I saw the post on Reddit and thought to share because I find it interesting.
The Numbers behind Why GP's Can Not Continue to Bulk Bill
Comments
Amen to that. Just saw my regular patient today who had coughing for years saw multiple specialists who couldn't diagnose this issue. Guess who eventually diagnosed her? Me. I only made $70 for the consult after spending 30mins with her. Piss poor imo I will be moving to private billing in the future. Medicare rebates suck.
It really depends on where you live. For example, in Sydney, I can barely afford a decent house on GP's pay. This is why I am sub-specialising so I can charge more. If I lived in a rural area where the house I am living in costs $500k I could live on a bulk-billing GP's pay sure but there are many other downsides. You could be oncall 24/7 and you are unable to take leave due to inadequate locum cover etc. You might be earning more money but your effective income is not high. Now I have a mortgage for $2 million so I can't afford to bulk bill people without dropping my quality of care. Bulk billing also results in more audits occurring from Medicare so you are at increased risk of having to pay the Government back but it also causes undue stress. There are so many item numbers now which are a pain in the arse for me to remember when all I want to do is just do medicine and get paid well. People often don't understand the concept of compounding interest so every year the Medicare rebate hasn't kept up with inflation means it's compounded the following year. It has occurred enough now that the logarithmic upward trend is starting to be quite apparent.
In addition, bulk-billing patients tend to be more entitled than patients paying a gap. The patients I've advised to not come back have all been bulk-billing patients. $90 per hour is actually low pay in my opinion for someone who has studied 11+ years and who continues to be required to study excessively to provide the best care. I pay my tutors $60-70 per hour and these tutors are university-level students. You also don't get paid super, annual leave, sick leave etc. so the effective salary of a GP is about 15% less than what is quoted.
From a business point of view, Medicare has continued to cut costs with certain item numbers for example ECGs now only pay about $17. They used to pay about $45. ECG dots cost ~$6-12 for each patient, not including nursing time and software costs which is probably another $15 per episode. GPs get paid 60-70% of that so each clinic only gets 30-40%. That's $6-7 per episode of ECG paid to the clinic when it costs $20-30. The clinic will be losing money each time they perform an ECG. It's the equivalent of opening a hot dog stand and selling drinks for $1 when costs are $2. So blame the Government for not funding your care.
Also, I understand this is targeting a specific audience of people who love bargains so of course they might have an issue with this. Furthermore, I've seen plenty of patients with allergies (my sub-specialty) given the wrong advice from bulk-billing doctors. You usually get what you pay for. On average I'd say bulk billing doctors are going to be of inferior quality either due to lack of skill or the time constraints of their consults because they don't spend the time getting to the root of the problem. Why would you pay a painter $150 per hour over someone who is $50 per hour? I've diagnosed many missed issues because I took the time to work through the patient's complaint rather than just prescribe medication and tell the patient to fudge off. For example, I've diagnosed a large B cell lymphoma in a patient presenting with just bloating, sacroiliitis in a young patient presenting with lower back pain for a few months (the radiologist missed the sacroiliitis on the x-ray which I reviewed), hypogonadism that was missed by other doctors who told him to just eat more food (he came in with gynecomastia) all because I took the time to do a proper exam and noted his feminine features, Von Willebrand's disease in a patient presenting with chronic iron deficiency with no other bleeding sequelae just to name a few.
I don't understand why people are flaming doctors when it's your Government that has (profanity) this up by continually restricting the amount of money they put into Medicare. Also, hospitals are continuously double dipping into Medicare to fund state operations which patients have no idea about. Pathology companies and big pharma are always lobbying for more coverage by Medicare and the PBS which always happens but no one bats an eye at their profit margins. With the trend that is happening you will be paying a lot more for the GPs in the future there is no doubt about that due to the lack of interest from medical students there will be a supply and demand equilibrium that will be reached.
People need to stop saying I can't barely afford a decent house on GP pay and the likes of it.
Since it will sound like everyone else below a GP would be dead meat and doesn't deserve a decent home. Which would be the rest of the 95% of the adult population.Why can't I tell the truth? I don't have generational wealth and I have to support my extended family monetarily as well. I am a migrant and worked my ass off to get into medicine thinking it would be enough to live a comfortable life. My family never went on holidays let alone go to the cinemas on the weekends. Housing affordability and healthcare affordability is not my problem to deal with. It's the Government's responsibility and they have failed the Australian population time and time again.
Who here has gone to a bulk-billed Dr and remotely got any form of health advice concerning their symptoms? I'd hazard none.
