In the past weeks, we’ve written about how GPs have changed their payment schemes, moving away from bulk billing. Many doctors now charge fees for consultation in addition to the Medicare subsidy.

For most, it’s a matter of survival - costs in providing care have risen in the past years, but the government has not matched the rebate rates. Still, doctors continue to be the highest earning professionals in the country, according to the latest data from the Australian Taxation Office (ATO).

On OzBargain, a member started a conversation about doctors and medical centres that now require a co-pay.

They wrote: ‘I know there have been new articles and doctors whinging about the medicare care rebate not being raised forever.

‘My local medical centre just announced that they are moving to a co-pay system. Now it's going to cost $80 for a consult, and the Medicare rebate is $39.75, so the person pays $40 out of pocket.

‘The doctors claim they are going broke by just taking the current $39.75. I don't think that is the case. But even if it is, in what world does someone go from claiming to be going broke to doubling their revenue?’

The post prompted members to share recommendations, thoughts, and personal experiences.

Someone had a simple suggestion: ‘*Go to another medical centre.’ While the advice received support on the site, others replied that it was not as simple or sustainable.

A comment said: ‘I agree with the sentiment of “vote with your feet”. However, no fee/gap high-quality GP consultations are not sustainable, and soon we won't be able to go to another clinic unless we demand more from the Federal Government.’

They continued: ‘The Medicare subsidy/rebate is OUR tax dollars, and for ~10 years the Government has not increased it to fund cost-effective GP-led healthcare (a standard consult currently ~$39 adjusted for inflation should be ~$85). Healthcare is a fundamental human right - and if we have money to spend on the Olympics, submarines, tanks, bailing out private companies like Qantas, we can spend it on our most important asset.’ The member urged others to ‘make as much noise’ by writing to local parliament members or Health Minister Mark Butler.

One comment questioned if GP consults are worth what doctors are asking for: ‘Should a consult really be $85? There are many quick consults (for example, just picking up scripts) that are a quick 5 minutes and easy money for a doctor.’

‘Agree. For a script pickup, there should be bulk billing, but you don’t see the doctor,’ one Aussie said.

Others felt the cost was justified, though.

A reply said: ‘Good clinics allocate 15-20 minutes per patient. You are paying for the total time, and they can't just see an extra patient with 5 minutes' notice.’

‘Yes, I think that's a reasonable cost. It's not $85. It's $46 out of pocket ($85-$39 rebate you get back). For $46, you get a professional with over 10 years of training to make an assessment of your request and provide you advice. In your example, a prescription - it may appear to be quick, but they assess the appropriateness/effectiveness of the medication, consider alternatives and monitoring… time permitting, they may even consider and recommend age-appropriate opportunistic health activities such as vaccinations, cancer screening and other investigations that could pick up early problems,’ another chimed in.

One response explained where the money goes: ‘Don't forget that GPs pay between 30 to 35 per cent of their billings to the clinic. It's called service fee.’

Most doctors in the country are well-compensated, but the highest paid are often specialists. According to Medical Recruitment, a recruitment agency based in Australia, full-time GPs earn between $200,000 to $300,000 on average every year. The amount would depend on a doctor’s location, types of services offered, average hours, where they’re working (hospital, clinic, or private practice), and the proportion of bulk-billed patients.

However, the wages cover more than just personal necessities for doctors. If they have a private clinic, they also cover facilities, insurance, rent, medical utilities, and medicines. The pandemic necessitated changes, such as outdoor clinics and telehealth consultations, which required doctors and clinics to spend more. Medicare rebates are insufficient in covering these costs.

Smaller clinics benefit the least from the current rebate system. More patients go to well-established, large clinics that see plenty of appointments and have many doctors in multiple locations - and these can afford to bulk bill. While they tend to do very well, it can be at the cost of quality and personal care - a claim that the Royal Australian College of General Practitioners has questioned.

General practitioners favour gap payments to compensate for low and delayed Medicare rebates. Credit: Karolina Grabowska​

OzBargain members have their share of less-than-desirable experiences with some GPs and have wondered if the increase or the co-pay is worth it.

One Aussie said: ‘I wouldn't mind paying more for going to a GP if I could find one that was competent. I don't know what other people's experience of the medical profession is, but mine is that they are a lot less useful and effective than they have convinced themselves they are. Sure, the thing they do is very valuable, but only if they do it effectively.’

Another also shared: ‘Most of the GP we have seen are useless and are only there to write scripts or a referral to a more competent specialist. If we have to pay the GP, I'd rather have the Medicare scheme cancelled so that we don't have to pay thousands of Medicare levy.’

‘There needs to be a lot more checks and balances (audits) in place to ensure that the service that is provided by GPs is up to scratch. Otherwise, people have to visit multiple doctors to get the care they should have received at the first visit,’ according to another member.

