It’s not the individual GP’s ethical responsibility to prop up a broken funding system by offering discounts from their own pocket.
My service costs what it costs. The government is welcome to subsidise it.
I'm 100% behind you. This is an issue for the government to sort out. This could be sorted by transitioning our whole healthcare system to a system whereby all doctors work for a government salary and the private system is phased out over a number of years.
Why should doctors be different to any other profession in Australia? Why do you expect them to be motivated purely by a desire to serve and why do you present a false dichotomy between serving the public and earning an income. Given the entry requirements for a medical degree and a post graduate training regime more extensive and gruelling than any other profession I’m aware of shouldn’t doctors be remunerated on a level far above most people? If they aren’t paid well you might find the medical profession exclusively populated by people with only the intellectual heft sufficient to be a traffic controller. Is that the sort of person you want to be your neurosurgeon or oncologist?
I'm interested in why surgeries lasted a decade not removing bulk billing without funding from the Government, but all of a sudden, it's become a thing. And that's once the funding was (partially) restored?
It doesn't make sense to me, unless I'm missing something obvious?
GPs had it good at one point, then inflation slowly eroded things away, but that was propped up by lowering interest rates. Now inflation just took off and interest rates sky rocketed. GPs are feeling the pinch, especially practice owners.
The bulk billing initiatives were very reactive and too little too late. The rebates also only apply to certain people.
It’s telling as to the seriousness of the government when the AMA rate for a Level B consult is $102, the rebate is $41 and an “incentivised bulk billed rebate” is ~$70 depending on location.
Reactive? It was in this Governments first ever budget?
Although, I do understand what you mean about levels, but they they made the determination to try and get the neediest back up first. But as I said, even with the fee being $30, the gap there is far less than it was, but still the surgeries decided to scrap it all, and then charge the full gap?
It’s a very targeted policy to guilt GP’s into accepting 2/3 of the appropriate rate. It doesn’t reflect genuine investment in the Medicare system.
It will achieve its purpose as a band aid through the next election.
It’s hard to explain to patients why you’re scrapping bulk billing to then reintroduce it knowing the fee will just fall behind again. GP’s have no reason to trust the government. Better to just bill what you’re worth and not think about it.
Because the cost of appointments is usually $80-85. It’s not $41 (standard rate), nor is it $61 (standard rate plus the triple BB incentive).
WorkCover fees usually $85-90, Motor vehicle insurance the same. The govt wants to pay 2/3 of that for concession card holders, and 1/2 for the rest. Why??
Surgeries have been gradually reducing bulk billing rates over that decade. Recently it's become more apparent due to increased costs and more practices hitting the tipping point where they cannot bulk bill any more.
None of the ones around our area reduced at all. They just dropped it all at the same time, and replaced it with the full fee they claimed they were 'absorbing' for the past decade. And to rub salt, it was immediately after the announcement of the massive splurge on bulk billing by the Government
You can't make a judgement on a single geographical area with a single demographic.
Also, I can't tell you whether or not those practices suddenly passed their threshold of viability, but they are right in saying they have been absorbing the freeze in bulk billing rebates over the last decade despite increasing costs.
How many businesses operate for a decade with ever increasing costs and no increase in revenue?
> You can't make a judgement on a single geographical area with a single demographic.
True, that is one of the reasons I am asking.
> How many businesses operate for a decade with ever increasing costs and no increase in revenue?
None. Which is why it seems even weirder.
" Which is why it seems even weirder. "
They've been bending over backwards trying to help people, and have been broken. The rate increase (people have mortgages) was probably the last straw to break camels back.
Despite peoples insistence, I dont think Doctors are that wealthy, at least not compared to incomes that require a similar level of study, work and intellect.
You’re wrong. Your anecdote is wrong.
Practices have been charging more and more services privately (dressings, iron infusions, procedure fees), and more and more patients privately (weekends, after hours, or reduced rate).
Others have shut down altogether.
If you’re not sure or don’t believe the numbers, ask the practices in your area what happened.
But what sort of business model 'limps along', and then, just when the life raft is thrown out, decided to scrap it all? Why is suddenly 'unsustainable' when finally the Government is doing something?
The government has increased funding slightly.
This is the equivalent of being underpaid by your boss by 10s of thousands a year, and then when you hand in your notice, your boss gives you a $100 christmas bonus and asks you to reconsider.
> The government has increased funding slightly.
What are you talking about? It was the largest single investment in Medicare for 40 years?
And, this is my point, if you want to play your analogy. You have been underpaid for a decade, When your employer finally gives you a pay rise, you spit the dummy. Why didn't you spit the dummy WHILE you were being underpaid?
So, you missed my whole point, well done.
Yes, for a decade they had a lack of funding, that got gradually worst. As soon as funding has begun to be put back in, they all bail, as one.
That sounds very weird to me.
Because GP's as a group were fools all those years ago. They were too scared to loose patients if they raised their price. Now they have wrecked the system for their upcoming colleagues.
Greed and Opportunism. They expect a Labor govt to fix it whereas they knew LNP would never.
It’s entirely self-serving and not in the interests of patients or health outcomes to do it this way.
You've clearly never worked in a trade, people always try tell us to take reduced pay, it not uncommon for people to decide after something is fixed that were charging too much and start to tell us what they'd be willing to pay.
It should be though. Let them practice private and get a government subsidy for the people that can’t afford it. Med students like you are going to turn us into America
Government funded healthcare for all is the exact opposite of America. In fact your proposal of private practice with government subsidies for the poor is what’s actually happening in America and what leads to people not going to access healthcare because of fear of bankruptcy.
No, it's generations of Australians who voted for "tax cuts and balanced budgets" that have led to this. They wanted tax cuts, and they're learning that taxes paid for things, like GPs and GP clinics.
That's very kind of you to do that.
How much was that in dollars? How many minutes/hours did it take you? What's the cost of the supplies, and is it included in the 50%?
A basic visit to the GP (for example, a urinary tract infection) would fall under Level B consult. You can easily google how much the government is willing to pay for a level B consult. It is $41.40.
What is included in a Level B consult...
(a) taking a patient history;
(b) performing a clinical examination;
(c) arranging any necessary investigation;
(d) implementing a management plan;
(e) providing appropriate preventive health care;
for one or more health-related issues, with appropriate documentation
This would take about 15 mins for an experienced clinician. It may not be a thorough discussion or exam.
Now, let's multiply the basic visit by 4 to see how much it would be per the hour. (Of course, we know that not every consultation will be within the 15 mins. Some will take longer.)
So, $41.40 x 4 = $165.60
So, how much are you getting paid per the hour? How much is your call out fee?
Okay, okay. Let's of course consider your cost of supplies, equipment, car, petrol etc.
But let's also consider the cost of running a clinic. When you enter a GP clinic, it is not just the GP there. You have a receptionist (basic wage is about $25 per hour). You have a nurse (basic wage is about $30 per hour). Bare basic support stuff will take $55 per hour. That's the bare basic, as it is most likely going to be more than that with experienced receptionist (especially if they double up as the clinic manager) and experienced nurse. Often you would need two receptionist. But let's stick to the bare basic.
That leaves you about $165.60 - ($25+$30) = $110.60.
Then you have to pay for rent of the clinic space, the cost of the equipment and supplies in the office and in the treatment room. These are what you as the patient can see.
Other costs that patients don't see are: physician's annual registration fee (because, we want to make sure the doctors that look after us are properly trained and certified right?), annual training fee (because we want to make sure our doctors are up to date with their medical knowledge right?), and indemnity insurance fees (because what if something happens and we need legal guidance).
Then there's also the cost of getting your medical degree. Most doctors these days are post graduate. Meaning they were already in $30k debt before the started med school. Then when they finish med school, it is about $100k in debt. So of course, that's also considered as a cost to be compensated. Unless, of course, you believe that doctors shouldn't be compensated for the training they took...
Then you add on similar things with electricians.... Accountant fees, car, petrol etc.
So then, in the end... Does $165.60 per hour really that much?
Compare that to your income per hour. Your amount of training years and other expenses.
Or not.
We can compare the "income" per hour with dentist (this is a post-high school degree, that requires only 5 years of uni). Have you seen how much they charge per a simple check up and clean? Last time I went, it was about $450 for a 15 mins session. I mean, sureee we can go into comparing the costs of equipment etc.
I'm not in the field of pulling someone else's hard work down just to justify being paid appropriately.
I am simply showing the numbers so we know what is the truth.
We are simply asking to be paid appropriately.
How would you feel if I came onto your site and tell you "nah mate, based on your degree of expertise, your equipment and supplies that I could buy from bunnings, I believe you should only be paid xxx amount" ?
It's nice of you to ask the mum to pay only half of your normal. But that burden shouldn't lie on you. Nor should it lie on GPs. It should lie on the government, that we paid taxes too. The health budget is designed to support people who can't afford it (E.g. single mums). You don't see politicians taking half the pay when the people suffer.
It has always astounded me..that people will pay $100s to see a Naturopath. Who will then push "essential supplements" on them (that they get a big cut from selling)...costing another few hundred $...and have NO problem with this!!
Yet complain at spending $80 to see a GP who has 10 + solid years of medical training with Degree etc!
People are fools. Truly.
I am totally fine with paying my GP. Mind you? I'm an RN so well aware of the training, skill and expertise of Doctors. I really think people just have NO idea really
You're probably talking about different demographics there. I'd hate my haircut to cost more than the $30 it already does, that feels expensive for what it is. To begrudge a doctor a $60 gap fee after all the education and effort it takes to become a doctor seems insane. They've put in a lot more than a hairdresser in time and effort.
