‘Practices like ours are dying’: GPs explain why Medicare’s investment isn’t enough

As the years go by, what used to be occasional trips to the doctor can start to feel like regular appointments. 

Patients, many of whom have been visiting the clinic since it opened nearly four decades ago, are welcomed by familiar faces, reflecting the strong relationships that have developed over the years. 

However, despite the busy atmosphere and full appointment schedules, a pressing concern cannot be overlooked: the future of general practices is at risk.

The recent federal election was hailed as a ‘health election,’ with the government proudly announcing a record investment in Medicare, including expanding the bulk-billing incentive to all Australians.

However, many general practitioners (GPs) are not celebrating. They argued that these measures are not adequately addressing the financial viability of their practices, which are already operating on razor-thin margins.

Dr Loxley, a cornerstone of his community’s healthcare, described himself as a ‘dinosaur’ in the current medical landscape. 

‘Practices like ours are dying out. It would be hard to have a practice like this these days. We can do it because we’ve been doing it for 40 years,’ he said.

His practice serves around 6,500 patients, including multi-generational families, and is a rarity in today’s fast-paced world. 

The challenges GPs face today are starkly different from those at the beginning of Dr Loxley’s career. 

The rent was significantly lower then, and in 1993, seven years after establishing his practice, Dr Loxley purchased a nearby house for $240,000. He said that it would now be worth at least $1.8 million.

Fast forward to the present, and GPs are grappling with the high costs of complex software, indemnity insurance, and other operational expenses. 

Despite the advantage of starting his practice at the time he did, Dr Loxley is required to charge $75 for an appointment to one in four patients, which leaves them $33.80 out of pocket after getting the rebate for a standard consultation, to ensure the practice stays financially viable. 

As he approaches retirement, he cannot find a young GP interested in taking over his practice.

The situation is even more daunting for newly qualified GPs like Dr Claire Francis, who described her role as having the best medical job but with the worst pay. 

The reality of bulk billing means that after covering various expenses, including superannuation and taxes, a GP like Dr Francis is left with a fraction of the fee for her time and expertise. 

Dr Louise Stone, a professor of general practice at the Australia National University, highlighted the immense amount of unpaid administration work that GPs undertake, estimating it at around $1.2 billion a year. 

This unpaid labour is a critical component of the healthcare system, as GPs often find themselves as the ‘catch-all’ for various social issues, from housing to income support.

Some, including Dr Francis, see the government’s $8.5 billion policy to expand bulk-billing incentives as ‘designed to fail.’ 

Stone mentioned that practices shut down ‘left, right and centre’. She said the transition to more complicated patient cases, including mental health issues and chronic illnesses, was a challenge.

‘The sweet spot for Medicare is six minutes. If you see a doctor for less than 10 minutes, the Medicare rebate is about $6 a minute. If you see a patient for 30 minutes, it’s about $2 a minute,’ she said.

‘It shouldn’t matter if you need your cut finger bandaged or you need your five chronic diseases managed, you should get the same support per minute of time or per problem.’

However, Stone noted that many straightforward consultations are being redirected to other facilities, such as urgent care clinics, where the government allocates $246.50 per patient, nurse-led clinics, which receive $200 per patient, or emergency departments, which incur a cost of $692 per patient without an admission. 

She clarified that GPs are left to manage longer, more intricate consultations with a significantly lower Medicare rebate per minute. In comparison, government funding is just $42 per patient. 

Currently, the government provides a $20.65 incentive in metropolitan areas in addition to the rebate to bulk-bill pensioners, concession card holders, and children, with the incentive increasing for practices in more remote locations. 

Beginning 1 November, the government plans to broaden this incentive to include all Medicare cardholders and offer clinics that bulk bill every patient an additional 12.5 per cent loading. 

According to Stone, another challenge GPs face in maintaining financial viability is that the rebate has been stagnant for an extended period, resulting in less than 50 per cent of the actual service cost. 

Even though the government promotes bulk-billing incentives, Stone said they represent only a minor bonus above the rebate.

Official statistics reveal that 272 general practices have shuttered their doors, while 704 new practices have been established since the previous election. The data does not specify the types of practices closing or opening. 

Dr Michael Wright, the president of the Royal Australian College of General Practitioners, said that although some practices currently bulk bill patients and rural ones benefit from higher incentives, they have expressed interest in adopting the government’s policy. 

‘We’re here to do it, and if we’re properly funded to do it, we can do it, but if the funding is only for quick consultations, then that’s going to make it harder and harder,’ he said. 

How should the government’s investment in Medicare truly support the GPs who are the backbone of our healthcare system? What’s your take on this issue? Share your thoughts and insights in the comments below. 

Also read: Medicare rebate boost of up to $11.15—did your town make the list?