It also seems that finding ‘quality’ GPs is a challenge. A member responded: ‘Whether they bulk bill or not, it is extremely difficult to find quality care. Unfortunately, most of the truly caring, competent professionals will not take on any new patients. Word gets around pretty quickly that Dr X is the one to see…’

Another had generally better experience with GPs who ask for gap payments: ‘Having been to bulk billing and co-pay medical centres, the difference is night and day - from my experience, co-pay is a much better service and well worth the extra expense. I admit I’m in a position where I can afford it, but there is a sacrifice you make to get something for (essentially) nothing.’

However, this is not possible for many Aussies. The most vulnerable are already struggling to find bulk-billing GPs - and they usually have conditions that require longer and multiple consultations. Many others are delaying receiving healthcare.

Where do you stand on this? Do you think GPs are justified in abandoning bulk billing for gap payments? Let us know in the comments!

 

[aquarius123]

I am a pensioner and my GP still bulk bills but I am going to have to pay a gap fee for the "allied health visits" that come with a GP plan. The strange thing is that these visits to the physio and podiatrist are going to be bulk billed for disability pensioners but not old age pensioners. I think this is a bit unfair. If my doctor does away with bulk billing for pensioners I will hesitate before visiting the clinic and no doubt others will do the same. This will mean people with health conditions will go untreated unfortunately.

 

[Myrie]

I am also a pensioner and I don't mind paying as I still get money back from Medicare, and I get 5 free visits to physio or podiatrist a year as that is a big help.

 

[Big G]

Correction - GPs do charge for script repeats; through a quick visit bulk-billed visit - it does take time to print-out and sign scripts.

 

[Rubyroo]

This is my observation …. that GPS no longer make a proper diagnosis. You are referred to Specialists when you push for further answers. I think the doctors are too scared to diagnose a chest infection for example and have been told to say that everything now is a virus. So what are we actually paying for. Chest infections can very quickly turn nasty and my 8 year old for 3 years has had nothing but virus after virus…. I’ve stopped taking her to get checked . I haven’t had a prescription for her in years…

Another point is what are medical students taught…. Perhaps it’s all about Specialists now. Are GPS just going to be a referral centre In the future? . I don’t know…..just my thoughts
I’m not looking for a fight here…

 

[Big G]

I am also a pensioner and I don't mind paying as I still get money back from Medicare, and I get 5 free visits to physio or podiatrist a year as that is a big help.

NDSS by the sound of it - know it well.

 

[KGP]

The problem is far larger than simply what GPs are charging.

Firstly, successive governments have declined to take on the AMA and bring in a capitation fee. GPs spend a large proportion of their time seeing people with chronic illnesses. Rather than paying the GP every time the person comes to their practice, the GP should be paid an annual amount for keeping a person with a chronic illness well and out of hospital. They could do that by having practice nurses spending time with each of these patients teaching them how to self-manage their disease, by helping them develop appropriate diets and exercise regimes, issue them prescription repeats, etc., all possible within the safe scope of practice of a nurse. GPs only need to see chronic patients to treat some unavoidable outcome of the disease. Capitation would provide a solid foundational income for GPs and fee for service could be restricted to one-off issues. Secondly, MBS rebates need to be structured to control specialist fees. When cataracts were first being removed through surgery, it meant a large, skilled surgical team and, usually, days in hospital. It was well worth the $1000+ MBS fee they were paid. Now, it is so mechanical, a specialist can remove 20 cataracts in a morning but the MBS fee is still the same. The same goes for stents - once a sophisticated, specialised procedure, now any physician can do it quickly and safely and still be paid as much for each as when they took hours to implant.

There is no question that the whole of health is in financial crisis but the government's response has simply been to have an ever increasing amount of the rising cost paid for by patients, out of pocket.

 

[Vertho]

I am old enough to remember when doctors would visit your home when called 24 hrs a day. Gone are the days when your local GP meant the oath they took when they decided to be a doctor. Yes, there are many good ones out there who genuinely want to help their patients get well, but, in the country, it is not so easy. We get so many overseas doctors who must do their 2 yrs. in the area to prove their ability. We see them come from some of the poorer countries with nothing much and in a matter of about 2 months they are wearing suits and have new cars, then they leave and go to the cities where they can earn more money and have access to more training facilities. Now, most country areas are begging the government for doctors. If you want an appointment here, you must, often, wait at least 3 weeks or longer. Our doctors are so worn out, but they still need to keep going because there no replacements due to covid. This is no longer the lucky country. We are on a downward slide of the poor get poorer and the rich live like fat cats.

 

[mark godwin]

my out of pocket yesterday was $25 .

 

[Ezzy]

In the past weeks, we’ve written about how GPs have changed their payment schemes, moving away from bulk billing. Many doctors now charge fees for consultation in addition to the Medicare subsidy.

For most, it’s a matter of survival - costs in providing care have risen in the past years, but the government has not matched the rebate rates. Still, doctors continue to be the highest earning professionals in the country, according to the latest data from the Australian Taxation Office (ATO).

