A sobering story emerged during a discussion between AMN and a member of the public this week who was requesting to be connected with a General Practitioner (GP) in Brisbane. They shared that they wanted to start looking for a new doctor because their current GP of 15 years was planning to retire by year's end. When asked why, the GP lamented it was because of the changing landscape of healthcare and medicine. According to the GP, doctors can no longer practice medicine in the way they believe is best for their patients, and bureaucratic intervention is eroding the core of medical care. This sentiment is echoed by the exodus of experienced GPs across Australia—many of whom are still years from traditional retirement age. We are witnessing a loss of talented doctors, compounded by a reluctance among younger professionals to pursue what is a noble career in general practice, as they perceive a diminishing value placed on this vital branch of medicine.
This article delves into the crisis currently gripping general practices and offers insights into potential solutions. From the necessity of an efficient business model to the pressing issue of a system that increasingly restricts doctors' autonomy, the path forward demands a fresh perspective and innovative strategies.
Understanding the Affordability Gap
Running a medical practice in Australia is increasingly becoming financially unsustainable. The successful practices and medical centres focus on volume and multiple revenue streams. GPs across Australia are grappling with underutilisation and inadequate compensation, highlighting a pressing gap that private sector, universities and the government must address.
The Medicare rebate, introduced in the 1970s, has struggled to keep pace with the rising costs of running a medical practice. Originally intended to ensure accessible healthcare for all Australians, the rebate's poor indexation and years of freezing have left GPs unable to maintain viable businesses while providing quality medical care. What was once a feasible model for GPs to earn a living through bulk billing has now become financially untenable. In late 2023, a growing number of practices increased their average fee for a standard consultation from $64 to just under $75 as they face pressure from rising costs. (For a standard consultation, Medicare rebate is $41.20).
Contrary to popular belief, not all doctors enjoy lucrative incomes. GPs, in particular, are often paid poorly compared to other medical specialists. Despite their extensive training and expertise, many GPs find themselves struggling to make ends meet, with some earning more from teaching aspiring GPs than from practicing medicine themselves.
The government's reimbursement rates for bulk-billed services are inadequate compared to other industries it subsidises, leaving GPs financially burdened each time they provide care to patients. With additional expenses such as practice fees and no sick leave or superannuation, GPs are left with diminishing returns, making it increasingly difficult to sustain private practices. This financial strain has led to the consolidation of practices by corporate entities, further exacerbating the issue.
Efforts aimed at maximising patient throughput, often driven by non-medical entities, unfortunately, come at the expense of the quality of care offered by GPs. Patients frequently express frustration over the brief duration of consultations, which impairs the ability of GPs to make accurate diagnoses. This often results in patients being sent on a costly journey of tests and specialist referrals. It is neither safe nor ethical for non-medical individuals to dictate the duration of patient consultations. Such practices jeopardize patient safety and well-being, underscoring the urgent need for a re-evaluation of priorities within the healthcare system.
Balancing the need for sustainable healthcare financing with the imperative to safeguard patient care remains a complex and pressing challenge for policymakers and healthcare professionals alike.
Misconceptions About GPs
It is important to dispel the misconception that GPs are not specialists; in fact, they undergo additional training to specialise in General Practice after completing medical school. Despite the role of GPs evolving over time, many are now primarily focused on managing patient referrals and prescribing medications, rather than providing the more comprehensive care that could alleviate pressures on the hospital system and specialists' workloads. This shift has resulted in some patients waiting months to see a specialist, highlighting the need to reassess the distribution of healthcare responsibilities and resources.
In the past, GPs often performed a wide range of medical procedures as part of their care for patients. These procedures could include:
- Conducting minor surgical procedures such as suturing wounds, removing moles or skin tags, and draining abscesses. While some GPs do this still today, fewer are learning these skills.
- Prenatal care and assisted with deliveries.
- Being the first point of contact for medical emergencies in their communities, and they would perform procedures such as setting fractures, managing acute injuries, and stabilising patients before referral to a hospital.
- Conducting a variety of diagnostic procedures in their offices, including simple blood tests, electrocardiograms (ECGs), and basic imaging studies such as X-rays or ultrasounds
The Past v Now
The role of GPs has evolved significantly over time, leading to several differences between GPs in the past and those practicing today:
In the past, GPs often had a broader scope of practice, however today the increasing specialisation within medicine means that some procedures and services are now typically handled by specialists.
Advances in medical technology have transformed the way GPs practice medicine. Today, GPs have access to a wide array of diagnostic tools, electronic health records, telemedicine capabilities, and medical devices that were not available in the past. These technological advancements have in some cases improved patient care and communication but have also added complexity and over diagnostic testing to the practice of medicine which in some cases can be invasive and cause further issues with the patient.
GPs today often face a higher administrative and insurance burden compared to their counterparts in the past. Increasing regulations, documentation requirements, insurance complexities, and electronic health record systems can consume a significant amount of time and resources, potentially detracting from direct patient care.
