More people are avoiding visits to their GP and seeking medical help from hospital emergency departments because they can’t keep up with expensive consultations at their local doctor’s office, according to a report in The Daily Telegraph on Monday.
From July, the Medicare rebate for a standard GP visit will increase by 55 cents to $37.60, a raise that many doctors aren’t happy with. The paper reported that more GPs are providing customers with shorter consultations and refusing to deal with more than one problem per visit, resulting in patients being forced to pay for numerous visits.
AMA (NSW) President Professor Brad Frankum told Starts at 60 that over-60s in particular are feeling the impact of shorter consultations and multiple visits on a regular basis.
“The shorter consultations are more likely to impact on elderly patients because they are more likely to have a number of chronic conditions and more healthcare needs that must be met,” he said. “The problem is that the Medicare rebate on its own is not enough to allow doctors to hire staff, pay rent, pay for a practice’s utility bills, and provide high quality care that patients deserve.”
He said the 55-cent rise on the Medicare levy wasn’t enough to help GPs make ends meet and that some have no choice but to squeeze pennies out of patients.
“It certainly doesn’t represent a transformation of general practice, as the Health Minister Greg Hunt claims,” Professor Frankum said. “This isn’t just about doctors’ incomes. It’s about our ability to pay for all the expenses of a medical practice including staff, equipment, utilities, and so on. The Medicare rebate freeze also froze our ability to keep up with the rising costs of running a practice.”
He added that with the Medicare rebate remaining low, it is up to doctors who bulk bill to make tricky choices about the patients they see and how quickly they see them.
“If a doctor needs to see more patients to keep his or her practice afloat financially, is that more wrong than if that same doctor has to close their practice because they can’t afford to pay necessary staff or bills to keep it open?”
The government announced it was lifting the rebate freeze in the 2017 Budget, with a staggered plan over two years that included extra funding for the PBS, mental health services and medical research. While the rebate lift was welcome news for doctors, Labor argued patients would feel the sting of rising consultation fees.
The freeze was lifted from bulk billing incentives for GP consultations from 1 July 2017, and indexations for consultations, which make up the vast bulk of general practice revenue, will kick off from 1 July, 2018.
Despite the AMA’s protestations, not all doctors feel hard done by. Brisbane-based GP Dr James Moran told Starts at 60 that while GPs who own their own practices would have strong opinions about the rebate, it’s still possible for doctors to earn a decent income without unnecessarily seeing patients multiple times.
“I don’t think from a financial point of view you need to do that to survive,” he explained. “I don’t think it’s related to that. I’m happy with the amount of money I earn. I think it’s a good amount and is reflective of the amount of work I put in, considering everything going on in the world, but I can definitely see how GPs who have been around for quite a while would be upset and feeling like they’re not being listened to by the government.”
He said GPs should only be making patients return for multiple appointments if their health concerns aren’t complex, noting that nurses are usually required to perform other observations and assessments to make the visit with the GP run as smoothly as possible.
“Certainly, if someone came in with something really minor or to have their blood pressure checked or a prescription printed and then they brought up another thing, I don’t see how you wouldn’t talk about that,” Dr Moran said. “But if you came in with a complex issue and the second thing they wanted to talk about was also going to require extensive history taking, we’re always told at medical school that it’s important not to try and rush through things. If you feel like you had to rush through it, that’s when you’d make another appointment to go through it again.”
He advised people to avoid confusion by being upfront when booking an appointment with a GP, but said they shouldn’t feel restricted by what they bring up in a consultation.
“Giving as much heads up as you can is helpful, but I’d hate for patients to think that’s the only thing they can bring up in the consult,” he said.
Prof Frankum said anyone worried they’re not receiving proper care from their GP, or wish to seek a second opinion, can contact the Health Care Complaints Commission.
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