On OzBargain, a member started a conversation about doctors and medical centres that now require a co-pay.

They wrote: ‘I know there have been new articles and doctors whinging about the medicare care rebate not being raised forever.

‘My local medical centre just announced that they are moving to a co-pay system. Now it's going to cost $80 for a consult, and the Medicare rebate is $39.75, so the person pays $40 out of pocket.

‘The doctors claim they are going broke by just taking the current $39.75. I don't think that is the case. But even if it is, in what world does someone go from claiming to be going broke to doubling their revenue?’

The post prompted members to share recommendations, thoughts, and personal experiences.

Someone had a simple suggestion: ‘*Go to another medical centre.’ While the advice received support on the site, others replied that it was not as simple or sustainable.

A comment said: ‘I agree with the sentiment of “vote with your feet”. However, no fee/gap high-quality GP consultations are not sustainable, and soon we won't be able to go to another clinic unless we demand more from the Federal Government.’

They continued: ‘The Medicare subsidy/rebate is OUR tax dollars, and for ~10 years the Government has not increased it to fund cost-effective GP-led healthcare (a standard consult currently ~$39 adjusted for inflation should be ~$85). Healthcare is a fundamental human right - and if we have money to spend on the Olympics, submarines, tanks, bailing out private companies like Qantas, we can spend it on our most important asset.’ The member urged others to ‘make as much noise’ by writing to local parliament members or Health Minister Mark Butler.

One comment questioned if GP consults are worth what doctors are asking for: ‘Should a consult really be $85? There are many quick consults (for example, just picking up scripts) that are a quick 5 minutes and easy money for a doctor.’

‘Agree. For a script pickup, there should be bulk billing, but you don’t see the doctor,’ one Aussie said.

Others felt the cost was justified, though.

A reply said: ‘Good clinics allocate 15-20 minutes per patient. You are paying for the total time, and they can't just see an extra patient with 5 minutes' notice.’

‘Yes, I think that's a reasonable cost. It's not $85. It's $46 out of pocket ($85-$39 rebate you get back). For $46, you get a professional with over 10 years of training to make an assessment of your request and provide you advice. In your example, a prescription - it may appear to be quick, but they assess the appropriateness/effectiveness of the medication, consider alternatives and monitoring… time permitting, they may even consider and recommend age-appropriate opportunistic health activities such as vaccinations, cancer screening and other investigations that could pick up early problems,’ another chimed in.

One response explained where the money goes: ‘Don't forget that GPs pay between 30 to 35 per cent of their billings to the clinic. It's called service fee.’

Most doctors in the country are well-compensated, but the highest paid are often specialists. According to Medical Recruitment, a recruitment agency based in Australia, full-time GPs earn between $200,000 to $300,000 on average every year. The amount would depend on a doctor’s location, types of services offered, average hours, where they’re working (hospital, clinic, or private practice), and the proportion of bulk-billed patients.

However, the wages cover more than just personal necessities for doctors. If they have a private clinic, they also cover facilities, insurance, rent, medical utilities, and medicines. The pandemic necessitated changes, such as outdoor clinics and telehealth consultations, which required doctors and clinics to spend more. Medicare rebates are insufficient in covering these costs.

Smaller clinics benefit the least from the current rebate system. More patients go to well-established, large clinics that see plenty of appointments and have many doctors in multiple locations - and these can afford to bulk bill. While they tend to do very well, it can be at the cost of quality and personal care - a claim that the Royal Australian College of General Practitioners has questioned.

View attachment 5535
General practitioners favour gap payments to compensate for low and delayed Medicare rebates. Credit: Karolina Grabowska​

OzBargain members have their share of less-than-desirable experiences with some GPs and have wondered if the increase or the co-pay is worth it.

One Aussie said: ‘I wouldn't mind paying more for going to a GP if I could find one that was competent. I don't know what other people's experience of the medical profession is, but mine is that they are a lot less useful and effective than they have convinced themselves they are. Sure, the thing they do is very valuable, but only if they do it effectively.’

Another also shared: ‘Most of the GP we have seen are useless and are only there to write scripts or a referral to a more competent specialist. If we have to pay the GP, I'd rather have the Medicare scheme cancelled so that we don't have to pay thousands of Medicare levy.’

‘There needs to be a lot more checks and balances (audits) in place to ensure that the service that is provided by GPs is up to scratch. Otherwise, people have to visit multiple doctors to get the care they should have received at the first visit,’ according to another member.

It also seems that finding ‘quality’ GPs is a challenge. A member responded: ‘Whether they bulk bill or not, it is extremely difficult to find quality care. Unfortunately, most of the truly caring, competent professionals will not take on any new patients. Word gets around pretty quickly that Dr X is the one to see…’

Another had generally better experience with GPs who ask for gap payments: ‘Having been to bulk billing and co-pay medical centres, the difference is night and day - from my experience, co-pay is a much better service and well worth the extra expense. I admit I’m in a position where I can afford it, but there is a sacrifice you make to get something for (essentially) nothing.’

