Am I dumb or are we led by dumb “experts”?

5th February 2023, Dr Chee L Khoo

I have to write this post. I really must. All of you know that Medicare is totally non-functional. It was meant to make healthcare affordable and accessible. It is definitely neither and has been like this for years. More specifically, general practice is hurting real bad. In particular, your GP is really really hurting.

According to the RACGP’s estimates, within 3-5 years, we will be about 11,000 GPs short nationally. That represents one third of the GP workforce. Because your GP is so poorly remunerated for the last 25 years, the number of medical graduates who want to become a GP has dropped from 60 out of 100 to only 19 out of 100. You would have noticed that the number of GPs retiring is rapidly increasing. You will be used to seeing GPs working into their late 70s or 80 years old but we now seeing GPs retiring soon after 60 years old. In South Western Sydney, one practice closes every 40 days. Because the remuneration is such a pittance and have been so for so long, GPs have to see more patients to make ends meet. The average GPs work 12-14 hour days.

Thus, over the next few years, it will be harder and harder to get to see a GP and the cost of seeing one will skyrocket if you can get to see one. So, what do the experts think is the solution?

Well, let’s looking at what we already know from the above:

  • GPs are by and large burnt out because of years of neglect by the system. By the way, we worked extremely hard during the pandemic years to keep the country safe. GPs vaccinated 70% of the population. The majority of GPs braved the Covid-19 infections and continue to look after the community. We continue to see patients during the entire pandemic. None of us went hiding. We put both our own health and our family’s health on the line. Our rebates were frozen during that time and we got a $1.60 rebate increase after the freeze. We did not even get a thank you from the government. Alright, horn for your doctor or bang some pots and pans. What about a rebate increase that is at least on par with inflation?
  • GPs have to see increasing number of patients because it is just not viable to work just 8 hours a day 5 days a week. Oh, if you see too many patients, you are deemed to be overservicing. Really? Do I really want to see more patients? You can’t do too many mental health plans. You cannot spend too long with patients who has complex diseases. You cannot order too many blood tests either.
  • Despite all that, most of you will agree that the quality of general practice in Australia is of a very high standard. Australia has one of the most vibrant general practice in the world. We have one of the most cost effective general practice in the world. Your GP can manage quite a wide range of complex medical conditions albeit sometimes, with the help of the specialist. More often than not, GPs work as a team with the specialist. We are up there in quality. No one is actually disputing that fact.
  • We already work well together with the allied health professionals like your physiotherapy, your chiropractor or your dietitian or exercise physiologist. We are the gatekeepers of the allied health so that no everyone need to see an allied health. We are tasked with managing the national health budget to decide on clinical grounds who needs allied health services.

After 7 months of “high level” meetings amongst the stake holders including health department (state and federal), AMA, RACGP, treasury and health economists and oodles of bureaucrats, what they are proposing are:

  • Sorry, no details yet – that will come in May 2023. Really? I thought this is an emergency crisis in Medicare. How many more patients will die in the meantime? How many more GPs will be lost between now and then. Once gone, they are gone. Retired GPs don’t normally come back!
  • It is unlikely that GPs remuneration will increase even come May 2023 “because increasing rebates will not improve patient outcomes”. That’s the famous cliche. Are we struggling with patient outcomes here? Are we even talking about poor patient outcomes by GPs? Or are we talking about your GP’s health. I thought Mark Butler, the federal health minister agree that GPs are in big trouble. I thought we should be looking at slowing down the loss of GPs from burnout and from throwing the towel in after waiting for the situation to improve over the last 25 years. I thought improving GP remuneration may attract more graduates to become GPs and even if we do that soon (real soon), it will take another 3-5 years to get them on the ground. Perhaps, improving GP remuneration might stop some from abandoning universal bulk billing. Perhaps, it might slow down the exodus of GPs from their practice. No, looks like, they are still talking about patient outcomes. If paying a higher rebate doesn’t improve outcomes, we won’t be increasing the rebate. Geez.
  • They want to put in more allied health into general practice so that patient can bypass the GP which will save patients time. Doesn’t that mean a further reduction in GP incomes? They are also missing something fundamental. When patients have symptoms, they first need the GP to make the diagnosis and discuss with the patient what the treatment options are. They are proposing to let the patient make the diagnosis tehmselves and then choose who should treat them before the diagnosis is made? Really clever.
  • At least 50% of GPs are either solo GPs or GPs in a small group. Where are we going to find the room to house an allied health professional? Is the proposed plan stand to benefit the 50% of practices which are big medical centres and once again, your traditional GPs in smaller clinics are left out. We all know that everything under one roof doesn’t always work better.

Am I missing something? Am I the only dumb one here? Or are our “experts” missing the point here? I understand the objective in all health policies has always been about patient outcomes but they have definitely forgotten about the health of the doctor providing the care. Would you like your airline pilot to be in absolutely good health? Would you like your anaesthetist to be awake and on the ball? Would you like your surgeon to have had a good night sleep last night? Would you like your GPs to be adequately remunerated, healthy and well and have time to get updated?