While the traditional doctor-patient relationship remains pivotal in general practice, it has undergone notable evolution over time. Present-day GPs are increasingly navigating a landscape characterised by heightened bureaucratic demands, which sometimes overshadow their ability to freely discuss diverse opinions and treatment options with colleagues. Additionally, there has been a concerning surge in anonymous complaints against doctors, coupled with restrictions that hinder GPs from maintaining open and transparent communication with patients. These shifts underscore the challenges faced by modern GPs in fostering trust and collaboration within the healthcare ecosystem while upholding the highest standards of patient care.
In the past, many GPs operated as solo practitioners or in small group practices. Today, there is a trend towards larger group practices, corporate-owned medical centres, and healthcare networks. This shift can affect the autonomy and working conditions of GPs, as well as patient outcomes and the financial aspects of their practice.
Voluntary Patient Enrolment
As we confront this crisis, it's crucial to recognize the broader implications and acknowledge the indispensable role of GPs in our healthcare system. By addressing the systemic challenges they encounter, we can guarantee not only an ample number of GPs contributing to the system but also ensure access to high-quality healthcare for all Australians.
The Australian federal government is now attempting to convince GPs that voluntary patient enrolment (VPE) is a beneficial initiative. VPE, also known as MyMedicare, has emerged as a contentious issue within the medical profession. Advocated by the Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA), VPE is promising to be a blended funding model focused on chronic care. However, for many GPs, this proposal evokes apprehensions reminiscent of the capitation model employed by the National Health Service (NHS) in the United Kingdom.
Under the VPE system, GPs would receive payments from the government based on the number of patients enrolled in their practice. While proponents argue that this approach promotes continuity of care, incentivises comprehensive healthcare services, improves the patient-doctor relationship, enhances care coordination, and funding distribution. Those who do not support the proposed changes are apprehensive about the potential consequences, including a further loss of autonomy and a decline in reimbursement rates for fee-for-service consultations. Doctors express concerns about potential interference in the doctor-patient relationship by health bureaucrats, who already exert significant influence over the profession. Moreover, they worry about increased administrative burdens, worsening patient outcomes, decreased income for GPs, and the risk of government overreach.
The Growing Demand For GPs
In Australia, the measurement of data regarding the movement of GPs in and out of their careers lacks proper organisation. The most recent comprehensive data available is from the RACGP’s Health of the Nation 2022 report. According to this report, one-quarter of surveyed GPs expressed intentions to retire within the next five years, marking a notable increase from 18% reported in 2021. Translated into numbers, this equates to over 7500 GPs. Such trends exacerbate existing concerns regarding workforce projections, which anticipate a deficit of 11,517 GPs by 2032.
Factors such as unsustainable workloads, bureaucratic pressures, and burnout within the profession contribute significantly to early retirements. The repercussions of this exodus are felt keenly in general practice clinics, where a growing number of practice owners struggle with sourcing and retaining GPs, a challenge magnified by the increasing demand for GP services.
Deloitte's estimations suggest a significant growth in demand for GPs between 2021 and 2032, projected at 38.5%. Specifically, demand in major cities is anticipated to surge by 47.0%, while regional and remote areas are expected to see a more modest increase of 17.6% over the same period. As demand outpaces supply, a widening shortfall of Full-Time Equivalent (FTE) GPs is predicted, reaching 11,392 (FTE) by 2032, representing 27.9% of the workforce.
This predicament is not unique to Australia but also affects countries like the UK and Germany. Patients bear the brunt of the GP workforce crisis, experiencing a notable decline in their overall satisfaction with general practice services.
What Can We Do
Addressing the GP crisis requires proactive measures that acknowledge and respond to the challenges faced by the general practice sector. As a medical and health network deeply engaged with both GPs and patients, we recognise the urgent need for action in three key areas:
- Enhancing the Appeal of General Practice Careers: Job satisfaction for GPs hinges on their ability to meet professional standards while addressing the genuine needs of patients. This entails prioritising patient care over meeting incentivised targets that may not align with patient needs. To make general practice more attractive, we must create environments where GPs have the time and resources to deliver high-quality care without undue administrative burdens or unrealistic expectations.
- Recognising the Role of the Expert Generalist: The 'expert generalist' role is central to effective primary care. GPs must have sustainable work schedules that allow them to provide comprehensive clinical support, not only to their patients but also to their colleagues. Training programs should equip practitioners with the diverse skill set necessary for managing the broad spectrum of cases encountered in general practice. Preserving the integrity of the 'expert generalist' role is paramount in any restructuring of the primary care workforce.
This entails addressing the gap in emergency care. By providing additional training to GPs, they can effectively manage more complex procedures, thereby easing the strain on hospitals and specialists.
- Empowering GPs with Practice Autonomy: GPs should have greater autonomy in managing their practices. This includes flexibility in organisational structures, decision-making processes, and resource allocation. Empowering GPs to tailor their practice models to suit the unique needs of their patient populations fosters innovation and responsiveness to local healthcare demands.
By addressing these critical areas, we can work towards revitalising general practice, ensuring better patient access, safety, and overall healthcare experiences. It is imperative that we act swiftly and decisively to safeguard the future of primary care.