However, this is not possible for many Aussies. The most vulnerable are already struggling to find bulk-billing GPs - and they usually have conditions that require longer and multiple consultations. Many others are delaying receiving healthcare.

Where do you stand on this? Do you think GPs are justified in abandoning bulk billing for gap payments? Let us know in the comments!

For Doctors l think this is a case for damned if l do & damned if l don't. If they abandon Bulk Billing many people will be disadvantaged by having to find money they don't have for a visit to a Dr. & the Dr may lose patients. More people may in turn visit hospitals for consults & have to wait longer there than at a surgery for attention & overworked staff in emergency become more overworked.

The already disadvantaged will be further disadvantaged.

I thought Medicare was working well until the Whitlam Labour Govt decided to change things "for the better".

Leave the system as it is unless it will be restructured to use the levy as it was meant to be used.

My G.P. , part of a large practice, is very efficient, Bulk Bills me & all appointments are structured according to your requirements. Most appointments are for 10 minutes only but can be 20 minutes etc. Not all G.P's here do Bulk Bill.

 

[Allie1919]

NDSS by the sound of it - know it well.

Most care plans don’t cover the cost of a podiatrist, physio, dietitian or other allied health ‘professionals’ - they all charge above the Medicare rebate!! In my experience and I worked for doctors!!! GP’s get incentive payments from the govt eg pips and sips, get hundreds for ‘doing a care plan and health assessments (incidentally that a nurse completes and the doc signs - without reading the nurses recommendations for referral s to psychologist or a podiatrist or for ear clean etc - there is very little follow up on the care plans !!! The govt knows this!! They all earn a darn good salary as evidenced by the tax man!!!!’ Its all about the money et - greed!!!

 

[ElizaKaye]

In the past weeks, we’ve written about how GPs have changed their payment schemes, moving away from bulk billing. Many doctors now charge fees for consultation in addition to the Medicare subsidy.

For most, it’s a matter of survival - costs in providing care have risen in the past years, but the government has not matched the rebate rates. Still, doctors continue to be the highest earning professionals in the country, according to the latest data from the Australian Taxation Office (ATO).

On OzBargain, a member started a conversation about doctors and medical centres that now require a co-pay.

They wrote: ‘I know there have been new articles and doctors whinging about the medicare care rebate not being raised forever.

‘My local medical centre just announced that they are moving to a co-pay system. Now it's going to cost $80 for a consult, and the Medicare rebate is $39.75, so the person pays $40 out of pocket.

‘The doctors claim they are going broke by just taking the current $39.75. I don't think that is the case. But even if it is, in what world does someone go from claiming to be going broke to doubling their revenue?’

The post prompted members to share recommendations, thoughts, and personal experiences.

Someone had a simple suggestion: ‘*Go to another medical centre.’ While the advice received support on the site, others replied that it was not as simple or sustainable.

A comment said: ‘I agree with the sentiment of “vote with your feet”. However, no fee/gap high-quality GP consultations are not sustainable, and soon we won't be able to go to another clinic unless we demand more from the Federal Government.’

They continued: ‘The Medicare subsidy/rebate is OUR tax dollars, and for ~10 years the Government has not increased it to fund cost-effective GP-led healthcare (a standard consult currently ~$39 adjusted for inflation should be ~$85). Healthcare is a fundamental human right - and if we have money to spend on the Olympics, submarines, tanks, bailing out private companies like Qantas, we can spend it on our most important asset.’ The member urged others to ‘make as much noise’ by writing to local parliament members or Health Minister Mark Butler.

One comment questioned if GP consults are worth what doctors are asking for: ‘Should a consult really be $85? There are many quick consults (for example, just picking up scripts) that are a quick 5 minutes and easy money for a doctor.’

‘Agree. For a script pickup, there should be bulk billing, but you don’t see the doctor,’ one Aussie said.

Others felt the cost was justified, though.

A reply said: ‘Good clinics allocate 15-20 minutes per patient. You are paying for the total time, and they can't just see an extra patient with 5 minutes' notice.’

‘Yes, I think that's a reasonable cost. It's not $85. It's $46 out of pocket ($85-$39 rebate you get back). For $46, you get a professional with over 10 years of training to make an assessment of your request and provide you advice. In your example, a prescription - it may appear to be quick, but they assess the appropriateness/effectiveness of the medication, consider alternatives and monitoring… time permitting, they may even consider and recommend age-appropriate opportunistic health activities such as vaccinations, cancer screening and other investigations that could pick up early problems,’ another chimed in.

One response explained where the money goes: ‘Don't forget that GPs pay between 30 to 35 per cent of their billings to the clinic. It's called service fee.’