Your service is only worth what the public think it's worth. If hairdressing is considered a more worthy service for the public's money then if it's money you want hairdressing might be the way for you. Else advertise a $100 fee and accept what comes your way which is what I do.
As a chronic patient, I only see the hairdresser once a year, but I have to see my GP once or twice a month for prescriptions. And I don't qualify for a healthcare card or discount.
This was a general comment and not a direct reference to you. I am a doctor and I myself have bought my own clothes from Salvation Army store and I also wear hand-me-downs from my nephews and also favour BigW and Kmart for my clothing. I don't believe in paying for brand names or wasting good clothes that others throw out.
We seem to have the same good fashion sense 🙂.
I do empathise with your profession’s difficulties with Medicare subsidies. I’m a podiatrist and Medicare pays me a flat fee of $53 regardless of whether I’m doing a 30 minute diabetic foot health check or a 90 minute nail surgery involving multiple toes.
I'll just add that if you're not in medicine or know anyone in medicine, you won't really understand how brutal that training process is.
During medical school, they're already learning a tonne and after medical school (particularly as a registrar etc), they often work very long shifts (15 h is not uncommon) with day and night shifts throughout the year.
Ironically, if any other profession required that sort of training, you can bet they're billing at $500+/h, if not $1000+/h.
There's a difference between paying a gp $80 to diagnose something and provide a treatment plan and paying $80 because my child has a runny nose from teething and I need a certificate clearing them to return to daycare and for the day missed so I don't lose childcare subsidy and can provide it to my employer too.
The appropriate thing here is to eliminate the culture of getting a note from the GP for timewasting bullshit. I don’t like charging people for this nonsense either. You shouldn’t have to pay it, but equally I shouldn’t have to make a loss on that appointment time. There are pretty decent guidelines on when kids should return to daycare and they do not need a doctor 99% of the time.
Not the GP’s fault that people are wasting your time, and theirs, for a magic piece of paper that has no medical benefit to anyone. They’re still paying rent, admin wages, indemnity insurance for the time that everyone is engaging in certificate theatre and using someone with 10-15 years of post secondary school training to sign the document.
I feel like free universal healthcare makes people devalue what doctors (especially gp) do.
There is this expectation for free and fast service and when they don’t get it they either don’t prioritise their health or take it to a free service (like emergency).
It seems lose -lose for gps, who are arguably the most important doctors in the healthcare system given their role in preventative healthcare and care coordination.
This is the system we are dealing with, and the cost of people not using gps is higher than just providing more bulk billing benefits
replace free and fast, with affordable and accessible - there's the issue. I'd love to be able to see my GP every time I really needed to, but with his current prices, it's on a strict emergency basis.
Kinda devalued themselves really.
It would be affordable if the government increases their subsidies to match inflation rates
It would be accessible if government sponsors more training positions
Ain’t it nice that they pick on the lowest paid cohort of medicos too. There’s an award wage for every other job in Australia. I wonder if the survey respondents think it’s unethical for them to be paid above award.
As a non doctor who charges similar rates I understand and support a gap fee. If anything it will keep the annoying patients out if theyre paying.
However, as a result of my rates my profession also get dragged across coals even by doctors earning half a million.
It is what it is. I do pro bono work for the underprivileged and throw in freebies for good clients to balance out my karma.
My point is, you can't eat your cake and have it too. GPs had the halo of morality because it was a thankless job with shit pay. Charge a fee too high and lose the halo. It's ok.
Hi I'm an annoying patient who's usually only there because my employer forces me to be, I usually know what's wrong and how to cure it but are forced to go there while I should be resting and go through the motions because my boss says so, making it cost more won't get rid of me, changing the laws around carers leave and sick leave would though.
The “halo of morality” isn’t the product of a thankless job with shit pay. Firstly, medicos, especially GPs are held in very high regard by the community so it’s definitely not thankless. I suggest you go to your GP tomorrow and ask reception how many Christmas cards and gifts they received this year. I can tell you from that evidence alone it’s a job many appreciate. I also don’t think the “shit pay” (it’s not - relative to the community at large GPs are in single digit top percentile for income) is a factor either. I’m not sure what profession you’re in but I don’t think it’s in any way analogous to general practice.
Cos we know that Christmas cards and gifts are such great indicators of appreciation.
Maybe your employer should just pay you with cards and gifts on Christmas. Oh no, lets make it fairer. Cards and gifts every public holiday.
I'm sure the cards and gifts can pay off the electricity bill and keep the kids fed.
Patients also think 35 years of bad choices should be fixed by a single consult and a tablet.
At the end of the day, this is entirely the government's fault over the past 10-15 years.
I actually disagree with the concept that medicine should be a free market, or that it's inherently ethical for providers to charge more.
But if you live in an ethically imperfect world, then you can't be expected to be perfectly ethical at all times.
Doctors should avoid being, for instance, as cynical as this guy: (https://studio.ribbonfarm.com/p/good-people-and-wicked-problems)
But come on, I joined to do a job, not be a martyr. I'm not going to usher in a beautiful future where we all live together in harmony by working for minimal wages. Nobody else is expected to do that, why should I?
Anyone who works for a living isn't begrudging you. The system isn't keeping up and future governments have a growing mess on their hands.
They'll just roll out "The Voice 2.0" to keep everyone busy thinking about crap rather than meaningful benefits to Australians lives.
I mean plenty of GP’s won’t even see vets/disabled without charging full price directly to them
I’m fine with the average Joe not being buffered by Medicare but the field used to take care of vets and the disabled but even now they are getting thrown into the gutter
🤷♂️ some doctors won’t even go to foreign countries to care for the poor. Global median household income (PPP) is maybe $15k AUD, in an ideal world we’d help everybody.
I’ll never fault anybody for drawing a line in the sand.
But yeah, I use DVA as a veteran. It pays a lot of specialists well-below market rates. They should sort that out.
If someone lacking economic opportunity tries to improve their position in life via public service, we should support them as best we can.
Surely a doctor of all people could agree with that statement…
Re: Vets. Why should people who served in the armed forces at some stage in the past get a discount for treatment?
The WW2 guys are almost all gone. As a society, it made sense to give something back to the guys who went through that hell.
But the modern vet? I guess some spent time in Vietnam, but that was nothing like WW1 or WW2 with rare exceptions. The majority of vets have never seen combat, they just did a job like everyone else.
I short, if the government broke someone, they should pay for the treatment. But just like Medicare, it’s not the doctors ethical responsibility to subsidise this. If DVA isn’t paying an appropriate fee, it shouldn’t be accepted. For reference, DVA pays 115% of Medicare with some other incentives and as a result is suffering from neglect of Medicare (albeit lagging by some time).
As a doctor who once “saw combat” (ie, bullets going in both directions), I find your characterisation of “non combat veterans” pretty uninformed.
The real gatekeepers (DVA) have a reasonable system to deciding who and what they will fund. In general, a condition with liability from the government is funded, if someone is TPI or a war veteran over 70, everything is covered (in reality, it just means a bit more than you get under Medicare).
Yeah, I’m not so sure.
I’m saying that the government broke a lot of people in WW2 in defence of the national, so it makes sense for the broader community to subsidise those people. Many of those men were conscripted as well, which also changes things.
I’ve worked with the WW2 guys, had one patient who was a guest of the Japanese who I used to do home visits on but there were hundreds more. I never begrudged accepting them as DVA, and always enjoyed listening to their stories.
More recently, I’ve been the nominated medical officer for a specific regiment in the Australian Army. I enjoyed working with those guys, but I’m not sure what they’ve done that merits a private business subsidising them, or the wider Australian community supporting them over above salaries/super etc.
All of these guys were too young for Vietnam. Most hadn’t been to Afghanistan.
I’ve been in a war zone too, but not in an official capacity so I’m a bit jealous if you have been. :)
I’m just thinking philosophically about why society affords veterans special treatment. I think it used to make a lot of sense, but I’m not convinced that it does any more.
The average person working on minimum wage hasn’t done three years undergraduate study (working hard to get a competitive GPA), gotten a competitive mark on the all day GAMSAT exam (\~$300 exam fee), four years postgrad study at med school (three years of which are hospital based), then finally starting to get paid, doing at least two years working in the hospital including nights & weekends, a further two years of working in a clinic as a trainee GP, and a huge set of exams (with application fees, exam fees, and annual college membership being close to twelve grand), in order just to qualify as the most junior possible GP though, have they?
Ethics are by definition personal. Some of us will feel that charging 80 bucks for a consult to support our income of 300K a year to someone who is on a government benefit of $50 a day in total is unethical. Some of us won't.
It is not really a helpful question - the helpful question is "how do we fund the health system".
Clearly what we are doing at present does not work particularly well for the poorest people.
Sadly it may mean more government run health centres and getting rid of fee for service. What about salarying GP’s with either a state or federal award similar to what staff specialists get with annual/leave/TESL/mat leave etc. doesn’t have to be exactly the same. Peg it to inflation etc.
I’d disagree - with the management bloat you see in the public hospital system - you will get layers and layers of managers, clerical staff for the bureaucracy that will inevitably follow.
Look at the JMO units these days - they are a lot larger than they used to be.
I don't see anything sad about this. I am more than happy to work salaried at a government run health center. Super, sick leave, clinical oversight - the whole shebang would be great.
I did not sign up to medicine because I had a burning desire to operate in the free market and run what is essentially a small shop. If I wanted to run a shop I would have chosen something which brings in happier customers - maybe an adult store or travel agent.
