, are becoming unwell​

The rate of physical and mental illness among GPs is rising. The causes are complex, and include the stress of increasing workloads, vicarious trauma (the cumulative effects of exposure to traumatic events and stories), administrative overload and financial worries.

The suicide rate for female doctors is more than twice the national average, and rates of depression are high. It can be difficult for doctors to access care, particularly if they work in rural practice.

Abuse and violence is also more common, with one survey finding at least 80% of GPs saw or experienced a form of violence at their place of work.

However, it is the moral distress of knowing how to help patients, but being unable to do so, that often damages their health the most.

View attachment 13847
Illness among GPs is rising. Shutterstock​

4) Fewer junior doctors are choosing general practice​

Around 40% of junior doctors used to choose general practice as a career. It is now 15%.

Junior doctors now carry more than A$100,000 in HECS debts, so it is understandable they may choose other specialties with similar lengths of training that will earn them double or triple the yearly income.

However, we suspect one of the key reasons junior doctors avoid general practice is the denigration of GPs. GPs are portrayed as greedy, unethical and incompetent.

We cannot attract young doctors to a profession that is constantly under public and political attack. Education Minister Jason Clare recognised this in teaching, saying “It’s also about respect. […] We need to stop bagging teachers and start giving them a wrap.” We need this for GPs too.

5) Rural GPs are leaving​

It has always been challenging to attract GPs to country practice. Rural practice often involves a wider scope of practice, personal isolation and increased workloads with less professional support.

Rural GPs often work long hours and have on call responsibilities. Jobs, schools and services for GP families can be difficult to access.

Despite a growing number of programs for educating and training rural doctors, the uneven distribution of GPs may be worsening.

6) Fewer overseas-trained doctors are arriving​

There is a global shortage of all health-care workers, which is expected to worsen. Supply of international medical graduates may drop as their options for work in other countries increases. Border closures during COVID have also reduced supply.

View attachment 13848
There is a global supply of doctors. Shutterstock​

International medical graduates make up more than 50% of the rural workforce. However recent changes mean these doctors can now work in urban locations, rather than the more isolated practices in rural areas. This may worsen GP shortages in rural communities.

International medical graduates have to fund their own training and assessment. This starts with becoming registered as a doctor in Australia and then involves training as a GP. The training is long, arduous and expensive, and doctors often need additional support. There is also an ethical question of recruiting health-care workers from countries that need their services more.

While the Strengthening Medicare Taskforce supports GP care, it doesn’t identify the specific changes required to improve accessibility and affordability and requires significant structural change.

It will be months before the recommendations of the report can be translated into policy, and it may be years before radical changes can be implemented. Without addressing the GP shortage in the meantime, there may be a much smaller workforce to strengthen.

This article was first published on The Conversation, and was written by Louise Stone, General practitioner; Associate Professor, ANU Medical School, Australian National University, Jennifer May, Betty Fyffe Chair of Rural Health Director of University of Newcastle Dept of Rural Health, University of Newcastle

I am so lucky. I have a great health fund, 5 great specialists, and a wonderful GP. I was told many years ago to get a health fund as it would be a necessity and that is exactly what has happened.

 

[Jest]

That is crap. If those gps have the luxury of a mansion then it must have occurred via another source of income or prior to 1974 when Whitlam introduced Medicare. If the drs are working in a corporate practice they only get a percentage of their earnings. Those that are the sole owners of their practice have enormous expenditure including their rents. There definitely is a huge more drs that are needed. My husband was a gp but had to retire when he became sick with COVID and 12mths down the track is still having problems. He never wanted to retire prior to this. He loved his patients was still doing home visits until he got sick at age of 77. He now has the early stages of dementia caused by COVID. A once very active man now can’t remember simple tasks.
It is sad to loose so many gps now either through retirement, illness and other situations whereby it may have been an overseas recruit that finds Australia’s healthcare lacking with bureaucratic b…s
Some of the female gps think they are primadonas and maybe nice to their patients but the other side of them is abusive to staff etc. Yes have seen this first hand and will demand their patients are charged very long consults for patients having a Pap smear or breast examination and this way they get better income

Honestly I wouldn’t believe all the media crap

Thank you for your reply. If some of these whingers were to swap places, guess what, no whinging. My Gp does not stop and I have received phone calls at 6 pm. Please people wear their shoes for a while. There are ratbags in any service and those are the greedy.

 

[Jest]

Thank you for your reply. If some of these whingers were to swap places, guess what, no whinging. My Gp does not stop and I have received phone calls at 6 pm. Please people wear their shoes for a while. There are ratbags in any service and those are the greedy.

also i feel for you and your husband. I now have long covid had a covid and pneumonia and was isolated for 8 days. My best.

