Seven-minute scripts: How top cannabis company encourages quick consults with doctor bonuses

Australia’s biggest medicinal cannabis company is offering bonuses to doctors to maximise the number of patients they treat, as recruitment ads show it expects medics to spend as little as seven minutes with new patients.

Cannabis firm Montu employs more than 100 doctors, who the company says are typically allocated 10 minutes a patient.

But an advertisement in May, posted by a recruitment firm, said they could earn $30 a script issued for “each seven- to 10-minute consultation”, which could include initial assessments and repeat scripts.

An email from a recruitment firm shows them telling a doctor the eight roles advertised would be working for Montu. A Montu spokeswoman denied the company produced the ad.

Another Montu job ad posted on LinkedIn this week offers a base salary and a “bonus per consult”.

Australia’s health laws prohibit doctors from accepting bonuses that induce them to change patient treatments. Doctors who work in medicinal cannabis say it is impossible to provide proper treatment to a patient in seven to 10 minutes.

Launched in 2019, Montu’s revenue was $103,000 in its first financial year. In the 2024 financial year, Montu expects revenue of $255 million. The company has no physical medical clinics or offices, with all nurse and doctor consultations done via telehealth.

Named the nation’s top start-up by LinkedIn this year, critics question whether Montu is more tech firm than healthcare provider. LinkedIn noted the company’s most common job was software engineer.

The company boasts in a current job ad that its “hyper-growth” is the result of an “integrated, end-to-end ecosystem” to sell cannabis. The company stocks its own brands of cannabis, has telehealth clinic Alternaleaf and distribution business Leafio.

A typical 10-gram “tub” of cannabis shipped by Montu.Credit: Reddit

Montu’s marketing has landed it in frequent trouble with the Therapeutic Goods Administration, which alleges in a Federal Court case that Montu has illegally flouted medical advertising guidelines. Montu says it has not breached ad laws.

On Friday, Montu’s online Alternaleaf clinic advertised on Instagram cut-rate $19 consultations for new patients seeking medicinal cannabis. Asked if this was appropriate, a TGA spokesman declined to comment because of the “ongoing [court] proceeding against Montu and Alternaleaf”.

Legalised in 2016, medicinal cannabis took off during the pandemic when both patients and recreational users realised they could access the drug legally using telehealth. The market is now worth about $500 million in annual sales.

Montu streamlines doctors’ work by using telehealth nurses to screen patients for medicinal cannabis eligibility. Often, the nurse will recommend the treatment. So effective is this method that doctors rarely see a patient to whom they do not prescribe cannabis.

Two doctors who recently worked for Montu’s Alternaleaf telehealth clinic talked to this masthead about their roles but asked to speak anonymously to protect future employment elsewhere.

“You are incentivised to make money from prescribing,” said one doctor. Montu put the greatest value on getting new patients onto its system, he said.

“They realised that if you got [patients] in cheaply, the money to be made is not from the doctor’s consult but from them buying the product – which is actually quite expensive.” A typical 10-gram tub of cannabis flower from Montu’s brands is about $130 to $150.

“There’s also some pretty slick marketing from cannabis companies that doesn’t always reflect the reality of their products.”

Dr Joel Wren

A second doctor said he joined Montu after burning out in a high-stress hospital role. He said Montu’s “fantastic” technical support made his job easier and stress-free. “They make their money by me signing scripts, so they’ve done everything they can to make the time between me starting the day and the end of the day to maximise the number of scripts I can sign and the subsequent sales of the product.”

He said high-volume cannabis companies made it difficult for doctors trying to do the right thing when prescribing. “It becomes this really hard space to negotiate with that patient because they haven’t had proper medical conversations before – they’ve just been given access to weed.”

A Montu spokeswoman said the company only issued scripts to patients with responsible treatment plans. “There are no definitive guidelines on the prescription of medical cannabis in Australia. Patient treatment is determined by doctors based on the patient’s needs in accordance with their clinical judgment, professional responsibilities and regulatory guidelines.”

Patient safety was crucial, the spokeswoman said, and doctors followed state-based requirements on lawful prescription of medical cannabis.

Asked about payments to doctors per patient, she said this was confidential. “Doctors are paid for their time – whether or not the patient attends the consultation, and whether or not the doctor determines that they are eligible and suitable for a prescription for medical cannabis.

“We value and respect our doctors, their time is the backbone to everything that we do: providing quality care for our patients.”

She said Montu’s doctors were scheduled for patient consultations in 10-minute blocks, but some longer appointments lasted up to 30 minutes “where clinically appropriate”.

Adelaide GP Joel Wren has regularly prescribed medicinal cannabis for the past five years. Recognised as an expert in the field, he sees patients in person and via telehealth.

While he wouldn’t comment directly on Montu, he said a 15-minute GP consult was acceptable, “depending on the patient”. “If it’s a single issue, and you’re looking at a couple of prescriptions and maybe a blood pressure check or a discussion around cholesterol, four patients an hour is manageable.”

He said issues “like anxiety... or other more complicated, mental health issues, can make it really tricky to formulate a comprehensive, safe treatment plan in 15 minutes”. It was “getting harder” to deliver good patient outcomes because so many patients had complex needs and chronic diseases.

He said his initial medicinal cannabis consultations with new patients were always at 30 minutes. While telehealth was useful, doctors needed to see patients in person for some issues, Wren said.

Patients often asked for specific cannabis products because of the unfettered access many telehealth clinics offered, Wren said. “A lot of patients are well-informed, so I don’t necessarily have a problem with it ... But there’s also some pretty slick marketing from cannabis companies that doesn’t always reflect the reality of their products.”

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