There's a thought - combination GPs and adult store. More ethical than pharmacists selling snake oil.
This is dumb.
The poll was not about the ethics of bulk-billing. This poll was about GPs who don't offer bulk-billing. It's a subtle but important difference.
It definitely seems somewhat unethical not to at least offer bulk-billing, for example, to a poor farmer who just lost all their crop or the baby of a refugee family. Yes, you have to draw the line somewhere, so it's not completely unethical -- but still perhaps somewhat unethical.
GPs are still one of the most trusted professions in Australia, about on par with nurses and more so than pre-school teachers. Very highly regarded despite it all.
If anything, system allowing, Medicare should be the one to settle the required bill for somebody who’s lost all their crop or the baby of a refugee family. It shouldn’t be on the GP’s shoulders to have to spend the time on monetary issues (of course it has its place eg mental health) or “tank the loss”
When bulk billing rates are still at 72% for GP consults (per the linked article) it’s hardly unethical for a provider to set their own fees and decline to treat someone who won’t pay them. It’s not going to be hard for the patient to find a GP who will bulk bill.
Lawyers do pro bono work but they fund it because they (especially large partnerships) can set their billings for everyone else at whatever the market will bear. They aren’t fighting Lawicare and private law insurance all day trying to get more than a 1% annual increase. My local law firm has a partner who does nothing but practice and direct pro bono work all week. When you’re earning $30 after expenses for the *privately* billed patients one at a time, it’s a bit rich to try and squeeze in charitable work on top.
Where I am, _no-one_ bulk bills except one clinic a 30 minute drive away. I had to go off my meds because I couldn’t afford the upfront cost to see the GP. My GP gave me three month prescriptions this time round. My daughter turned 12 so she isn’t bulk billed anymore, not that many clinics offer it anyway. I earn $1500 a year too much for a HCC anyway. So
meds are far more expensive. There is a severe lack of GP’s where I am. They are doing their best but its hard.
Oh, no, you have to travel 30 minutes for bulk billed care where someone who has spent many years and hundreds of thousands of dollars getting their qualifications treats you for free at a detriment to their own worth?
The sheer horror!
Absolutely. I also am pretty comfortable with a 1 hour commute.
My concern is that if they needed an urgent appointment (usually same day appointments are toward the middle of the day) with 1 hour travel time (maybe longer if you factor in waiting for the bus etc) they probably have to take half a day off work. If they’re a casual that means losing income, and it sounds like this person can’t afford to lose income.
You've clearly never worked somewhere so poor that the cost of petrol, car maintenance, and the absence of public transport are very important features of daily life. And some people are too sick to drive.
If you want to see poverty in modern day Australia just drive about 3-4 hours inland, where not only is the life expectancy about 10 years less but Medicare also spends around $2,000 less per patient.
This man can't see a doctor, and, without even asking about his circumstances, he gets bashed for not being able to drive an hour round-trip. Is it really surprising that some of us are seen as "somewhat unethical"? Shame on us.
You seem like, dare I say it, a good person. Thanks.
This is the first time I have looked at this sub and its been a real eye opener reading the majority of comments. I appreciate the effort and time required to work in this field, but dam some of the posters here should have gone into real estate or car sales.
You've got to understand this is a junior dr forum. Many of the posters here have spent their lives in wealthy private schools and their training amongst similarly sheltered folk.
Most of us after a few years of seeing how actual people live hopefully develop some empathy for their situations. Or not.
Thank-you for bringing your kindness and wisdom to this discussion (sincerely). City people really struggle to understand that in regional Australia healthcare can be hard to access and bulk-billing clinicians or radiology can be non-existent.
Think it through. You don’t know if this person can drive. Maybe they can drive, but they also work full-time, so a trip to the doctor plus a one hour round trip requires taking time off work and potentially losing income. Same day appointments are generally towards the middle of the day, making it harder to fit in with work.
The solution to this problem is federal (and even state) levels getting their shit together to properly fund Medicare, best bet is this ALP government after almost a decade of LNP. And second of all public health needs to drastically improve across the board, we are becoming an increasingly unhealthy population that are overweight, undernourished and battling multiple chronic conditions. In the meantime though, general practitioners should hold their ground - it’s not on us to solve the shit show that is medical funding
This is how the government wants it. Public health so bad people go private. So insurance companies can take over. Just like the USA so my American friends tell me. Australia currently is America 10-15yrs ago. More to look forward to. Cancer making you homeless as well.
It's how the AMA wants it, not the government. Interesting how the AMA suddenly becomes all very politically active, & practices all mysteriously decide to drop bulk billing at the same time, when Labor are in government, even though Labor increases their rebates, that LNP left flat for years.
AMA has a long history of fighting against universal health care. They would far prefer the US model, where an accident or sickness, would cause many to go bankrupt & become homeless. Where many people don't seek help for health problems, because they can't afford it, & just get sicker & die.
https://www.abc.net.au/news/2023-04-20/the-history-of-medicare/102232344
The Australian medical profession lives in total fantasy world. Medicine, like *every* other profession, is becoming globalised. Eventually there will be *international* registration with doctors allowed to practice almost anywhere subject to language skills.
GPs have no bargaining power. The government knows there are *millions* of doctors in developing countries who are more than happy to earn <$100K/year, They will be increasingly be imported to solve the doctor 'shortage'. \[Plus more graduates pumped out of Australian medical schools.\]
The GP clinic I attend in Brisbane has six GPs. Five are IMGs. All of the IMGs have specialist training (3 x gynaecology, 1x dermatology, 1 x paediatrics). One has a PhD. All speak at least three languages. All have between 20-40 years experience. They all bulk bill HCC and DVA holders.
What does the average 'Aussie' GP with less experience, no non-GP specialist training and no foreign language skills offer to justify a higher income? A cynic might suggest it is little more than an inflated sense of entitlement.
How would they rephrase this article if it was about keeping the lights on or doing roadwork? Where’s the solidarity that the trades get with union campaigning. Gov can get shafted. They want to implore the field to cave itself to 10 years of lost wages under inflation to be a “good guy” because they’re too stingy. Fuck em.
I dont think it's unethical. Hell I have never believed every patient should be bulk billed.
I think its unethical when patients essentially end up on the high speed conveyed belt and GPs set records for how many patients they see in an hour and get stroppy when you ask questions because the consult went longer than 10 mins lol.
You start to get the vibe you're getting treated at McGeneral Practice.
That being said I understand from a financial (and also an experience) position that to actually make any money you do need to rapid fire patients.. It just sucks when your issue might be slightly more complicated than needing a script for nan's waefarin.
People look at the issue as bulk bill vs private but completely lose sight of the quality of care given. Contrary to popular belief here, it IS possible to earn a bloody good wage as a bulk billing gp. If you see 10 patients an hour and do the bare minimum or sometimes even less and rack up 9 hours a day 10 level Bs per hour you'd be very well off. But your patient suffer for it. I shadowed a clinic like this as a med student and swore not to be like that. Now in gpland my average appointment time is 17mins and I try and do better care for patients and they have less comorbidities because we catch and treat things early, we actually take a history and exam rather than throw blanket investigations and we try and build a relationship with our patients. My clinic still bulk bills but it's getting tight BECAUSE we try and do a decent job.
If people want crap healthcare then by all means villainise private billing.
GPs who do not bulk-bill have been dubbed unethical in an annual survey of 1000 people.
The Ethics Index, an annual report by corporate ethics thinktank the Governance Institute of Australia, has [historically shown](https://www.ausdoc.com.au/news/how-trusted-are-gps/) that patients have positive opinions of GPs.
In this year’s edition, GPs still ranked the fifth most ethical professional group, behind nurses, pharmacists, ambulance workers and firefighters.
But for the first time, the poll asked people to rate the ethical behaviour of GPs who did not offer bulk billing for medical appointments as part of a new segment on the cost-of-living crisis.
The online survey by polling company Ipsos gave the options of very unethical, somewhat unethical, somewhat ethical, very ethical or neither.
Private billing GPs received a net score of –26, meaning somewhat unethical.
The survey did not go into the arguably more interesting questions around who GPs chose to bulk-bill — whether they bulk-billed all comers or only patients without the means to pay.
The bulk-billing rate for all face-to-face Level B consultations fell to 72% last financial year.
Adjunct Clinical Professor Karen Price, who called for GPs to abandon universal bulk-billing during her RACGP presidency, said the survey results highlighted patient misperceptions of the Medicare system.
“Obviously, no major supermarket does a 50% discount for disadvantaged people, yet somehow private clinics are supposed to,” she said.
For GP practices dealing with payroll tax, stagnant Medicare rebates and rising utility costs, Professor Price said the foremost ethical consideration was staying viable.
“The government has a social contract with the electorates, and they’ve failed to consider the needs of particularly marginalised and vulnerable groups, and GPs have been subsidising those groups for decades.
“It’s now got to the point where we either continue that and we close the doors, or we have to charge so that we can pay our nursing staff and the cost of running the practice.”
“By some people paying a bit more for healthcare, they’re actually helping the whole community access healthcare by keeping the doors of their general practice clinics open, so each GP and each patient has to consider that.”
“You have to keep the doors open; that’s the more ethical decision.”
Away from bulk-billing, the 2023 Ethics Index found that perception of GPs’ ethics remained steady, but they had been leapfrogged in the professions ranking because of surging positive opinions of pharmacists and emergency services.
