By Angus Thomson and Daniel Lo Surdo
Doctors have warned that a plan to let patients bypass their GP to get a specialist referral could lead to a US-style health system and longer waits for specialities in high demand, reigniting a turf war with advocates who say it would save patients time and money and lead to better health outcomes.
At present, patients are ineligible for a Medicare rebate for many specialist appointments unless they have a referral from a GP.
Rovie Peralta supports changes to referral pathways, saying it makes sense to allow her son Leon’s physiotherapist to refer him to other specialists. Credit: Jessica Hromas
Under a proposed shake-up made public last week by the federal government, patients would be able to get a referral from other medical professionals, including physiotherapists and midwives, without needing to return to their doctor.
The recommendation is one of 18 in a year-long review of the rules governing healthcare workers. Health Minister Mark Butler said many of the recommendations were common sense, and the government would consider each on its merits.
“If a GP has referred someone to a psychologist for mental health treatment, and that psychologist with all of their training takes a view that the patient needs to see a psychiatrist, do they really have to go back to the GP?” he told ABC radio last week. “There are all sorts of inefficiencies that mean that a lot of precious time of our GPs is being soaked up through these … back-and-forth of referrals.”
The idea has the support of Sydney mother Rovie Peralta, who has been frustrated by the back-and-forth and months-long waits for specialist appointments. Her 10-year-old son, Leon, has had a number of medical complications – the latest being a broken ankle.
Peralta, who balances her job in pharmaceutical sales with making social media content about her experience migrating from the Philippines, said that allowing her son’s physiotherapist to make decisions about further care would save time and money – if the rule change did not result in increased demand to see a specialist.
Under the plan, direct referral pathways would allow:
- Physiotherapists, chiropractors and osteopaths to refer to orthopaedic surgeons
- Psychologists to refer to psychiatrists
- Midwives to refer to psychiatrists, anaesthetists and obstetric physicians
- Remote area nurses to refer to any medical specialist (according to need and context)
“To actually be able to get that specialist appointment as quickly as possible, I think it will be better for a lot of parents and patients,” Peralta said.
Royal Australian College of General Practitioners president Dr Nicole Higgins said the skill of general practice was knowing when not to make a referral, and bypassing that expertise would result in an influx of patients seeking specialist care.
“That consumer-driven demand will … move us to that US-style system where there, they don’t have GPs, where people can go to whichever health professionals they wish,” she said. “The concern is, in the Australian system, that’s going to blow out those waiting times even more.”
Dr Omar Khorshid, an orthopaedic surgeon and former Australian Medical Association president, said he didn’t expect a “massive flood” of referrals from chiropractors or physiotherapists but was concerned the change would further erode the role of the GP as a co-ordinator of care.
“[Visiting the GP] doesn’t always meet the expectations of patients, but the way to fix that is not to further undermine general practice, it’s actually to invest in it.”
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