Family doctors bowing out as multi-doctor medical centres and super-clinics grow

ONLY one in 10 GPs is a traditional family doctor, with the vast majority of patients now seen by overworked medicos in medical centres.

ONLY one in 10 GPs is a traditional family doctor, with the vast majority of patients now seen by overworked medicos in medical centres and super-clinics.

The change is threatening Australians' lifelong relationship with their family GPs, many of whom have retired and left their patients in the hands of multi-doctor practices.

The proportion of independent GPs who run a solo practice has almost halved across the country in the past 14 years, and many independent doctors fear patients will suffer impersonal, "fast food" health care at corporate clinics.

According to the University of Sydney's 2011-12 Bettering the Evaluation and Care of Health study program of general practice data, practices that have five to nine doctors jumped from 38.6 per cent the previous year to 42.3 per cent.

At the same time the proportion of solo practices have dropped to 10.7 per cent, down from 17.9 per cent in 1998-99. Doctors Action head Dr Adrian Sheen warned the older system of family GPs would soon become extinct.

"It's not under threat, it's dying out," Dr Sheen said.

"The future has been made so uncertain that young doctors are turned off from working in small practices by the federal government's promotion of large medical centres and super-clinics."

The high cost of running a single practice was also a factor, as well as GPs wanting a more flexible workplace.

Independent GPs said NSW residents were losing out on personalised care.

Dr Donald McKenzie, who has worked in a small Hornsby practice for 40 years, said family GPs provided a more thorough service.

"In our clinic, we're dealing with third and fourth-generation patients, and that is continuity of care," he said.

"But in the super-clinics, it is like fast food ... a patient comes in and tells you what they want, a certificate or some antibiotics, and they get it. There is pressure on the doctors in these clinics to push patients through quickly."

It's a concern echoed by doctors who have worked in the corporate clinics.

Last month, medical industry journal Australian Doctor surveyed 323 doctors, 40 per cent of whom now work for the four main corporate health services, to gauge their attitudes to the corporates.

Responding to the survey, one ex-corporate doctor wrote: "The no-appointment system of some practices ... is not beneficial for patient care, especially when patients are not necessarily followed up by the same doctor.

"Bulk billing only encourages shorter, less comprehensive consultations, which encourages patients to go to these practices for their easy, quick problems - sick notes, repeat prescriptions.

"This is unfair to doctors and practices dealing with the more complex and less financially rewarding problems."

A spokesman for Health Minister Tanya Plibersek said the government had invested heavily in providing doctors with incentives to bulk bill.

Dr Mark Robinson, a former NSW locum who worked for a major corporate clinic for five years, said there was pressure on doctors at the large medical centres to deal with a huge workload but maintained there had never been any directive to speed up consultations.

``At times there were a lot of people in the waiting room because of the no-appointment system ... but I was never told to rush patients,'' he said.

``There were doctors who could see large numbers of patients and I could sometimes see 60 patients in a 12-hour day, so there was that pressure due to the volume in the waiting room.

It could compromise patient care with some doctors but ``I never rushed a patient''.

The average time a GP spends in consultation with a patient during a consultation is 15 minutes, which has not changed in a decade.

``The AMA does not want to see the family doctor-patient relationship change, no matter what the setting,'' he said.

``If you go into a place and just take a number, then that will diminish that relationship, but management needs to encourage that relationship to be built between the doctor and the patient.''

Australian Babich Medicos director Chris Babich has been in the medical brokerage industry for 30 years and said more buyers are looking for practices which can house a number of doctors.

``You have to consider the size of practice to generate a profit because of the cost and that's why solo practices are so difficult to shift,'' Mr Babich said.

Primary Health Care group operates 56 large-scale GP services around the country.

Its boss Ed Bateman said the company monitored a large centre, with 20 doctors, for one year and discovered the average consultation time GPs spent with patients was 14 minutes and 18 seconds.

He said it was smaller practices which had less time to spend with patients because they were inundated with paperwork and didn't have extra staff to support GPs, as larger practices do.

Australian Medical Association president Dr Steve Hambleton said it was clear the days of the sole general practitioner were numbered but it was important doctors maintained a good relationship with patients.

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Benefits of a trusted friend

SEBREENA Cronin is so reliant on her GP Donald McKenzie she thinks of him as a treasured member of her family.

