Desperate times as GP shortage puts local health at risk

Our GP shortage has reached crisis point and it’s tipped to worsen. We meet the north shore doctors on the frontline to find out why.

It’s been a long, hard winter for local GPs – and many are feeling the pressure. The combination of Covid-19, a bad flu season and rising practice costs has made what is already a tough job even more challenging.

“In the last few weeks, we have had barely enough people to cover the floor because we have had doctors sick from Covid or the flu,” says Dr Amy Ho, clinical lead general practitioner at Our Medical Crows Nest.

“It’s quite difficult to get doctors on board. We have to ask GPs that are not rostered on that day to come in. At one stage we had one doctor working 10 days straight to cover the others. That’s not healthy. We are lucky that we can pool our resources to cover that, but if the pressure keeps up like this, I don’t know how long we can manage to keep going.”

With the critical GP shortage Australia is facing, relief is unlikely to come anytime soon. In Cornerstone Health’s General Practitioner Workforce Report 2022, Deloitte Access Economics forecasts demand for GP services will grow by 47 per cent in Australia’s major cities by 2032, while the number of full-time equivalent GPs is projected to fall by 15 per cent.

Dr Amy Ho at Our Medical Crows Nest. Picture: Julian Andrews

According to The Royal Australian College of General Practitioners, the proportion of final-year students listing general practice as their first preference specialty fell to 15 per cent in 2019. In decades past, up to half of all recent medical graduates would enrol in general practice.

Many GPs believe the Medicare repayment rate is not enough to cover the rising costs of running a practice. According to the Australian GP Alliance, health inflation rose 5 per cent per year from 2010 to 2019, but Medicare rebates only increased by 0.5 per cent per year.

As a result, more and more practices are changing from a bulk-billing model, in which doctors accept the Medicare benefit as full payment for their service so patients are not out of pocket, to mixed or private billing.

While being a doctor has traditionally been considered a wealthy profession, general practice is not as lucrative as many other specialties.

“A lot of young people don’t find it attractive,” Dr Ho says. “It’s hard work and not that well paid.

“There’s been hardly any increase in what we are paid now to what we were paid 30 years ago, but our costs like indemnity and staff wages have increased a lot. We are still paid $39 for a consult, which is supposed to be 20 minutes.

Working as a GP is less attractive to graduates compared to previous decades. Picture: Julian Andrews

“When you add those things up, you can see why a lot of people would say they’d rather be a cleaner than a GP because it’s not really financially viable to be in a small practice.”

The ageing workforce is another major issue the industry is facing.

“The average GP is already in their 60s because not many young people are taking on this specialty, but a lot of them found it really hard with Covid, so a lot of them are taking on early retirement,” Dr Ho says.

Dr Ho, who is also on the Australian Medical Association’s Council of General Practice, says there are no easy answers.

“The AMA had a meeting a couple of months ago to address the issue,” she says. “At the end of the day we still haven’t found a solution.”

Dr Jonathan Phan, co-chief executive of Nuvo Health, says the organisation is struggling to find more GPs for its centres at Neutral Bay, Lane Cove, Chatswood and Gordon. The company has advertised on LinkedIn, Seek, The Royal Australian College of General Practitioners’ website, local Facebook pages and in Australian Doctor magazine.

“We have reached out to our network of GPs to see if any colleagues or friends are interested to join a modern and innovative team,” Dr Phan says. “But the number of graduates coming out is getting smaller and smaller, and practices are becoming more and more competitive in terms of what they offer GPs to come on board.”

Dr Jonathan Phan is searching for GPs. Picture: Julian Andrews

He says some practices might offer terms that aren’t ideal, such as no overtime or no weekend work. “We want to operate a practice that’s open as many hours as possible,” he says.

Dr Phan says there has been a seismic shift towards mixed or private billing in the past few months, thanks to increased costs. All of Nuvo Health’s practices are mixed billing.

“This year there has only been a 1.6 per cent increase in the Medicare rebate,” he says. “It essentially becomes unsustainable for practices to bulk bill. Every time you do a consult in which you bulk bill it’s a loss-making exercise.

“Ultimately, doctors have an altruistic approach to care for patients and focus on quality care and we don’t like to talk about money, but at the end of the day we go to work to support our families.

“I hope that the community understands that we are doing everything we can to continue to support them.”

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Despite its challenges, Dr Ho says being a GP is extremely rewarding.

“I’m really into continuity of care and I’ve seen many of my patients for years and years, and now I’m seeing their kids,” she says.

“They’re like family. You know about their miscarriages, their divorces, everything. It’s like helping a family friend through their life.

“I also love the variety. People will walk in wanting a cream and you open a can of worms and 20 minutes later you’re doing a mental health plan.”