Most doctors in the country are well-compensated, but the highest paid are often specialists. According to Medical Recruitment, a recruitment agency based in Australia, full-time GPs earn between $200,000 to $300,000 on average every year. The amount would depend on a doctor’s location, types of services offered, average hours, where they’re working (hospital, clinic, or private practice), and the proportion of bulk-billed patients.

However, the wages cover more than just personal necessities for doctors. If they have a private clinic, they also cover facilities, insurance, rent, medical utilities, and medicines. The pandemic necessitated changes, such as outdoor clinics and telehealth consultations, which required doctors and clinics to spend more. Medicare rebates are insufficient in covering these costs.

Smaller clinics benefit the least from the current rebate system. More patients go to well-established, large clinics that see plenty of appointments and have many doctors in multiple locations - and these can afford to bulk bill. While they tend to do very well, it can be at the cost of quality and personal care - a claim that the Royal Australian College of General Practitioners has questioned.

View attachment 5535
General practitioners favour gap payments to compensate for low and delayed Medicare rebates. Credit: Karolina Grabowska​

OzBargain members have their share of less-than-desirable experiences with some GPs and have wondered if the increase or the co-pay is worth it.

One Aussie said: ‘I wouldn't mind paying more for going to a GP if I could find one that was competent. I don't know what other people's experience of the medical profession is, but mine is that they are a lot less useful and effective than they have convinced themselves they are. Sure, the thing they do is very valuable, but only if they do it effectively.’

Another also shared: ‘Most of the GP we have seen are useless and are only there to write scripts or a referral to a more competent specialist. If we have to pay the GP, I'd rather have the Medicare scheme cancelled so that we don't have to pay thousands of Medicare levy.’

‘There needs to be a lot more checks and balances (audits) in place to ensure that the service that is provided by GPs is up to scratch. Otherwise, people have to visit multiple doctors to get the care they should have received at the first visit,’ according to another member.

It also seems that finding ‘quality’ GPs is a challenge. A member responded: ‘Whether they bulk bill or not, it is extremely difficult to find quality care. Unfortunately, most of the truly caring, competent professionals will not take on any new patients. Word gets around pretty quickly that Dr X is the one to see…’

Another had generally better experience with GPs who ask for gap payments: ‘Having been to bulk billing and co-pay medical centres, the difference is night and day - from my experience, co-pay is a much better service and well worth the extra expense. I admit I’m in a position where I can afford it, but there is a sacrifice you make to get something for (essentially) nothing.’

However, this is not possible for many Aussies. The most vulnerable are already struggling to find bulk-billing GPs - and they usually have conditions that require longer and multiple consultations. Many others are delaying receiving healthcare.

Where do you stand on this? Do you think GPs are justified in abandoning bulk billing for gap payments? Let us know in the comments!

I am wondering why most doctors only work part-time - if they are not earning enough

 

[Pat T]

In the past weeks, we’ve written about how GPs have changed their payment schemes, moving away from bulk billing. Many doctors now charge fees for consultation in addition to the Medicare subsidy.

For most, it’s a matter of survival - costs in providing care have risen in the past years, but the government has not matched the rebate rates. Still, doctors continue to be the highest earning professionals in the country, according to the latest data from the Australian Taxation Office (ATO).

On OzBargain, a member started a conversation about doctors and medical centres that now require a co-pay.

They wrote: ‘I know there have been new articles and doctors whinging about the medicare care rebate not being raised forever.

‘My local medical centre just announced that they are moving to a co-pay system. Now it's going to cost $80 for a consult, and the Medicare rebate is $39.75, so the person pays $40 out of pocket.

‘The doctors claim they are going broke by just taking the current $39.75. I don't think that is the case. But even if it is, in what world does someone go from claiming to be going broke to doubling their revenue?’

The post prompted members to share recommendations, thoughts, and personal experiences.

Someone had a simple suggestion: ‘*Go to another medical centre.’ While the advice received support on the site, others replied that it was not as simple or sustainable.

A comment said: ‘I agree with the sentiment of “vote with your feet”. However, no fee/gap high-quality GP consultations are not sustainable, and soon we won't be able to go to another clinic unless we demand more from the Federal Government.’

They continued: ‘The Medicare subsidy/rebate is OUR tax dollars, and for ~10 years the Government has not increased it to fund cost-effective GP-led healthcare (a standard consult currently ~$39 adjusted for inflation should be ~$85). Healthcare is a fundamental human right - and if we have money to spend on the Olympics, submarines, tanks, bailing out private companies like Qantas, we can spend it on our most important asset.’ The member urged others to ‘make as much noise’ by writing to local parliament members or Health Minister Mark Butler.

One comment questioned if GP consults are worth what doctors are asking for: ‘Should a consult really be $85? There are many quick consults (for example, just picking up scripts) that are a quick 5 minutes and easy money for a doctor.’

‘Agree. For a script pickup, there should be bulk billing, but you don’t see the doctor,’ one Aussie said.

Others felt the cost was justified, though.