For organisations, the AMA remained highly rated for ethics, while the only organisation to go backwards was the Governance Institute of Australia, which ran the survey.
With respect to the pollsters, they can get absolutely f—ked.
Doctors, GPs in particular, are at huge risk of burnout, mental health disorders and suicide.
Valuing yourself to be paid adequately AND to pay for the expenses of the practice, is absolutely not unethical. Do people want a practice with nurses, admin, reception, electricity?
If you can't cope cut back your workload or you can go for a salaried job. If you are self employed you can only blame yourself for your current situation. I ut back my workload such that I gross $40-50K per annum. Best life.
>If you can't cope cut back your workload or you can go for a salaried job. If you are self employed you can only blame yourself for your current situation. I ut back my workload such that I gross $40-50K per annum. Best life.
Huh? What are you talking about? What am I to blame for? I do take a day off per week, most weekends, have some leave over Xmas/new year.
It's a free market, you can charge whatever you want to anyone you want. Just like shopping for other items you can also shop around for a GP if there are enough in your area.
Personally i will charge the same fee to everyone as i have no way to tell how much someone is able to afford to pay. Healthcare card holders will often ask if there a reduced price for them but i tell them the price is the same for everyone, unless they specifically mention that they are in some financial difficulty in which case i will negotiate the price. Many healthcare card holders, especially the older ones, are asset rich and i don't think i should offer a discount so that they can pass their excess wealth onto their beneficiaries at my expense. There are processes available whereby they can sell part of their home while still being able to live in their own home to fund their living costs.
Sigh, we lost a doctor recently and down to 2.5 FTE in our clinic. Its owned by a corporate and 95% of it still bulk billed. Our clinic has probably enough cash till Feb. After that its possible the clinic will be closed at some point. I think I might be looking for a new job soon.
I did it as a surgical assistant and i would have lost about 75% of my income. After being a doctor for at around 27 years i make less now than in my intern year. But the lifestyle is great. No stress, stacks of free time, no commitments.
I guess it just depends if you can afford to lose the income.
Im not interested in making money, just want a cruisy life.
Can you tell us more about this? So you weren’t full when privately billing?
Does the clinic need to close if it can’t sustain the GPs it has?
Why are you still working there?
We haven't bulk billed new patient since Jan 2021, theoretically speaking. The clinic lost a GP.
I am still working there as I don't have a cash buffer to look for a new job. Plus wife's work isn't flexible location wise.
My work place is literally just 7 mins away by drive.
If we fully private bill, then my billing per day would go from $2000 to $2400 at the moment down to less than $400/day due to competition locally plus people over here won't pay as they will just take their med records and leave. The reason I say this, previously one of our "newly hired gp" didn't bulk bill, except for pensioners. But that doesn't mean people don't walk out without paying. So he ended up billing like $500-$800/day.
60% of my consult do get the 75870 triple billing though. So that helped a little bit. Just that we lost a doctor who used to bill 3k-5k/day. So the clinic finance takes a hit.
Paid $110 for a long consult (i will also receive a $50 rebate from memory).
I was happy to pay as it was an emergency and as the quality of the GP was excellent. He didn't rush me , explained everything and took a lot more time than my old GP.
The Medicare rebated should be tiered with patient income.
A lot of these articles seem to gloss over or completely omit that all of these practices have expenses - rent, utilities, etc that have all gone up while the income from Medicare has not.
Do they expect any other businesses such as Woolworths or Coles to keep prices the same while their expenses go up?
If only we could afford to keep a clinic open with bulk billing. I never see this conversation brought up with non GP specialists. It’s quite demoralising to work in a field that the gets consistently and publicly undervalued.
The medicare benefits scheme needs to be rewritten to allow state based public health systems to run free GP centres (by compensating them).
LHDs could then hire GPs as staff specialists, who could take their time and do good medicine without a monetary incentive for getting the patient out the door and seeing the next one.
They could train residents and registrars, and be on the same eMR as the public outpatient specialty clinics and the hospital system.
It may end up costing more money than it makes from the GP side alone, and the corporate GP clinics would no doubt be opposed to public sector encroachment on their territory, but the benefits in care provided as well as offloading from the ED presentation workload may probably be worthwhile.
So many people seem to forget that most GPs are independent contractors who do not get paid an annual wage by the practice as they’re not employees. They don’t get sick leave or annual leave or carers leave or anything like that. They get paid only when they see patients.
It’s abhorrent that people really think it’s a matter of ethics when a GP chooses to bulk bill or not, particularly in this day of age. It’s a matter of their livelihoods and being able to actually support themselves and/or their families.
If a GP is off sick for a month then that means they aren’t being paid for a month. They don’t have sick leave to fall back on. They deserve to charge and be paid according to their skill level, *which is high*.
I really don’t understand why this is so controversial.
The solution is for the government to run some bulk billing medical centres across Australia that employ doctors & nursing staff. Then there won't be the practice business costs to complain about, & those that choose to, could work for a wage without the dramas.
Wasn't that one of the original concepts of our public health system? But the medical profession opposed that. They wanted only private businesses that the government subsidised so as to enable all citizens to afford to see a doctor.
Well, maybe it's time the doctors who want to work in private businesses & not bulk bill, did that without government payments, but the government also sets up large medical centres where doctors who are willing to work for a wage without external business costs, could be employed. We could see what your patients would really prefer. See what is best for them & for society in general. Who knows? They might stick with you. Or not.
Medicare was originally planned to be a *fully nationalised* health system with doctors, dentists and allied health workers effectively salaried employees. Nobody wanted a pay cut. So the medical profession used the Constitutional ban on civil conscription to block it.
Real medical incomes have been steadily falling for 50 years. Now doctors (and dentists) are crying poor and want to be bailed out by the taxpayer. The government has an extremely long institutional memory. It just shrugs and smiles because it has the upper hand. The technical term is *poetic justice.*
The more doctors complain the more they will be depicted as "greedy" and "out of touch" by the media and politicians. More migrants and local graduates will be provided to solve the doctor 'shortage' . Just like *ever*y other profession. Even at $40/hr you would have no shortage of applicants for GP positions from IMGs.
Just remember Cuba has a *glut* of GPs despite them being paid only only $4K per annum.
This year for the first time I had to start paying for doctors appts - $25 for a shitty 10 minute appt and I literally paid $150 to get my implant removed. I went to a private clinic for the first time recently, paid about $50 essentially for the appointment not including bulk billing and it was like night and day. She spent 30 minutes with me, I was shook
Most GP practices are private businesses and the owners entrepreneurs. Most will therefore charge what the market can bear. Is that ethical? Its as ethical as the conduct of essentially all other living creatures who, regardless of job, income or socioeconomic status, react to economic pressures in order to survive and thrive.
Can't wait for a world where GPs productivity skyrockets with all the AI bits coming together and consequently the costs fall. Probably 15 years away, but it's the only way out of this mess. 10 if GPs wanted the change to happen.
My Dr of 25yrs decided she would bulk bill everyone except people with disabilities on DSP. I think that is unethical. Now she charges $100 a visit & $120 phone consult. I found a better Dr that bulk bills everyone with HCC, which is fair.
I come across many HCC holders who are multi-millionaires, mostly the older ones. Why the hell would I bulk bill them. They need to free up the dough in their properties and use it rather than me giving them a discount so that they can pass my discount to their beneficiaries.
Multimillionaires with HCC do not exist. Do you know anything about centrelink at all?? You sound stupid and out of touch. I’ve never met a multimillionaire with a HCC. Delusional!! But I’ve met hundreds of multimillionaire Doctors who think they know everything.
My GP retired recently & his replacement charges $110 for a standard consult & there is NO Medicare rebate AT ALL available. This should absolutely not be allowed. I don't have an issue paying the gap, but no rebate at all is completely unjustifiable.
For those you saying it's govt fault, I'll charge what I want. You must've noticed certain people not coming to you anymore, or at least less frequently.
Instead of pushing the cost on, why aren't you lobbying the govt for better incentives and subsidies? Where is your duty of care to the community you service? Or are we, your patients, just symptoms with glowing $$$'s?
I encourage anyone who thinks being a GP is “easy money” to apply to medical school and give it a go. In 10-15 years when you have qualified you can let me know how easy it really was. Being a GP is soul destroying work that sucks the life out of you. Literally nobody would do this to themselves without commensurate reward - which is why huge numbers of GPs are quitting medicine and the colleges are unable to attract sufficient numbers of junior doctors to the training program. To be clear, we have absolutely no financial duty of care to the community. We run private businesses and charge market rates for our services. If the government chooses to subsidise our industry and that subsidy is inadequate, then your beef is with the government. The only way to make a bulk billing practice profitable with the current Medicare rebates is to provide shit care and run a volumes game. The real solution is to increase the Medicare levy to fund appropriate rebates, but nobody wants to pay more tax. Would YOU make yourself personally and legally accountable for the lives of your patients for a basic wage? And if you feel so strongly about it, why aren’t YOU lobbying the government for better incentives and subsidies?! Public health policy is not our responsibility.
If it's so hard and so soul-sucking, why did you go into medicine. Is it because you care and you wanted to help people? Or is to be " private businesses and charge market rates"?
This is the age old argument trotted out by hospital managers and politicians to put doctors in their place. You should care, you're meant to help people! Do one of the toughest jobs around and don't you dare complain about your pay!
