The $8.5 billion health pledge doctors say will disadvantage women

Doctors warn that a significant election pledge from both major parties to increase Medicare payments for doctors could disadvantage women because it disproportionately boosts funding for “standard” length appointments.

Under the $8.5 billion plan unveiled by the Albanese government, and matched by the opposition, appointments at city bulk-billing practices that last 20 to 39 minutes will attract a 38 per cent funding boost, compared to 62 per cent for shorter standard appointments.

Dr Michael Wright, the president of the Royal Australian College of General Practitioners, said women needed to be able to spend more time with their GP and not be disadvantaged by it.Credit: Dion Georgopoulos

Royal Australian College of General Practitioners president Dr Michael Wright said the current Medicare system provided higher rates of funding for doctors conducting multiple short consults at the expense of spending more time with patients.

“These low Medicare rebates for longer consultations are a real barrier for women getting the time they need with their GP,” he said. “These proposals might actually worsen it.”

The comments come as this masthead launches its investigation into medical misogyny, informed by the experiences of almost 2000 Australian women, more than 1700 of whom reported they felt dismissed or ignored when seeking healthcare. A similar number said they were misdiagnosed.

This masthead has joined health experts, advocates and peak doctors groups calling on the major parties to commit to redress the inherent bias in Medicare by better funding longer GP consultations. The longer appointments would allow doctors to better address women’s common health issues such as menopause and pelvic pain, as well as complex presentations and chronic diseases in men.

The Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP) are calling on the federal government to commit about an additional $1 billion in annual funding to allow for longer GP consultations.

The federal government spent $9 billion in 2023-2024 on GP attendances through Medicare benefits.

Australian women are greater users of GP appointments than men. This trend is starker for longer appointments – women attended 59 per cent of short consults, according to Medicare data from 2023-2024, but 63 per cent of consults lasting at least 40 or 45 minutes.

Sylvia Freedman, the co-founder of endometriosis charity Endo Active, said longer appointments were essential for people with complex health conditions.

“Conditions like endo are whole-of-body conditions, which means you could have three, four or five various symptoms and things impacting your immune system that are seemingly unrelated but that are all part of the same picture. That’s complex. That takes time. You might have to get four different referrals in that appointment,” Freedman said.

As the gap widens between Medicare rebates and the cost of delivering care, some GP clinics are requesting that patients only discuss one issue during a standard consultation.

“We need to [redesign] the system … so that we can actually have the time to listen and to be curious,” said experienced Melbourne GP Associate Professor Ines Rio.

AMA president Danielle McMullen.

The AMA wants an overhaul of the Medicare rebate structure so that a greater range of longer consultations is funded. The current rebate for an appointment that lasts six minutes is the same as a consult that lasts 19 minutes.

AMA president Dr Danielle McMullen said Medicare was introduced 40 years ago when “people went to the GP with one or two quite simple problems”.

“Now we’ve got the situation where we’ve got more chronic disease, an ageing population, more mental healthcare issues, and, in fact, even for really relatively simple problems, healthcare has gotten more complicated.”

The RACGP is calling for a 40 per cent boost to rebates for consults over 20 and 40 minutes, estimating its plan will prevent about 4000 emergency department presentations and 11,000 hospitalisations annually.

In February, the Albanese government pledged more than $573 million to new women’s health initiatives, including cheaper contraceptives and new rebates for menopause assessments at the GP. The announcement was welcomed by health groups and matched by the Coalition.

Medical misogyny has been a focus of Albanese’s Assistant Health Minister, Ged Kearney, who in 2023 asked members of the National Women’s Health Advisory Council to update the National Women’s Health Strategy to tackle the phenomenon. The government also commissioned a gender review of Medicare items.

“We’ve listened to women and have delivered historic reforms,” Kearney said.

Shadow health spokesperson Anne Ruston said the women’s stories uncovered by this masthead were “extremely distressing”.

As well as pledging to match Labor’s women’s health funding package, the Coalition has promised a review to address gaps in Medicare funding of women-specific items.

In 2024, the average time GPs spent with patients was 18.7 minutes, according to RACGP data. However, female GPs, who were far more likely to be consulted on women’s health and mental health issues, spent longer – an average of 20.2 minutes with their patients, compared to 16.7 minutes for male GPs.

Dr Samantha Saling, a GP with a private-billing practice in east Sydney, said her standard appointment was 20 minutes. This would be considered a “long” consultation under the current Medicare system.

“My new patients appointments are much longer. I find that this is the minimum amount of time it takes to hear a patient’s story, work through the nitty-gritty issues, and often there are multiple things that are brought up in a consult,” she said.

“They say 80 per cent of your diagnosis is in your history and your history comes from conversation. You need that time to get to the core of what the patient’s agenda is and what medical issues are causing that. And then, of course, your psychosocial issues and factors as well.”

Dr Jillann Farmer, a former United Nations medical director and a rural GP with additional specialist training, said improved GP rebate funding alone would not solve “medical misogyny”, which was pervasive.

“Everyone, not just doctors and not just men, is socialised to believe that women exaggerate, that they should not be believed, that they are manipulative, emotional, stupid or hormone-mad,” she said.

She agreed, though, that there was an enormous need to better fund doctors who treat patients with complex presentations, in women’s health and across the board.

“So a doctor who sees a 90-year-old man with multiple comorbidities, and gives him 45 minutes, because he needs it – that doctor deserves to be paid as much as the doctor who sees five patients in those 45 minutes – perhaps even more, because the GP who successfully manages complexity saves the healthcare system an enormous amount of money,” Farmer said.

“We also need to remember that there is a really terrible GP shortage, especially in the regions. Those GPs that we do have are working absolutely flat out – no longer having the luxury of appointments held for “urgent” same day appointments… If it can help keep doctors in the workforce, then that would help.”

With Emily Kaine

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