A reply said: ‘Good clinics allocate 15-20 minutes per patient. You are paying for the total time, and they can't just see an extra patient with 5 minutes' notice.’

‘Yes, I think that's a reasonable cost. It's not $85. It's $46 out of pocket ($85-$39 rebate you get back). For $46, you get a professional with over 10 years of training to make an assessment of your request and provide you advice. In your example, a prescription - it may appear to be quick, but they assess the appropriateness/effectiveness of the medication, consider alternatives and monitoring… time permitting, they may even consider and recommend age-appropriate opportunistic health activities such as vaccinations, cancer screening and other investigations that could pick up early problems,’ another chimed in.

One response explained where the money goes: ‘Don't forget that GPs pay between 30 to 35 per cent of their billings to the clinic. It's called service fee.’

Most doctors in the country are well-compensated, but the highest paid are often specialists. According to Medical Recruitment, a recruitment agency based in Australia, full-time GPs earn between $200,000 to $300,000 on average every year. The amount would depend on a doctor’s location, types of services offered, average hours, where they’re working (hospital, clinic, or private practice), and the proportion of bulk-billed patients.

However, the wages cover more than just personal necessities for doctors. If they have a private clinic, they also cover facilities, insurance, rent, medical utilities, and medicines. The pandemic necessitated changes, such as outdoor clinics and telehealth consultations, which required doctors and clinics to spend more. Medicare rebates are insufficient in covering these costs.

Smaller clinics benefit the least from the current rebate system. More patients go to well-established, large clinics that see plenty of appointments and have many doctors in multiple locations - and these can afford to bulk bill. While they tend to do very well, it can be at the cost of quality and personal care - a claim that the Royal Australian College of General Practitioners has questioned.

View attachment 5535
General practitioners favour gap payments to compensate for low and delayed Medicare rebates. Credit: Karolina Grabowska​

OzBargain members have their share of less-than-desirable experiences with some GPs and have wondered if the increase or the co-pay is worth it.

One Aussie said: ‘I wouldn't mind paying more for going to a GP if I could find one that was competent. I don't know what other people's experience of the medical profession is, but mine is that they are a lot less useful and effective than they have convinced themselves they are. Sure, the thing they do is very valuable, but only if they do it effectively.’

Another also shared: ‘Most of the GP we have seen are useless and are only there to write scripts or a referral to a more competent specialist. If we have to pay the GP, I'd rather have the Medicare scheme cancelled so that we don't have to pay thousands of Medicare levy.’

‘There needs to be a lot more checks and balances (audits) in place to ensure that the service that is provided by GPs is up to scratch. Otherwise, people have to visit multiple doctors to get the care they should have received at the first visit,’ according to another member.

It also seems that finding ‘quality’ GPs is a challenge. A member responded: ‘Whether they bulk bill or not, it is extremely difficult to find quality care. Unfortunately, most of the truly caring, competent professionals will not take on any new patients. Word gets around pretty quickly that Dr X is the one to see…’

Another had generally better experience with GPs who ask for gap payments: ‘Having been to bulk billing and co-pay medical centres, the difference is night and day - from my experience, co-pay is a much better service and well worth the extra expense. I admit I’m in a position where I can afford it, but there is a sacrifice you make to get something for (essentially) nothing.’

However, this is not possible for many Aussies. The most vulnerable are already struggling to find bulk-billing GPs - and they usually have conditions that require longer and multiple consultations. Many others are delaying receiving healthcare.

Where do you stand on this? Do you think GPs are justified in abandoning bulk billing for gap payments? Let us know in the comments!

 

[Stanier123]

In the past weeks, we’ve written about how GPs have changed their payment schemes, moving away from bulk billing. Many doctors now charge fees for consultation in addition to the Medicare subsidy.

For most, it’s a matter of survival - costs in providing care have risen in the past years, but the government has not matched the rebate rates. Still, doctors continue to be the highest earning professionals in the country, according to the latest data from the Australian Taxation Office (ATO).

On OzBargain, a member started a conversation about doctors and medical centres that now require a co-pay.

They wrote: ‘I know there have been new articles and doctors whinging about the medicare care rebate not being raised forever.

‘My local medical centre just announced that they are moving to a co-pay system. Now it's going to cost $80 for a consult, and the Medicare rebate is $39.75, so the person pays $40 out of pocket.

‘The doctors claim they are going broke by just taking the current $39.75. I don't think that is the case. But even if it is, in what world does someone go from claiming to be going broke to doubling their revenue?’

The post prompted members to share recommendations, thoughts, and personal experiences.

Someone had a simple suggestion: ‘*Go to another medical centre.’ While the advice received support on the site, others replied that it was not as simple or sustainable.

A comment said: ‘I agree with the sentiment of “vote with your feet”. However, no fee/gap high-quality GP consultations are not sustainable, and soon we won't be able to go to another clinic unless we demand more from the Federal Government.’