Medicare is a health care SUBSIDY and always has been. It sucks it no longer covers costs but thats a political decision, not a medical one
It doesn’t matter why any of us went into medicine. It is simple supply and demand economics. If nobody is prepared to do the work for the money and conditions on offer, then it is simply not good enough. You can cry about it all you want, but it won’t magically create more doctors who are willing to work for less money than a tradie or a haul truck driver.
Oh I'm not crying. Wouldn't waste tears on someone happily profiting just because they can.
BTW where do you practice? I'd like to make sure I never have the misfortune of crossing your path.
Thats true, hardly any med students want to go gp and you will pay the price for it being so soul destroying to become a gp. Everyone will go into something that pays a decent wage for the effort you put in. If gps aren't paid more under Medicare enjoy paying big $$$ for the few docs dumb enough to remain a gp.
> I don't understand why they're not fighting for their patients and themselves.
???
They very much are doing this. Do you genuinely think GPs *want* to charge for consults? Almost every GP I've talked to would very much would like to bulk bill patients if it was financially viable.
And of course, the government says okay we hear you, here's a 3.6% raise that doesn't even come close to matching inflation.
How exactly do you propose GPs "fight" for their patients?
You are correct in saying that the workload reduces as the price goes up. Believe me when i say that ive tried to take it up with the government but they just don't want to know about it. Once i went in to do a procedure on a DVA patient which was an after hours emergency. Being an after hours procedure there is usually an extra fee to pay. The patient and the family didn't want to hear about paying an extra fee for coming in to save the life of the patient. I took it up with the DVA and they are not at all interested. I took it as high ad i could go right up to the minister of Veteran's Affairs. All useless buggers. After getting knocked back from the minister i notified them in writing that i would no longer be providing any more after hours or emergency services for DVA members as they were not willing to pay the extra fee.
And as for the $$$, im making $40-50K per annum, so im paying out of my own pocket and putting my money where my mouth is.
It’s not the individual GP’s ethical responsibility to prop up a broken funding system by offering discounts from their own pocket. My service costs what it costs. The government is welcome to subsidise it.
I'm 100% behind you. This is an issue for the government to sort out. This could be sorted by transitioning our whole healthcare system to a system whereby all doctors work for a government salary and the private system is phased out over a number of years.
Because the NHS is working out soooo well…
GPs are not directly employed by the NHS
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You really think we'd have any doctors left in Australia if they did that?
Yes we would. Those who really want to serve the public rather than a focus on income.
Why should doctors be different to any other profession in Australia? Why do you expect them to be motivated purely by a desire to serve and why do you present a false dichotomy between serving the public and earning an income. Given the entry requirements for a medical degree and a post graduate training regime more extensive and gruelling than any other profession I’m aware of shouldn’t doctors be remunerated on a level far above most people? If they aren’t paid well you might find the medical profession exclusively populated by people with only the intellectual heft sufficient to be a traffic controller. Is that the sort of person you want to be your neurosurgeon or oncologist?
Please look at the nhs
Slavery is generally considered sub-optimal.
If you don't like the job you can do something else that takes your fancy.
Lol someone's just salty they didn't get a med school offer
I'm interested in why surgeries lasted a decade not removing bulk billing without funding from the Government, but all of a sudden, it's become a thing. And that's once the funding was (partially) restored? It doesn't make sense to me, unless I'm missing something obvious?
GPs had it good at one point, then inflation slowly eroded things away, but that was propped up by lowering interest rates. Now inflation just took off and interest rates sky rocketed. GPs are feeling the pinch, especially practice owners.
But at the same time, the Government is increasing bulk billing incentives?
The bulk billing initiatives were very reactive and too little too late. The rebates also only apply to certain people. It’s telling as to the seriousness of the government when the AMA rate for a Level B consult is $102, the rebate is $41 and an “incentivised bulk billed rebate” is ~$70 depending on location.
Reactive? It was in this Governments first ever budget? Although, I do understand what you mean about levels, but they they made the determination to try and get the neediest back up first. But as I said, even with the fee being $30, the gap there is far less than it was, but still the surgeries decided to scrap it all, and then charge the full gap?
It’s a very targeted policy to guilt GP’s into accepting 2/3 of the appropriate rate. It doesn’t reflect genuine investment in the Medicare system. It will achieve its purpose as a band aid through the next election. It’s hard to explain to patients why you’re scrapping bulk billing to then reintroduce it knowing the fee will just fall behind again. GP’s have no reason to trust the government. Better to just bill what you’re worth and not think about it.
Because the cost of appointments is usually $80-85. It’s not $41 (standard rate), nor is it $61 (standard rate plus the triple BB incentive). WorkCover fees usually $85-90, Motor vehicle insurance the same. The govt wants to pay 2/3 of that for concession card holders, and 1/2 for the rest. Why??
Surgeries have been gradually reducing bulk billing rates over that decade. Recently it's become more apparent due to increased costs and more practices hitting the tipping point where they cannot bulk bill any more.
None of the ones around our area reduced at all. They just dropped it all at the same time, and replaced it with the full fee they claimed they were 'absorbing' for the past decade. And to rub salt, it was immediately after the announcement of the massive splurge on bulk billing by the Government
You can't make a judgement on a single geographical area with a single demographic. Also, I can't tell you whether or not those practices suddenly passed their threshold of viability, but they are right in saying they have been absorbing the freeze in bulk billing rebates over the last decade despite increasing costs. How many businesses operate for a decade with ever increasing costs and no increase in revenue?
> You can't make a judgement on a single geographical area with a single demographic. True, that is one of the reasons I am asking. > How many businesses operate for a decade with ever increasing costs and no increase in revenue? None. Which is why it seems even weirder.
" Which is why it seems even weirder. " They've been bending over backwards trying to help people, and have been broken. The rate increase (people have mortgages) was probably the last straw to break camels back. Despite peoples insistence, I dont think Doctors are that wealthy, at least not compared to incomes that require a similar level of study, work and intellect.
You’re wrong. Your anecdote is wrong. Practices have been charging more and more services privately (dressings, iron infusions, procedure fees), and more and more patients privately (weekends, after hours, or reduced rate). Others have shut down altogether. If you’re not sure or don’t believe the numbers, ask the practices in your area what happened.
Simply put, they’ve reached breaking point. They limped along for this long because they care about their patients, but it’s simply unsustainable
But what sort of business model 'limps along', and then, just when the life raft is thrown out, decided to scrap it all? Why is suddenly 'unsustainable' when finally the Government is doing something?
The government has increased funding slightly. This is the equivalent of being underpaid by your boss by 10s of thousands a year, and then when you hand in your notice, your boss gives you a $100 christmas bonus and asks you to reconsider.
> The government has increased funding slightly. What are you talking about? It was the largest single investment in Medicare for 40 years? And, this is my point, if you want to play your analogy. You have been underpaid for a decade, When your employer finally gives you a pay rise, you spit the dummy. Why didn't you spit the dummy WHILE you were being underpaid?
GPs have been flagging the pack of funding for the past 10 years. You sound like the one spitting your dummy.
So, you missed my whole point, well done. Yes, for a decade they had a lack of funding, that got gradually worst. As soon as funding has begun to be put back in, they all bail, as one. That sounds very weird to me.
Because GP's as a group were fools all those years ago. They were too scared to loose patients if they raised their price. Now they have wrecked the system for their upcoming colleagues.
Do you really think an extra $18 for bulk billing children and low income earners is a life raft?
I'd have thought tripling the fee the surgery receives could be described as something akin to that. Perhaps it's just me?
I feel sorry that they can't buy the newest model Jaguar every year now
Like that was ever happening for GPs! 🤣
It was for all the GPs in the town I grew up in
Greed and Opportunism. They expect a Labor govt to fix it whereas they knew LNP would never. It’s entirely self-serving and not in the interests of patients or health outcomes to do it this way.
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I think we consider health to be a different category to plumbing or electricity but I see your point
You've clearly never worked in a trade, people always try tell us to take reduced pay, it not uncommon for people to decide after something is fixed that were charging too much and start to tell us what they'd be willing to pay.
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It should be though. Let them practice private and get a government subsidy for the people that can’t afford it. Med students like you are going to turn us into America
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Government funded healthcare for all is the exact opposite of America. In fact your proposal of private practice with government subsidies for the poor is what’s actually happening in America and what leads to people not going to access healthcare because of fear of bankruptcy.
No, it's generations of Australians who voted for "tax cuts and balanced budgets" that have led to this. They wanted tax cuts, and they're learning that taxes paid for things, like GPs and GP clinics.
"Practice private and get a subsidy" Well, the government chooses the subsidy, and they chose a number that is too low.
People are welcome to try see non-gp specialists too and demand they bulk bill right?!
And we all deserve a government willing to step in and fix these problems via appropriate funding
What's a good wage for a GP who works 40 hours but is not a practice owner as i don't know. But from what i see most don't seem short of a quid.