Why, because most bulk-billed Drs are nothing but Prescription Dispensers pulling in thousands a week to see you for < 5 mins.
These days these doctors are there to do 2 things:
1.) Prescribe AB
2.) Prescribe birth control pills
Most of them come from overseas (no need to specify) with some BS degree that they've converted and sat some 30min exam here to confirm it, the Medicare industry is a shamble and a cashcow.I once visited one of these BS Drs and spoke about my issue, Dr was uninterested and typing away. then he proceeds to tell me ill prescribe you some AB. cool.
Then I was like, yes and 1 more thing, I have this back problem… and he cut me off and said to come back for a 2nd visit to discuss this.But honestly thank god for these Bulk Bill GPs right…
Why do we need to visit and pay for a GP. for simple things.. like prescriptions, medical certs and all other simple stuff.
eg. winter , early spring every one gets cold / flu, typical healthy person visit doctor will be told viral infection. take fluid and rest.. the end.. and if you need an MC you get it.
Unless you have a history of health issues that's what you will be told.
The idea of allowing nurses and pharmacists for prescriptions renewal etc would be great.
Go for it. There are plenty out there so what's the problem. You can easily get a medical certificate for $17 online. I never went to a doctor ever for a cold or flu in my entire life. I also wonder what will happen if you got a pneumonia or urosepsis when pharmacists and nurses don't have the clinical acumen to diagnose.
I once saw a patient with a meniscal tear in his knee get prescribed flucloxacillin by a nurse practitioner because they had no idea what to do. Another time a nurse practitioner prescribed antihistamines for an obvious non allergic rash (but I have to admit many GPs do this too usually the bulk billing ones.)
$17 online vs bulk bill? Oh I forgot you are a doctor. so $17 is pocket change…
Quick thoughts (Context I'm a GP charging $96 for 15m roughly AMA rates, BB the vulnerable)
Agree GPs shouldn't cry poor, but at the same time just charge what we're worth and let the government explain to the electorate why the rebates are not keeping up.
What's appropriate? It's a comparison game. Lawyers and accountants charge almost double my hourly rate. Physician specialist friends of mine charge double in private practice what I charge per hour. Dermatologist friend charges almost Quadruple. His tax bill is still much higher than my pretax income.
People who pay me for my time are invariably more grateful than those who don't. Conversely the BB patients are ones who require more care, are sometimes less grateful.
Unfortunately leads to the Inverse Care Law in action, where less people want to provide healthcare to the populations that actually need it the most. I try do my bit but damn its exhausting trying to help those who are ungrateful.
then you should identify the ungrateful and tell them to GTFO. Tell your receptionist never book these types of people and they can go elsewhere leaving you with patients you prefer to treat and giving you a much better experience. I'm sure there's no shortage of patients for you.Entitlement culture needs to stop.
Don't worry I do. I just got rid of 2 patients in the last 2 weeks. Happier to not deal with these kinds of people. Instead of trying to clarify the issue they start doctor bashing like those on this forum. No wonder less and less people want to do this kind of work.
Its not comparable. Which lawyer or accountant charges $400/hr? I know doctorate consultant engineers only charge $250/hr.
So I went through 10 years of training which would be equivalent if not more. Many GPs are happy to accept $150 per hour but I won't be. I think $250 per hour is reasonable.
It's considerably more, and a doctorate isn't a requirement to work as an engineer, fellowship is if you want to become a GP. But even from a university perspective, most professions have a far lower training burden than Medicine does anyway.
Law, Accounting, Engineering all run on standard semesters, usually 12-13 weeks. So let's say 104 weeks of university study over 4 years (accounting can be done in 3 years though). All 3 degrees can be compelted completely online, and even on campus could be packed into 2 or 3 days.
Medicine runs on extended semesters, usually 17-20 weeks but sometimes even longer. Over 5 years this is 170-200 weeks of university study, which includes thousands of hours of unpaid placements. Nothing can be completed online and it's 5 days per week attendance.It's a ludicrous suggestion that medical doctors aren't significantly more educated compared to any other professional.
@downbythecreek: Totally agree. Don't forget all the extra training we endure to do better for our patients. Did I need to do all my certificates? Nope but I chose to so I can provide more specialised care and I think I deserve to charge more for it.
Any semi specialist lawyer or specialist accountant. Slater and Gordon charges something like $600p/h for their senior about 5 years back. (Junior was around 400). A conveyancer cheapest is like $800 for minimal time from the lawyer and mostly paralegal work.