 

[Colette 3799]

My clinic no longer bulk bills. I’m a part pensioner plus some super. I don’t have a problem paying the gap but my last visit was a “long consult” and I had to pay $100 up front. Why can’t they get a system in where you only have to pay the gap fee. A lot of people in these financially difficult times might not have enough to pay the up front fee. I can only hope there will be something in the budget for Medicare as the previous govt almost destroyed it.

My clinic no longer bulk bills. I’m a part pensioner plus some super. I don’t have a problem paying the gap but my last visit was a “long consult” and I had to pay $100 up front. Why can’t they get a system in where you only have to pay the gap fee. A lot of people in these financially difficult times might not have enough to pay the up front fee. I can only hope there will be something in the budget for Medicare as the previous govt almost destroyed it.

I’m pretty sure you can just pay the gap. I overheard someone while getting an X-ray and they told the lady she could pay the gap and Medicare would send her a cheque that she should return to the surgery. I did what she said some time after and it worked. As far as I know they haven’t changed the rules, it might be worth asking

 

[Gsr]

I’m pretty sure you can just pay the gap. I overheard someone while getting an X-ray and they told the lady she could pay the gap and Medicare would send her a cheque that she should return to the surgery. I did what she said some time after and it worked. As far as I know they haven’t changed the rules, it might be worth asking

A lot of drs surgeries won’t let you just pay the gap, I’m guessing so they don’t have to wait for their money from Medicare. Some pathology, imaging places will accept the gap only payment, a lot are starting to want you to pay the whole fee as well. I don’t know how long it takes for Medicare to refund now but it used to be overnight for gps and up to a week for specialists and pathology, imaging places. That was a few years ago, my husband and I being part pensioners usually have all our services bulk billed. Even my husbands heart specialist and the orthopaedic surgeon bulk bill him which is good.

 

[Rosalie30]

My clinic no longer bulk bills. I’m a part pensioner plus some super. I don’t have a problem paying the gap but my last visit was a “long consult” and I had to pay $100 up front. Why can’t they get a system in where you only have to pay the gap fee. A lot of people in these financially difficult times might not have enough to pay the up front fee. I can only hope there will be something in the budget for Medicare as the previous govt almost destroyed it.

I agree with you Trina. My gap as an Age Pensioner with a chronic illness is $15 for a 10min appt, be it in the surgery or on the phone. I have to pay the full amount upfront too. I can manage to do this, but many others cannot. This Labor Govt. needs to get its act together and raise the amount paid to GPs for consultations. If the Govt. made all GP and Specialist appointments free, as they are in UK, they could get rid of the expensive Medicare system, which is bureaucracy at its worst.

 

[Colette 3799]

A lot of drs surgeries won’t let you just pay the gap, I’m guessing so they don’t have to wait for their money from Medicare. Some pathology, imaging places will accept the gap only payment, a lot are starting to want you to pay the whole fee as well. I don’t know how long it takes for Medicare to refund now but it used to be overnight for gps and up to a week for specialists and pathology, imaging places. That was a few years ago, my husband and I being part pensioners usually have all our services bulk billed. Even my husbands heart specialist and the orthopaedic surgeon bulk bill him which is good.

A lot of drs surgeries won’t let you just pay the gap, I’m guessing so they don’t have to wait for their money from Medicare. Some pathology, imaging places will accept the gap only payment, a lot are starting to want you to pay the whole fee as well. I don’t know how long it takes for Medicare to refund now but it used to be overnight for gps and up to a week for specialists and pathology, imaging places. That was a few years ago, my husband and I being part pensioners usually have all our services bulk billed. Even my husbands heart specialist and the orthopaedic surgeon bulk bill him which is good.

Our dr bulk bills we’re so lucky.

 

[Lizzylou]

I agree with you Trina. My gap as an Age Pensioner with a chronic illness is $15 for a 10min appt, be it in the surgery or on the phone. I have to pay the full amount upfront too. I can manage to do this, but many others cannot. This Labor Govt. needs to get its act together and raise the amount paid to GPs for consultations. If the Govt. made all GP and Specialist appointments free, as they are in UK, they could get rid of the expensive Medicare system, which is bureaucracy at its worst.

Let's start with Labor government who have not been in power that long and have taken over from the Liberal government who were in for 10 years, demolishing Education, Health and many other things that Australians' need. So let's give them a chance to improve things before you complain about them. England's health system is in major crisis much like the American health system so let's worry about fixing ours instead of thinking about what other countries are doing, cos clearly they are not doing so well either. I do however agree that the amount paid to a GP should be raised.