They continued: ‘The Medicare subsidy/rebate is OUR tax dollars, and for ~10 years the Government has not increased it to fund cost-effective GP-led healthcare (a standard consult currently ~$39 adjusted for inflation should be ~$85). Healthcare is a fundamental human right - and if we have money to spend on the Olympics, submarines, tanks, bailing out private companies like Qantas, we can spend it on our most important asset.’ The member urged others to ‘make as much noise’ by writing to local parliament members or Health Minister Mark Butler.

One comment questioned if GP consults are worth what doctors are asking for: ‘Should a consult really be $85? There are many quick consults (for example, just picking up scripts) that are a quick 5 minutes and easy money for a doctor.’

‘Agree. For a script pickup, there should be bulk billing, but you don’t see the doctor,’ one Aussie said.

Others felt the cost was justified, though.

A reply said: ‘Good clinics allocate 15-20 minutes per patient. You are paying for the total time, and they can't just see an extra patient with 5 minutes' notice.’

‘Yes, I think that's a reasonable cost. It's not $85. It's $46 out of pocket ($85-$39 rebate you get back). For $46, you get a professional with over 10 years of training to make an assessment of your request and provide you advice. In your example, a prescription - it may appear to be quick, but they assess the appropriateness/effectiveness of the medication, consider alternatives and monitoring… time permitting, they may even consider and recommend age-appropriate opportunistic health activities such as vaccinations, cancer screening and other investigations that could pick up early problems,’ another chimed in.

One response explained where the money goes: ‘Don't forget that GPs pay between 30 to 35 per cent of their billings to the clinic. It's called service fee.’

Most doctors in the country are well-compensated, but the highest paid are often specialists. According to Medical Recruitment, a recruitment agency based in Australia, full-time GPs earn between $200,000 to $300,000 on average every year. The amount would depend on a doctor’s location, types of services offered, average hours, where they’re working (hospital, clinic, or private practice), and the proportion of bulk-billed patients.

However, the wages cover more than just personal necessities for doctors. If they have a private clinic, they also cover facilities, insurance, rent, medical utilities, and medicines. The pandemic necessitated changes, such as outdoor clinics and telehealth consultations, which required doctors and clinics to spend more. Medicare rebates are insufficient in covering these costs.

Smaller clinics benefit the least from the current rebate system. More patients go to well-established, large clinics that see plenty of appointments and have many doctors in multiple locations - and these can afford to bulk bill. While they tend to do very well, it can be at the cost of quality and personal care - a claim that the Royal Australian College of General Practitioners has questioned.

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General practitioners favour gap payments to compensate for low and delayed Medicare rebates. Credit: Karolina Grabowska​

OzBargain members have their share of less-than-desirable experiences with some GPs and have wondered if the increase or the co-pay is worth it.

One Aussie said: ‘I wouldn't mind paying more for going to a GP if I could find one that was competent. I don't know what other people's experience of the medical profession is, but mine is that they are a lot less useful and effective than they have convinced themselves they are. Sure, the thing they do is very valuable, but only if they do it effectively.’

Another also shared: ‘Most of the GP we have seen are useless and are only there to write scripts or a referral to a more competent specialist. If we have to pay the GP, I'd rather have the Medicare scheme cancelled so that we don't have to pay thousands of Medicare levy.’

‘There needs to be a lot more checks and balances (audits) in place to ensure that the service that is provided by GPs is up to scratch. Otherwise, people have to visit multiple doctors to get the care they should have received at the first visit,’ according to another member.

It also seems that finding ‘quality’ GPs is a challenge. A member responded: ‘Whether they bulk bill or not, it is extremely difficult to find quality care. Unfortunately, most of the truly caring, competent professionals will not take on any new patients. Word gets around pretty quickly that Dr X is the one to see…’

Another had generally better experience with GPs who ask for gap payments: ‘Having been to bulk billing and co-pay medical centres, the difference is night and day - from my experience, co-pay is a much better service and well worth the extra expense. I admit I’m in a position where I can afford it, but there is a sacrifice you make to get something for (essentially) nothing.’

However, this is not possible for many Aussies. The most vulnerable are already struggling to find bulk-billing GPs - and they usually have conditions that require longer and multiple consultations. Many others are delaying receiving healthcare.

Where do you stand on this? Do you think GPs are justified in abandoning bulk billing for gap payments? Let us know in the comments!

Why should I pay a GP to get a prescription for a medicine I have to take for the rest of my life? The pharmacists know more about medicines. Why do I need a recurring visit to a GP for a referral to a specialist who I need to see annually? Why should I see a GP about a condition I have researched in depth and know what specialist I need?

GPs complain they are overworked. They live in a protected bubble that isn’t tolerated in other businesses. They know very little about nutrition but plenty about support to the pharmaceutical industry.

Yes medicine can be wonderful. But the medical industry is funded to keep you sick. You need a routine blood test but need one appointment for the referral and another for the results. Results you may be able to interpret yourself.

Its time to take control of your own health.

