A GP of 20 years, Charlotte Hespe fears for the future of her profession. “Under these incentives, what junior doctor would want to come and work in primary care?” she asked.
“You’d be better off going and working as a barista than as an expert GP.”
Dr Hespe, who practises in the Sydney suburb of Glebe, is one of many doctors angry at the Medicare changes announced by Prime Minister Tony Abbott last week.
The package includes a $5 cut to the Medicare rebate paid for GP visits by non-concessional patients, which doctors can recoup through an “optional” fee, a freeze on other Medicare rebates until July 2018, and a smaller rebate for consultations of less than 10 minutes.
While initially welcomed as a measure to combat the “six-minute medicine” practised by profit-driven medical centres who churn through patients quickly to maximise income, the change to rebates for short visits has proven to be the most unpopular element of the package among GPs.
Under the new arrangements, the rebate for a six- to nine-minute appointment will drop from $37.05 to $16.95 for a concessional patient or just $11.95 for a non-concessional patient, a figure Dr Hespe describes as “insulting”.
She says the change creates an incentive for patients to see less experienced doctors who might take longer to perform a task, therefore attracting a higher rebate.
“Once you get expertise, you do something more efficiently,” Dr Hespe said. “I might do in nine minutes what my junior registrar might take 18 minutes to do.”
But in such a scenario, a patient without concessions would only be able to claim $11.95 from Medicare for seeing Dr Hespe, compared with $32.05 for seeing her more junior colleague.
Helena Britt, the director of the Family Medicine Research Centre at the University of Sydney, predicted the changes would encourage doctors to extend some appointments to qualify for a higher rebate.
“I certainly think the eight to nine minute ones will be extended to 10. From an economic viewpoint, that’s the only sensible thing to do,” Associate Professor Britt said.
But she said to remain accessible to their patients, doctors might need to cut other appointments short. “They may find savings by reducing their six- and seven-minute consultations to five minutes,” she said.
According to data collected by Associate Professor Britt and her colleagues for the Bettering the Evaluation and Care of Health program, about 10 per cent of GP visits are six minutes or less, and 26 per cent of visits are nine minutes or less.
The Royal Australian College of General Practitioners on Thursday hardened its opposition to the Medicare changes after consulting with its members, describing the proposals as “unacceptable” and calling on the government to “urgently reassess” its plans.
RACGP president Frank Jones initially said the change to the rebate for short visits had “some merit”, but on Thursday said the change would have “an immediate negative effect”.
“If the government is serious about addressing ‘six-minute medicine’ it should target the small minority of GPs practising ‘throughput medicine’ rather than making a poor broad-brushed decision that affects all GPs,” Dr Jones said.
The evolution of the RACGP’s position follows a similar shift by the Australian Medical Association, whose president, Brian Owler likened the changes to a “wrecking ball” in an email to the association’s GP members on Wednesday.
Meanwhile, the Consumers Health Forum and the Public Health Association of Australia have predicted the changes would deter people with chronic illness, many of whom would not qualify for concessions, to delay critical visits.
Health Minister Peter Dutton said the cost of Medicare had “ballooned” in the past decade, growing from $8 billion to $20 billion, and would “collapse under its own weight” unless changes were made.
“The government has proposed sensible measures to both improve the quality of patient care and make Medicare sustainable so that future Australians can continue to have access to affordable, world-class healthcare,” he said.