Erosion of income and the “politicisation of medicine” are the key concerns affecting GPs’ hopes for their economic future, an AusDoc Jobs survey1 has found.
Nearly 62% of over 500 GPs surveyed cited erosion of income in their top three economic concerns for the future, because remuneration has not kept pace with increasing practice running costs.
“Remuneration is totally inadequate for the years of medical education and training invested,” said one respondent.
Government intervention affecting the practice of medicine, such as the Medicare freeze, was the second-highest fear driver for GPs.
“General practice is the last bastion crumbling due to current socio-political erosive forces. The people are the losers,” said one GP.
GPs have been dealing with rising costs and stagnant Medicare reimbursement rates since 2014, with the last remnant of the Medicare freeze lifted only in July 2020.
The expectation to bulk bill also featured as a key concern for over 55% of GPs surveyed – and that figure jumped to 67.4% for those in corporate practice.
“I don't feel valued as a GP if I keep getting asked to bulk bill or forced to by the government when my colleagues in other specialties don't,” said one respondent.
Some GPs felt resentful that specialists were not under the same pressures to bulk bill as GPs: “Specialists earn so much more for so much less hassle and abuse by the public.”
National bulk billing rates remain high at 89.3%2 but this does not necessarily mean that GPs want to bulk bill.
A Central Coast NSW GP commented:
“The government looks at the bulk billing figures and decides GPs want to do it, but it’s a contentious issue, There is an expectation to bulk bill in lower socio-economic areas, and if everyone in your area is bulk billing, it’s very difficult to change. It’s up to GPs to try to buck the trend but that’s not easy.
I have patients who are not concession card-holders who have been bulk billed for more than eight years now. I feel I should send a letter, as some of my colleagues have done, to tell these patients they will be billed privately from now on. But when you care about your patients, that’s difficult to do.
It’s possible that I might lose half my patient population if I stop bulk billing, but when you add up the numbers, I might end up with the same income with half the patients. However, it’s very difficult to take the plunge, especially with long-standing patients.”
Although the recent budget announced more than $65 million in additional support to increase bulk billing rebates in regional, rural and remote areas from 1 January 2022, the reality of bulk billing is a big stressor for the average GP.
Due to amendments to the eligibility map, the Central Coast GP’s practice is no longer considered eligible for regional status and has to bulk bill at the same rates as busy city practices.
He said: “The increase for rural and remote practices affects very few people. The geographic reclassification from ’regional’ to ‘urban’ affects about 7000 GPs, so even though the MBS rebate for a level B standard consult has gone up by $1.15, they lose out on an extra $3 incentive for rural and remote bulk billing. It’s effectively a pay cut, coming after years of the Medicare freeze.”
Another factor that many GPs commented on was the encroachment on traditional general practice by other professions such as pharmacists and nurses.
“Other professions think they can do primary care without adequate training,” said one respondent.
Another said: “Pharmacists offering the flu jab seems reasonable, but in some areas there is clear encroachment on our role. How can pharmacists issue medical certificates, or offer diabetes or asthma management services? I can’t see how they are trained and qualified to do that.”
Three ways medical practices and recruiters can offset economic fears to attract and retain GPs – a GP’s insights
1. Offer a higher fee percentage
“What percentage of their GPs’ bulk billing fee does the practice charge? On average, a GP will get 70% of the fee, with the rest going to the practice owner. But some offer up to 80% for the GP. That’s attractive.”
2. Offer loyalty payments
“Corporate practices, in particular, could offer loyalty payments, where the GP gets a lump sum payment after three to five years with the same group. This may have tax disadvantages, however, so it instead they could offer an increased commission scheme, in which the GP’s commission rises from, say, 65% to 70% after three to five years with the same group.”
3. Share PIP incentives
“Through the Practice Incentives Program (PIP), practice owners get payments for services such as immunisation, but often the GPs don’t see any of that. Why not share those incentives with the doctors in the practice?”
1. Annual Australian Doctor & AusDoc.JOBS Job Seeker Study, Feb–April 2021.
2. Medical Benefits Division, Department of Health. GP Non Referred Attendances (NRA), 2020-21 Jul-Dec YTD. Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/32CC6EB4BCC0BB1CCA257BF0001FEB92/$File/Medicare%20year%20to%20date%20dashboard.pdf
Accessed 17 May 2021.