 

[Ian Crane-Luff]

I am old enough to remember when doctors would visit your home when called 24 hrs a day. Gone are the days when your local GP meant the oath they took when they decided to be a doctor. Yes, there are many good ones out there who genuinely want to help their patients get well, but, in the country, it is not so easy. We get so many overseas doctors who must do their 2 yrs. in the area to prove their ability. We see them come from some of the poorer countries with nothing much and in a matter of about 2 months they are wearing suits and have new cars, then they leave and go to the cities where they can earn more money and have access to more training facilities. Now, most country areas are begging the government for doctors. If you want an appointment here, you must, often, wait at least 3 weeks or longer. Our doctors are so worn out, but they still need to keep going because there no replacements due to covid. This is no longer the lucky country. We are on a downward slide of the poor get poorer and the rich live like fat cats.

This problem is not just the countries I'm on the Gold Coast and can wait for up to a month to see my GP who is a senior practice owner. He deals with my routine health matters but refers me to a specialist when needs be. His practice has now changed to a fee for service and it's noticeable his car park has gone from chockers to almost empty. The main problem I have is he's the only doctor around here whose qualifications I recognise, most of the others hold overseas quals many from countries of doubtful standards. Point in making is I'm stuck with my current one no matter how he charges and as a pensioner this is going to create unwanted problems.

 

[poppyshero]

Co payment is a struggle on the pension, my GP does not bulk bill. I pay $70 a visit plus $25 for repeat prescriptions. Some of my scripts have reduced from 5 down to 2 repeats adding extra cost. These costs mean less trips to the doctors, putting up with problems until i can afford another visit. It seems that if i want to continue getting quality health care from a reputable doctor, my situation will remain the same.

 

[Big G]

my out of pocket yesterday was $25 .

$40 for me

 

[Ezzy]

Why should I pay a GP to get a prescription for a medicine I have to take for the rest of my life? The pharmacists know more about medicines. Why do I need a recurring visit to a GP for a referral to a specialist who I need to see annually? Why should I see a GP about a condition I have researched in depth and know what specialist I need?

GPs complain they are overworked. They live in a protected bubble that isn’t tolerated in other businesses. They know very little about nutrition but plenty about support to the pharmaceutical industry.

Yes medicine can be wonderful. But the medical industry is funded to keep you sick. You need a routine blood test but need one appointment for the referral and another for the results. Results you may be able to interpret yourself.

Its time to take control of your own health.

A visit to a G.P. for a referral to a Specialist who is seen on a regular annual basis is not necessary if the G.P. writes up the referral & includes the words 'ongoing' or 'annually' as l have for a Specialist myself.

Why can't results for a blood test be done with a phone call from the G.P.? My practice does this. All that is needed is for me to request a call from my G.P. at an appointed time (just as l would a face to face appointment). I do not need to travel to the G.P. or wait in a Waiting Room to be seen. If the G.P. needs to see you instead a Receptionist can advise & make a time & date or the G.P. may tell you themself.

 

[Ezzy]

This problem is not just the countries I'm on the Gold Coast and can wait for up to a month to see my GP who is a senior practice owner. He deals with my routine health matters but refers me to a specialist when needs be. His practice has now changed to a fee for service and it's noticeable his car park has gone from chockers to almost empty. The main problem I have is he's the only doctor around here whose qualifications I recognise, most of the others hold overseas quals many from countries of doubtful standards. Point in making is I'm stuck with my current one no matter how he charges and as a pensioner this is going to create unwanted problems.

I used to have a problem seeing my G.P. in under a month so l started seeing someone else in the same Practice despite the fact I'd seen him for more than 30 years. More people all soon be in the same situation as me soon as he has wound back his hours & is believed to be retiring at the end of this year. There always seems to be a full waiting room to see any of the 10 Doctors, Podiatrist, Psych (both part time) or the Nurses here. Some patients are Bulk Billed while others pay a fee.

This has been a Training Practice for over 20 years with most practicioners staying on. There must be something that keeps them there & l would have no hesitation seeing any of them.

 

[Stanier123]

A visit to a G.P. for a referral to a Specialist who is seen on a regular annual basis is not necessary if the G.P. writes up the referral & includes the words 'ongoing' or 'annually' as l have for a Specialist myself.

Why can't results for a blood test be done with a phone call from the G.P.? My practice does this. All that is needed is for me to request a call from my G.P. at an appointed time (just as l would a face to face appointment). I do not need to travel to the G.P. or wait in a Waiting Room to be seen. If the G.P. needs to see you instead a Receptionist can advise & make a time & date or the G.P. may tell you themself.

I get a copy of the results that includes interpretation by a specialist. I don’t need a GP to read what I can read. It’s the AMA doctrine of over servicing and restrictive trade practices.

I don’t need the GP who invariably gets it wrong and just wants to dispense patent medicines. I can do the research myself and invariably have to explain to a GP the latest science.