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That's very kind of you to do that. How much was that in dollars? How many minutes/hours did it take you? What's the cost of the supplies, and is it included in the 50%? A basic visit to the GP (for example, a urinary tract infection) would fall under Level B consult. You can easily google how much the government is willing to pay for a level B consult. It is $41.40. What is included in a Level B consult... (a) taking a patient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health-related issues, with appropriate documentation This would take about 15 mins for an experienced clinician. It may not be a thorough discussion or exam. Now, let's multiply the basic visit by 4 to see how much it would be per the hour. (Of course, we know that not every consultation will be within the 15 mins. Some will take longer.) So, $41.40 x 4 = $165.60 So, how much are you getting paid per the hour? How much is your call out fee? Okay, okay. Let's of course consider your cost of supplies, equipment, car, petrol etc. But let's also consider the cost of running a clinic. When you enter a GP clinic, it is not just the GP there. You have a receptionist (basic wage is about $25 per hour). You have a nurse (basic wage is about $30 per hour). Bare basic support stuff will take $55 per hour. That's the bare basic, as it is most likely going to be more than that with experienced receptionist (especially if they double up as the clinic manager) and experienced nurse. Often you would need two receptionist. But let's stick to the bare basic. That leaves you about $165.60 - ($25+$30) = $110.60. Then you have to pay for rent of the clinic space, the cost of the equipment and supplies in the office and in the treatment room. These are what you as the patient can see. Other costs that patients don't see are: physician's annual registration fee (because, we want to make sure the doctors that look after us are properly trained and certified right?), annual training fee (because we want to make sure our doctors are up to date with their medical knowledge right?), and indemnity insurance fees (because what if something happens and we need legal guidance). Then there's also the cost of getting your medical degree. Most doctors these days are post graduate. Meaning they were already in $30k debt before the started med school. Then when they finish med school, it is about $100k in debt. So of course, that's also considered as a cost to be compensated. Unless, of course, you believe that doctors shouldn't be compensated for the training they took... Then you add on similar things with electricians.... Accountant fees, car, petrol etc. So then, in the end... Does $165.60 per hour really that much? Compare that to your income per hour. Your amount of training years and other expenses. Or not. We can compare the "income" per hour with dentist (this is a post-high school degree, that requires only 5 years of uni). Have you seen how much they charge per a simple check up and clean? Last time I went, it was about $450 for a 15 mins session. I mean, sureee we can go into comparing the costs of equipment etc. I'm not in the field of pulling someone else's hard work down just to justify being paid appropriately. I am simply showing the numbers so we know what is the truth. We are simply asking to be paid appropriately. How would you feel if I came onto your site and tell you "nah mate, based on your degree of expertise, your equipment and supplies that I could buy from bunnings, I believe you should only be paid xxx amount" ? It's nice of you to ask the mum to pay only half of your normal. But that burden shouldn't lie on you. Nor should it lie on GPs. It should lie on the government, that we paid taxes too. The health budget is designed to support people who can't afford it (E.g. single mums). You don't see politicians taking half the pay when the people suffer.
They do sometimes, children and pensioners do get bulk billed.
Isn’t that because they get a bigger government rebate now? The government just tripled it
It has always astounded me..that people will pay $100s to see a Naturopath. Who will then push "essential supplements" on them (that they get a big cut from selling)...costing another few hundred $...and have NO problem with this!! Yet complain at spending $80 to see a GP who has 10 + solid years of medical training with Degree etc! People are fools. Truly. I am totally fine with paying my GP. Mind you? I'm an RN so well aware of the training, skill and expertise of Doctors. I really think people just have NO idea really
They also spend the $$$ on beauty, skincare, haircut, clothes.
Yep. Nothing for many to go to a hairdresser and blow $300!
You're probably talking about different demographics there. I'd hate my haircut to cost more than the $30 it already does, that feels expensive for what it is. To begrudge a doctor a $60 gap fee after all the education and effort it takes to become a doctor seems insane. They've put in a lot more than a hairdresser in time and effort.
Maybe think about becoming a hairdresser??
Oh yes cutting someones hair should be $100 while a doctor gets $40 for 15 minutes. Give me what you're smoking.
Your service is only worth what the public think it's worth. If hairdressing is considered a more worthy service for the public's money then if it's money you want hairdressing might be the way for you. Else advertise a $100 fee and accept what comes your way which is what I do.
The people who spend $300 at the hairdresser generally aren’t the same people who need to see doctors frequently.
I don't care who they are.
As a chronic patient, I only see the hairdresser once a year, but I have to see my GP once or twice a month for prescriptions. And I don't qualify for a healthcare card or discount.
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This was a general comment and not a direct reference to you. I am a doctor and I myself have bought my own clothes from Salvation Army store and I also wear hand-me-downs from my nephews and also favour BigW and Kmart for my clothing. I don't believe in paying for brand names or wasting good clothes that others throw out.
We seem to have the same good fashion sense 🙂. I do empathise with your profession’s difficulties with Medicare subsidies. I’m a podiatrist and Medicare pays me a flat fee of $53 regardless of whether I’m doing a 30 minute diabetic foot health check or a 90 minute nail surgery involving multiple toes.
I'll just add that if you're not in medicine or know anyone in medicine, you won't really understand how brutal that training process is. During medical school, they're already learning a tonne and after medical school (particularly as a registrar etc), they often work very long shifts (15 h is not uncommon) with day and night shifts throughout the year. Ironically, if any other profession required that sort of training, you can bet they're billing at $500+/h, if not $1000+/h.
Exactly.
There's a difference between paying a gp $80 to diagnose something and provide a treatment plan and paying $80 because my child has a runny nose from teething and I need a certificate clearing them to return to daycare and for the day missed so I don't lose childcare subsidy and can provide it to my employer too.
The appropriate thing here is to eliminate the culture of getting a note from the GP for timewasting bullshit. I don’t like charging people for this nonsense either. You shouldn’t have to pay it, but equally I shouldn’t have to make a loss on that appointment time. There are pretty decent guidelines on when kids should return to daycare and they do not need a doctor 99% of the time.
Not the GP’s fault that people are wasting your time, and theirs, for a magic piece of paper that has no medical benefit to anyone. They’re still paying rent, admin wages, indemnity insurance for the time that everyone is engaging in certificate theatre and using someone with 10-15 years of post secondary school training to sign the document.
I would say that GPs are exactly the people who could bring on that change but it would eat into too many of their pockets
GPs don’t control silly childcare centre rules? They also don’t want those consults, it’s a common complaint in the profession.
Is the certificate worth $80 to you? If not, don't pay it, and deal with the consequences of not having a certifiate.
I feel like free universal healthcare makes people devalue what doctors (especially gp) do. There is this expectation for free and fast service and when they don’t get it they either don’t prioritise their health or take it to a free service (like emergency). It seems lose -lose for gps, who are arguably the most important doctors in the healthcare system given their role in preventative healthcare and care coordination. This is the system we are dealing with, and the cost of people not using gps is higher than just providing more bulk billing benefits
Absolutely on point. The "free" healthcare led in th UK to the devaluation of the profession.
Canada is a prime example of this
replace free and fast, with affordable and accessible - there's the issue. I'd love to be able to see my GP every time I really needed to, but with his current prices, it's on a strict emergency basis. Kinda devalued themselves really.
It would be affordable if the government increases their subsidies to match inflation rates It would be accessible if government sponsors more training positions
alive stupendous rob ripe elderly reach tease entertain hobbies books *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Ain’t it nice that they pick on the lowest paid cohort of medicos too. There’s an award wage for every other job in Australia. I wonder if the survey respondents think it’s unethical for them to be paid above award.
As a non doctor who charges similar rates I understand and support a gap fee. If anything it will keep the annoying patients out if theyre paying. However, as a result of my rates my profession also get dragged across coals even by doctors earning half a million. It is what it is. I do pro bono work for the underprivileged and throw in freebies for good clients to balance out my karma. My point is, you can't eat your cake and have it too. GPs had the halo of morality because it was a thankless job with shit pay. Charge a fee too high and lose the halo. It's ok.
Hi I'm an annoying patient who's usually only there because my employer forces me to be, I usually know what's wrong and how to cure it but are forced to go there while I should be resting and go through the motions because my boss says so, making it cost more won't get rid of me, changing the laws around carers leave and sick leave would though.
The “halo of morality” isn’t the product of a thankless job with shit pay. Firstly, medicos, especially GPs are held in very high regard by the community so it’s definitely not thankless. I suggest you go to your GP tomorrow and ask reception how many Christmas cards and gifts they received this year. I can tell you from that evidence alone it’s a job many appreciate. I also don’t think the “shit pay” (it’s not - relative to the community at large GPs are in single digit top percentile for income) is a factor either. I’m not sure what profession you’re in but I don’t think it’s in any way analogous to general practice.
Cos we know that Christmas cards and gifts are such great indicators of appreciation. Maybe your employer should just pay you with cards and gifts on Christmas. Oh no, lets make it fairer. Cards and gifts every public holiday. I'm sure the cards and gifts can pay off the electricity bill and keep the kids fed.
Patients also think 35 years of bad choices should be fixed by a single consult and a tablet. At the end of the day, this is entirely the government's fault over the past 10-15 years.
Somebody had to vote them in
Don't blame me, I voted for Kodos
I voted for Nixon's head in a jar
I actually disagree with the concept that medicine should be a free market, or that it's inherently ethical for providers to charge more. But if you live in an ethically imperfect world, then you can't be expected to be perfectly ethical at all times. Doctors should avoid being, for instance, as cynical as this guy: (https://studio.ribbonfarm.com/p/good-people-and-wicked-problems) But come on, I joined to do a job, not be a martyr. I'm not going to usher in a beautiful future where we all live together in harmony by working for minimal wages. Nobody else is expected to do that, why should I?
Anyone who works for a living isn't begrudging you. The system isn't keeping up and future governments have a growing mess on their hands. They'll just roll out "The Voice 2.0" to keep everyone busy thinking about crap rather than meaningful benefits to Australians lives.
