GPs quitting over bulk billing stress

Only one in eight GPs are bulk billing all their patients as doctors look to quit the profession. See the full details of the Health of the Nation report.

Only one in eight GPs are bulk billing all their patients as stressed doctors fear for the viability of their businesses and look to quit the profession.

A major survey of general practitioners has found the proportion who bulk bill all patients halved – from 24 per cent in 2022 to just 12 per cent in 2023.

Four in 10 GPs are now charging their patients over $85 for a standard consultation. The $41.40 Medicare rebate covers less than half of this.

The Royal Australian College of General Practitioner’s Health of the Nation report, to be launched on Wednesday, surveyed over 2000 GPs and reveals one in three are considering quitting the profession in the next five years.

Just 10 per cent of GPs are interested in becoming a practice owner, and four out of five current owners are concerned about the viability of their practice because Medicare rebates have not kept up with inflation for decades.

Only one in eight GPs are bulk billing all their patients as stressed doctors fear for the viability of their businesses and look to quit the profession. Picture: iStock

On top of this, state governments have started charging GP practices payroll tax which has resulted in enormous retrospective tax bills.

To make matters worse the number of medical graduates training to be GPs has plunged, the report found.

In 2022 over 225 fewer medical graduates signed up to GP training, and one in three GPs is now trained overseas.

Separate analysis has predicted by 2031 there will be a shortfall of more than 10,600 GPs.

This is adding to the pressure on the GPs still in the system who are seeing more patients with more complex conditions and the average time spent in a typical consultation has risen to over 18 minutes.

The annual survey of over 2000 doctors was taken before the Australian Medical Association recommended GPs lift their charges to $102 per consultation on November 1, and before the government tripled Medicare bulk billing incentives for some patients on the same date.

RACGP President Dr Nicole Higgins said urgent action was needed to boost the general practice workforce across Australia.

“We are facing a looming shortfall of GPs, and we need to do much more to attract and retain this essential workforce,” she said.

RACGP President Dr Nicole Higgins said urgent action was needed to boost the general practice workforce across Australia. Picture: Supplied

The RACGP is calling on the government to introduce an incentive payment in the first six months of community general practice training, as well as study leave, and paid parental leave for GPs in training.

Australia’s 39,000 GPs are seeing more patients than ever and four in ten (38 per cent) of consultations involve mental health.

Interestingly, the survey found the most satisfied GPs were those who earned a salary.

Eighty-one per cent of GPs who received a salary in 2022 and 2023 reported moderate to high job satisfaction, versus only 66 per cent of GPs who are remunerated by proportion of billings (the most common way of earning a living as a GP).

Dr Higgins said general practice was the most cost effective way of treating patients.

“When a person goes to a hospital emergency department, it costs the government and taxpayers, on average, over $600 – and much more if they’re admitted. Whereas it costs only $80 for 20–40 minutes with their GP,” she said.

DUBBO CLINIC LOSES MONEY IN BULK BILLING

Tanya Forster, the CEO of a leading Dubbo medical practice, said her business made a $10 loss every time it bulk billed a patient – even after the government tripled incentives.

“When we bulk bill patients our practice pays $10 to see that patient,” she said.

This is why the clinic will not cease privately billing patients even though Medicare rebates increased for concession card holders and children on November 1, she said.

To deliver a consultation with a doctor involves paying rent, power bills, medical insurance premiums, wages for nurses and receptionists, as well as costs for medical supplies and running a computer system and software - all of which have risen with inflation, Ms Forster said.

In addition the GP gets a set percentage of the fee charged, she said.

Tanya Forster said her practice won't return to bulk billing even though Medicare incentives have tripled. Picture: Supplied

The practice, which charges patients $85 to see a GP, is under pressure after three other medical practices in Dubbo closed in the last 12 months and another major not-for-profit healthcare provider withdrew from NSW – leaving five or six practices with no-one to run them.

Lots of doctors had also left the area after changes to incentives meant they got drawn to work in Western Sydney rather than the bush.

“At the moment in Dubbo every practice has their books closed. So if you move to town or if you don’t currently have a regular GP, you cannot get one. So there’s an incredible pressure on the system,” Ms Forster said.

Ms Forster, who is married to a farmer, said she wanted to provide a successful health care business in her community but it was becoming more and more difficult.

“I’m a local central west girl. I grew up in this community and I now raise a family here. I want to make sure that my grandma can access healthcare today and that my kids can access it for many years to come,” she said.

STATE-SPECIFIC BULK BILLING RATES

For all states, government data which shows the percentage of services bulk billed rather than the percentage of patients bulk billed shows a dramatic decline.

Most of the people who see a GP are older and are eligible for bulk billing incentives and they receive more services than healthy families who see a GP less often.

NSW

Australia-wide Medicare data shows GP bulk billing rates plunged from 83.4 per cent in September 2022 to 76.5 per cent in September 2023.

In NSW GP bulk billing rates fell 5.3 per cent from 86.6 per cent to 81.3 per cent. They are lowest in the Hunter/New England area where only 69.8 per cent of people are bulk billed.

VIC

Australia-wide Medicare data shows GP bulk billing rates plunged from 83.4 per cent in September 2022 to 76.5 per cent in September 2023.

In Victoria GP bulk billing rates declined 6.3 per cent from 83.8 per cent to 77.5 per cent. They are lowest in the Murray region where only 69.7 per cent of patients are bulk billed.

QLD

Australia-wide Medicare data shows GP bulk billing rates plunged from 83.4 per cent in September 2022 to 76.5 per cent in September 2023.

In Queensland GP bulk billing rates declined 7.6 per cent from 82.2 per cent to 74.6 per cent. They are lowest in North Brisbane where just 67.8 per cent of people are bulk billed.

SA

Australia wide Medicare data shows GP bulk billing rates plunged from 83.4 per cent in September 2022 to 76.5 per cent in September 2023.

In South Australia GP bulk billing rates declined 9.5 per cent from 81.2 per cent to 71.7 per cent. They are lowest in Country SA where only 70.9 per cent of patients are bulk billed.

TAS

Australia wide Medicare data shows GP bulk billing rates plunged from 83.4 per cent in September 2022 to 76.5 per cent in September 2023.

In Tasmania GP bulk billing rates fell 5.8 per cent from 72.6 per cent to 66.8 per cent.

Originally published as GPs quitting over bulk billing stress