Caring for four children, including four-month-old triplets, is a herculean task which Ms Cronin says is made that much easier by having her doctor guide her through the rough patches.

"All my life I've had a family GP and I see the benefits of someone knowing your history as opposed to seeing someone different all the time," she said.

When she and her husband moved to the area five years ago, Dr McKenzie helped the couple with fertility issues, guiding them through the roller coaster of IVF. Four babies later, the good doctor sees the whole family.

"What is important to me is trust, it's really important to have trust in your doctor and getting a good end result that is about your long term wellbeing," Ms Cronin said.

"As a family unit he understands how we work, I went with my partner for his cholesterol test and we talked about lifestyle changes and how that might work within the whole family."

The triplets, born eight weeks premature also have some issues that she trusts Dr McKenzie to understand.

"I want a doctor that takes into account the children's long term wellbeing, not just handing over some drugs to fix a short term problem."

A good doctor can tell by the way you look what is going on Ms Cronin said.

"I'm an upbeat bubbly person and one time he said 'you look tired', he noticed I looked different because we have that history," she said.

"And the other day, it was 4.30 and I had an appointment for the triplets and it was mayhem here and they rang me and said 'do you realise you missed an appointment' and I looked at my watch and thought 'oh no' and they said 'don't worry, come in at 5.30' and they squeezed me in."

Ms Cronin has used bulk-billing super clinics in the past but only as a last resort when she knows what she wants and can't get in to her usual doctor.

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The care is old-fashioned

DOCTOR Heather McIntyre has been a family GP for 30 years, treating patients the "old-fashioned way".

But the 60-year-old is moving to the Southern Highlands and she hoped she would have little trouble finding someone to take over her Surry Hills practice.

So far no such luck.

Dr McIntyre admits her personal touch - which included home visits and trips to nursing homes - and the concept of solo practices are a "dying breed".

"There's more continuity and it's more personal in a smaller practice and some patients really like that," Dr McIntyre said.

"I'm more distressed for my patients as I haven't been able to find a doctor to take over and I find it quite sad after 30 years to be leaving," she said.

She understands why doctors are choosing larger practices where they have more flexible hours and can take holidays without inconveniencing patients.

Reanna Price has been her patient since 2009 and said Dr McIntyre helped her through her pregnancy.

Her son Addison, aged two, has also been her patient since birth.

Ms Price said she is upset Dr McIntyre is no longer going to be their doctor and fears losing the "personal touch" that family GPs give.

"She gives us her time whereas the bigger medical centres tend to only allocate a certain amount of time and ship you out the door," Ms Price, 34, said.

"She's always taken the time to respond to whatever was happening - all your worries about your child, she's always there for that, giving it a personal touch.

"I did try going to other clinics and I would prefer to go to her any day. I'm now looking for another private doctor that has the same kind of service that she did. It's really sad that there's not another doctor taking her place," she said.

Dr McIntyre will see her last patient in Surry Hills on December 31.

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A chronic complaint against workers

DOCTORS and nurses top the list of medical professions attracting the most mandatory complaints in NSW, a report by a health watchdog reveals.

While the number of registered practitioners rose last financial year, so too did the number of mandatory notifications, in which instances of perceived misconduct must be passed on to the regulator.

The Australian Health Practitioner Regulation Agency released its annual report for 2011-12 this month.

The agency reported a 40 per cent rise on last year's figures, which did not include NSW.With NSW added for the first time this year - 186 complaints - there were 775 notifications nationwide.

The most common complaints in NSW concerned professional standards (48 per cent), impairment (37 per cent) and sexual misconduct (12 per cent). Alcohol and drugs accounted for only about 3 per cent of mandatory complaints.

An agency spokeswoman said the cause of the increase from outside NSW was unknown because the rates varied from state to state and for different professions. 

There were 7594 other complaints raised nationally, with 2978 made in NSW - most against doctors. No action was taken in 2158 instances but four doctors, two nurses and an osteopath had their registrations cancelled. About 50 more cases were referred to the Health Care Complaints Commission. 

More than 4000 professionals were found to have a criminal record with 404 cases classed as having a potential impact on registration. Action was taken in only nine cases: three applications were refused and six approved with conditions.