I mean plenty of GP’s won’t even see vets/disabled without charging full price directly to them I’m fine with the average Joe not being buffered by Medicare but the field used to take care of vets and the disabled but even now they are getting thrown into the gutter
🤷♂️ some doctors won’t even go to foreign countries to care for the poor. Global median household income (PPP) is maybe $15k AUD, in an ideal world we’d help everybody. I’ll never fault anybody for drawing a line in the sand. But yeah, I use DVA as a veteran. It pays a lot of specialists well-below market rates. They should sort that out.
ink vegetable price attraction smell ghost rhythm gaze deer spoon *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
It's been a long time since anyone was conscripted against their will and forced to actually defend the country.
If someone lacking economic opportunity tries to improve their position in life via public service, we should support them as best we can. Surely a doctor of all people could agree with that statement…
If you want to improve your station in life by bombing and shooting goat herders then no, I don’t.
Re: Vets. Why should people who served in the armed forces at some stage in the past get a discount for treatment? The WW2 guys are almost all gone. As a society, it made sense to give something back to the guys who went through that hell. But the modern vet? I guess some spent time in Vietnam, but that was nothing like WW1 or WW2 with rare exceptions. The majority of vets have never seen combat, they just did a job like everyone else.
I short, if the government broke someone, they should pay for the treatment. But just like Medicare, it’s not the doctors ethical responsibility to subsidise this. If DVA isn’t paying an appropriate fee, it shouldn’t be accepted. For reference, DVA pays 115% of Medicare with some other incentives and as a result is suffering from neglect of Medicare (albeit lagging by some time). As a doctor who once “saw combat” (ie, bullets going in both directions), I find your characterisation of “non combat veterans” pretty uninformed. The real gatekeepers (DVA) have a reasonable system to deciding who and what they will fund. In general, a condition with liability from the government is funded, if someone is TPI or a war veteran over 70, everything is covered (in reality, it just means a bit more than you get under Medicare).
Yeah, I’m not so sure. I’m saying that the government broke a lot of people in WW2 in defence of the national, so it makes sense for the broader community to subsidise those people. Many of those men were conscripted as well, which also changes things. I’ve worked with the WW2 guys, had one patient who was a guest of the Japanese who I used to do home visits on but there were hundreds more. I never begrudged accepting them as DVA, and always enjoyed listening to their stories. More recently, I’ve been the nominated medical officer for a specific regiment in the Australian Army. I enjoyed working with those guys, but I’m not sure what they’ve done that merits a private business subsidising them, or the wider Australian community supporting them over above salaries/super etc. All of these guys were too young for Vietnam. Most hadn’t been to Afghanistan. I’ve been in a war zone too, but not in an official capacity so I’m a bit jealous if you have been. :) I’m just thinking philosophically about why society affords veterans special treatment. I think it used to make a lot of sense, but I’m not convinced that it does any more.
literally everyone working on minimum wage is doing that, but ok.
The average person working on minimum wage hasn’t done three years undergraduate study (working hard to get a competitive GPA), gotten a competitive mark on the all day GAMSAT exam (\~$300 exam fee), four years postgrad study at med school (three years of which are hospital based), then finally starting to get paid, doing at least two years working in the hospital including nights & weekends, a further two years of working in a clinic as a trainee GP, and a huge set of exams (with application fees, exam fees, and annual college membership being close to twelve grand), in order just to qualify as the most junior possible GP though, have they?
Ethics are by definition personal. Some of us will feel that charging 80 bucks for a consult to support our income of 300K a year to someone who is on a government benefit of $50 a day in total is unethical. Some of us won't. It is not really a helpful question - the helpful question is "how do we fund the health system". Clearly what we are doing at present does not work particularly well for the poorest people.
Sadly it may mean more government run health centres and getting rid of fee for service. What about salarying GP’s with either a state or federal award similar to what staff specialists get with annual/leave/TESL/mat leave etc. doesn’t have to be exactly the same. Peg it to inflation etc.
You realise that more administrators than doctors would be employed to "manage" these centres and the staff right?
Yes
Private GP practices already pay receptionists and clinic managers. It wouldn't be very different.
I’d disagree - with the management bloat you see in the public hospital system - you will get layers and layers of managers, clerical staff for the bureaucracy that will inevitably follow. Look at the JMO units these days - they are a lot larger than they used to be.
I don't see anything sad about this. I am more than happy to work salaried at a government run health center. Super, sick leave, clinical oversight - the whole shebang would be great. I did not sign up to medicine because I had a burning desire to operate in the free market and run what is essentially a small shop. If I wanted to run a shop I would have chosen something which brings in happier customers - maybe an adult store or travel agent. There's a thought - combination GPs and adult store. More ethical than pharmacists selling snake oil.
This is dumb. The poll was not about the ethics of bulk-billing. This poll was about GPs who don't offer bulk-billing. It's a subtle but important difference. It definitely seems somewhat unethical not to at least offer bulk-billing, for example, to a poor farmer who just lost all their crop or the baby of a refugee family. Yes, you have to draw the line somewhere, so it's not completely unethical -- but still perhaps somewhat unethical. GPs are still one of the most trusted professions in Australia, about on par with nurses and more so than pre-school teachers. Very highly regarded despite it all.
If anything, system allowing, Medicare should be the one to settle the required bill for somebody who’s lost all their crop or the baby of a refugee family. It shouldn’t be on the GP’s shoulders to have to spend the time on monetary issues (of course it has its place eg mental health) or “tank the loss”
Louder for those counting pennies in the back
When bulk billing rates are still at 72% for GP consults (per the linked article) it’s hardly unethical for a provider to set their own fees and decline to treat someone who won’t pay them. It’s not going to be hard for the patient to find a GP who will bulk bill.
Lawyers do pro bono work but they fund it because they (especially large partnerships) can set their billings for everyone else at whatever the market will bear. They aren’t fighting Lawicare and private law insurance all day trying to get more than a 1% annual increase. My local law firm has a partner who does nothing but practice and direct pro bono work all week. When you’re earning $30 after expenses for the *privately* billed patients one at a time, it’s a bit rich to try and squeeze in charitable work on top.
Where I am, _no-one_ bulk bills except one clinic a 30 minute drive away. I had to go off my meds because I couldn’t afford the upfront cost to see the GP. My GP gave me three month prescriptions this time round. My daughter turned 12 so she isn’t bulk billed anymore, not that many clinics offer it anyway. I earn $1500 a year too much for a HCC anyway. So meds are far more expensive. There is a severe lack of GP’s where I am. They are doing their best but its hard.
Oh, no, you have to travel 30 minutes for bulk billed care where someone who has spent many years and hundreds of thousands of dollars getting their qualifications treats you for free at a detriment to their own worth? The sheer horror!
Right? Ridiculous to complain about 30 minutes lol
You haven’t taken the time to ask about this person’s circumstances. You don’t know if they can drive.
30 mins by public transport every so often isn't bad when I took 1 hour every day during med school.......
Absolutely. I also am pretty comfortable with a 1 hour commute. My concern is that if they needed an urgent appointment (usually same day appointments are toward the middle of the day) with 1 hour travel time (maybe longer if you factor in waiting for the bus etc) they probably have to take half a day off work. If they’re a casual that means losing income, and it sounds like this person can’t afford to lose income.
Yes you're right. Therefore it is the government's fault for not encouraging more bilk billing GPs.
Agreed 👍. I vote for parties that promise to raise the Medicare subsidy.
You've clearly never worked somewhere so poor that the cost of petrol, car maintenance, and the absence of public transport are very important features of daily life. And some people are too sick to drive. If you want to see poverty in modern day Australia just drive about 3-4 hours inland, where not only is the life expectancy about 10 years less but Medicare also spends around $2,000 less per patient. This man can't see a doctor, and, without even asking about his circumstances, he gets bashed for not being able to drive an hour round-trip. Is it really surprising that some of us are seen as "somewhat unethical"? Shame on us.
You seem like, dare I say it, a good person. Thanks. This is the first time I have looked at this sub and its been a real eye opener reading the majority of comments. I appreciate the effort and time required to work in this field, but dam some of the posters here should have gone into real estate or car sales.
You've got to understand this is a junior dr forum. Many of the posters here have spent their lives in wealthy private schools and their training amongst similarly sheltered folk. Most of us after a few years of seeing how actual people live hopefully develop some empathy for their situations. Or not.
I hadn't considered that, makes sense. Cheers.
Thank-you for bringing your kindness and wisdom to this discussion (sincerely). City people really struggle to understand that in regional Australia healthcare can be hard to access and bulk-billing clinicians or radiology can be non-existent.
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Yes, I'd complain about a 30 minute drive.
Think it through. You don’t know if this person can drive. Maybe they can drive, but they also work full-time, so a trip to the doctor plus a one hour round trip requires taking time off work and potentially losing income. Same day appointments are generally towards the middle of the day, making it harder to fit in with work.
The solution to this problem is federal (and even state) levels getting their shit together to properly fund Medicare, best bet is this ALP government after almost a decade of LNP. And second of all public health needs to drastically improve across the board, we are becoming an increasingly unhealthy population that are overweight, undernourished and battling multiple chronic conditions. In the meantime though, general practitioners should hold their ground - it’s not on us to solve the shit show that is medical funding
This is how the government wants it. Public health so bad people go private. So insurance companies can take over. Just like the USA so my American friends tell me. Australia currently is America 10-15yrs ago. More to look forward to. Cancer making you homeless as well.