Are GPs specialist? I dont think so…. I have relatives who are nurses who are more knowledgeable and give better advice than some of the GPs ive seen.
@mrvaluepack: GPs are specialists.
Take your point though that some GPs are not very good. Either due to laziness, rushing, or due to years of practising low value care that they've actually forgotten how to be a good doctor.
In some ways less bulk billing is a good thing so patients actually demand more from GPs and the "bad" ones go out of business. To be honest I've seen "bad" GPs practising 5 minute or less medicine outearn me significantly.
Edit: no problem with 5 minute medicine if that's appropriate in the scenario - just not when you consistently see 10 patients an hour for 6 hours then finish up early to avoid coming to Medicares attention.
@mrvaluepack: GPs are considered specialists, they require specialist registration with AHPRA. Nurses cannot compare to doctors in any way or form. Their training is not in diagnostics but rather care of the patient. ATAR requirements are as low as 60 which shows you the difference in intelligence levels required. I am not saying intelligence is everything but academic performance requirements are significantly increased for medicine. I've seen plenty of wrong diagnoses by "nurse practitioners" at urgent care centres to laugh at how the Government thinks they can function as GPs. Do orthopaedic nurse practitioners know more about slabs than me? Yes, they do but if you start to go outside their domain of speciality they will have absolutely no idea what to do.
I am also not saying there aren't bad GPs. I personally would not have recommended at least 50% of GPs when I was working in Western Sydney. Higher quality GPs tend to congregate towards the city areas which is the same thing for most other specialists.
My "mates-rate" fee for property law is $300 an hour cash. If I want to secure a quick contract I know will lead to a pile of add-on's and extra work at full rate down the line, I'll quote $350 an hour. For conveyancing it's $400 an hour. For the more meaty or complex work, starting fees are $600 an hour.
That money is peanuts compared to what the barristers and the big end of town charge for work if you need to go to court. It's like $800 an hour per legal rep (unless they are Jr's) and a $5K a day fee on top of that. Costs get wild real fast at that level.
Recently swapped to a new practise and he asked why I was changing when my previous doctor is well regarded and a personal friend of his.
Pretty much just because they no longer bulk bill… lolHe actually responded by saying people travel to see my previous doctor and reiterated how great he was, like he didn't understand why I didn't want to pay $123 just for a repeat prescription signing off.
Yeh not we aren't falling into that trap. $12 extra when there has been a short fall of $60. Good joke.
Funny you should say that because on November 1st the MBS/DVA updates were broken. New incentives showed the old incentives, $0 or outright refused to process the claim. It took Medicare a few days to resolve.
I never thought jv or OzB would convince me that specialising to become a GP/Rural Generalist would be a bad idea. Thanks for heads up everyone.
If you're basing it purely off financials then you got the wrong impression as rural generalists can earn loads of money. Lifestyle can be tough though for those places where you earn bucketloads.
Not purely on the financials (I do want to be able to support my family and buy a house which costs way too much) but just the general attitude of both the people here and politicians having unfortunately the same opinions. I've been told be a majority of GPs I've had to carefully consider whether to go into General Practice.
Had a chat with one of my state and federal MPs about the state of primary healthcare and they basically just said something to the effect that Doctors are basically just public servants (would be nice if that were true with all these stories of unpaid side work, we'd be able to unionise too :( )
Went on a Radiology rotation and they basically just said as all the previous comments have shown that General Practice is a political football and if I want to go out and go gods work good on me but if I just want to practice medicine and not have medicare trying to squeeze money out of you then go into a speciality.
I still don't know what specialty I want to go into but I'd like to go into one where the years of stress and missed opportunity cost of basically delaying the proper start of my adult life are recognised and not have to deal with the public flaming me for having a mortgage.
Reply isn’t a negative to you btw, just the whole situation in general, appreciate the insights🙂
General practice is a speciality with fellowship exams like any other. Don't make an argument when you are ignorant of basic facts. GPs are paid significantly less because the government imports labour from overseas and forces these doctors into areas of shortage. It is a basic market principle. This is not the case with any other speciality because they simply block any attempts to accept overseas quals of other doctors. Health outcomes of patients improve when someone has a regular GP. But domestic doctors are looking elsewhere and have done for years. The GPs that are left are now rightly charging gaps and don't accept the base insurance as full payment. It was never intended to be full payment anyway. If you want to still see a BB doctor who probably isn't even a specialist GP and get your 5min of time…good luck with your health in the long term!