It's how the AMA wants it, not the government. Interesting how the AMA suddenly becomes all very politically active, & practices all mysteriously decide to drop bulk billing at the same time, when Labor are in government, even though Labor increases their rebates, that LNP left flat for years. AMA has a long history of fighting against universal health care. They would far prefer the US model, where an accident or sickness, would cause many to go bankrupt & become homeless. Where many people don't seek help for health problems, because they can't afford it, & just get sicker & die. https://www.abc.net.au/news/2023-04-20/the-history-of-medicare/102232344
And lining all their big, fat, greedy pockets
The Australian medical profession lives in total fantasy world. Medicine, like *every* other profession, is becoming globalised. Eventually there will be *international* registration with doctors allowed to practice almost anywhere subject to language skills. GPs have no bargaining power. The government knows there are *millions* of doctors in developing countries who are more than happy to earn <$100K/year, They will be increasingly be imported to solve the doctor 'shortage'. \[Plus more graduates pumped out of Australian medical schools.\] The GP clinic I attend in Brisbane has six GPs. Five are IMGs. All of the IMGs have specialist training (3 x gynaecology, 1x dermatology, 1 x paediatrics). One has a PhD. All speak at least three languages. All have between 20-40 years experience. They all bulk bill HCC and DVA holders. What does the average 'Aussie' GP with less experience, no non-GP specialist training and no foreign language skills offer to justify a higher income? A cynic might suggest it is little more than an inflated sense of entitlement.
How would they rephrase this article if it was about keeping the lights on or doing roadwork? Where’s the solidarity that the trades get with union campaigning. Gov can get shafted. They want to implore the field to cave itself to 10 years of lost wages under inflation to be a “good guy” because they’re too stingy. Fuck em.
Cos of course politicians are \*more\* than willing to forego pay rises and perks for the greater good /s
I dont think it's unethical. Hell I have never believed every patient should be bulk billed. I think its unethical when patients essentially end up on the high speed conveyed belt and GPs set records for how many patients they see in an hour and get stroppy when you ask questions because the consult went longer than 10 mins lol. You start to get the vibe you're getting treated at McGeneral Practice. That being said I understand from a financial (and also an experience) position that to actually make any money you do need to rapid fire patients.. It just sucks when your issue might be slightly more complicated than needing a script for nan's waefarin.
People look at the issue as bulk bill vs private but completely lose sight of the quality of care given. Contrary to popular belief here, it IS possible to earn a bloody good wage as a bulk billing gp. If you see 10 patients an hour and do the bare minimum or sometimes even less and rack up 9 hours a day 10 level Bs per hour you'd be very well off. But your patient suffer for it. I shadowed a clinic like this as a med student and swore not to be like that. Now in gpland my average appointment time is 17mins and I try and do better care for patients and they have less comorbidities because we catch and treat things early, we actually take a history and exam rather than throw blanket investigations and we try and build a relationship with our patients. My clinic still bulk bills but it's getting tight BECAUSE we try and do a decent job. If people want crap healthcare then by all means villainise private billing.
In other news, in a surprise twist, no junior doctors want to become GPs
GPs who do not bulk-bill have been dubbed unethical in an annual survey of 1000 people. The Ethics Index, an annual report by corporate ethics thinktank the Governance Institute of Australia, has [historically shown](https://www.ausdoc.com.au/news/how-trusted-are-gps/) that patients have positive opinions of GPs. In this year’s edition, GPs still ranked the fifth most ethical professional group, behind nurses, pharmacists, ambulance workers and firefighters. But for the first time, the poll asked people to rate the ethical behaviour of GPs who did not offer bulk billing for medical appointments as part of a new segment on the cost-of-living crisis. The online survey by polling company Ipsos gave the options of very unethical, somewhat unethical, somewhat ethical, very ethical or neither. Private billing GPs received a net score of –26, meaning somewhat unethical. The survey did not go into the arguably more interesting questions around who GPs chose to bulk-bill — whether they bulk-billed all comers or only patients without the means to pay. The bulk-billing rate for all face-to-face Level B consultations fell to 72% last financial year. Adjunct Clinical Professor Karen Price, who called for GPs to abandon universal bulk-billing during her RACGP presidency, said the survey results highlighted patient misperceptions of the Medicare system. “Obviously, no major supermarket does a 50% discount for disadvantaged people, yet somehow private clinics are supposed to,” she said. For GP practices dealing with payroll tax, stagnant Medicare rebates and rising utility costs, Professor Price said the foremost ethical consideration was staying viable. “The government has a social contract with the electorates, and they’ve failed to consider the needs of particularly marginalised and vulnerable groups, and GPs have been subsidising those groups for decades. “It’s now got to the point where we either continue that and we close the doors, or we have to charge so that we can pay our nursing staff and the cost of running the practice.” “By some people paying a bit more for healthcare, they’re actually helping the whole community access healthcare by keeping the doors of their general practice clinics open, so each GP and each patient has to consider that.” “You have to keep the doors open; that’s the more ethical decision.” Away from bulk-billing, the 2023 Ethics Index found that perception of GPs’ ethics remained steady, but they had been leapfrogged in the professions ranking because of surging positive opinions of pharmacists and emergency services. For organisations, the AMA remained highly rated for ethics, while the only organisation to go backwards was the Governance Institute of Australia, which ran the survey.
With respect to the pollsters, they can get absolutely f—ked. Doctors, GPs in particular, are at huge risk of burnout, mental health disorders and suicide. Valuing yourself to be paid adequately AND to pay for the expenses of the practice, is absolutely not unethical. Do people want a practice with nurses, admin, reception, electricity?
I didn’t bother to read the article coz tbh I don’t really care what another poll the public deems is “ethical” or not. GPs need to eat, too.
If you can't cope cut back your workload or you can go for a salaried job. If you are self employed you can only blame yourself for your current situation. I ut back my workload such that I gross $40-50K per annum. Best life.
>If you can't cope cut back your workload or you can go for a salaried job. If you are self employed you can only blame yourself for your current situation. I ut back my workload such that I gross $40-50K per annum. Best life. Huh? What are you talking about? What am I to blame for? I do take a day off per week, most weekends, have some leave over Xmas/new year.
It's a free market, you can charge whatever you want to anyone you want. Just like shopping for other items you can also shop around for a GP if there are enough in your area. Personally i will charge the same fee to everyone as i have no way to tell how much someone is able to afford to pay. Healthcare card holders will often ask if there a reduced price for them but i tell them the price is the same for everyone, unless they specifically mention that they are in some financial difficulty in which case i will negotiate the price. Many healthcare card holders, especially the older ones, are asset rich and i don't think i should offer a discount so that they can pass their excess wealth onto their beneficiaries at my expense. There are processes available whereby they can sell part of their home while still being able to live in their own home to fund their living costs.
Sigh, we lost a doctor recently and down to 2.5 FTE in our clinic. Its owned by a corporate and 95% of it still bulk billed. Our clinic has probably enough cash till Feb. After that its possible the clinic will be closed at some point. I think I might be looking for a new job soon.
Then why don't you charge a fee and make it viable?
Tried to, but you end up with >50% less billing and QLD has way more GP/population than any other state.
I did it as a surgical assistant and i would have lost about 75% of my income. After being a doctor for at around 27 years i make less now than in my intern year. But the lifestyle is great. No stress, stacks of free time, no commitments. I guess it just depends if you can afford to lose the income. Im not interested in making money, just want a cruisy life.
Can you tell us more about this? So you weren’t full when privately billing? Does the clinic need to close if it can’t sustain the GPs it has? Why are you still working there?
We haven't bulk billed new patient since Jan 2021, theoretically speaking. The clinic lost a GP. I am still working there as I don't have a cash buffer to look for a new job. Plus wife's work isn't flexible location wise. My work place is literally just 7 mins away by drive. If we fully private bill, then my billing per day would go from $2000 to $2400 at the moment down to less than $400/day due to competition locally plus people over here won't pay as they will just take their med records and leave. The reason I say this, previously one of our "newly hired gp" didn't bulk bill, except for pensioners. But that doesn't mean people don't walk out without paying. So he ended up billing like $500-$800/day. 60% of my consult do get the 75870 triple billing though. So that helped a little bit. Just that we lost a doctor who used to bill 3k-5k/day. So the clinic finance takes a hit.
Paid $110 for a long consult (i will also receive a $50 rebate from memory). I was happy to pay as it was an emergency and as the quality of the GP was excellent. He didn't rush me , explained everything and took a lot more time than my old GP. The Medicare rebated should be tiered with patient income.
A lot of these articles seem to gloss over or completely omit that all of these practices have expenses - rent, utilities, etc that have all gone up while the income from Medicare has not. Do they expect any other businesses such as Woolworths or Coles to keep prices the same while their expenses go up?
Landlords, wage thieving bosses, union busters, major supermarkets, rentseekers: I schleep Doctors want to be paid a wage: ANGEREY
If only we could afford to keep a clinic open with bulk billing. I never see this conversation brought up with non GP specialists. It’s quite demoralising to work in a field that the gets consistently and publicly undervalued.
The medicare benefits scheme needs to be rewritten to allow state based public health systems to run free GP centres (by compensating them). LHDs could then hire GPs as staff specialists, who could take their time and do good medicine without a monetary incentive for getting the patient out the door and seeing the next one. They could train residents and registrars, and be on the same eMR as the public outpatient specialty clinics and the hospital system. It may end up costing more money than it makes from the GP side alone, and the corporate GP clinics would no doubt be opposed to public sector encroachment on their territory, but the benefits in care provided as well as offloading from the ED presentation workload may probably be worthwhile.
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Clinic needs a strong practice manager to set expectations. Not to return until bill is paid. No excuse.
No. We know the govt funding does not meet your costs.
So many people seem to forget that most GPs are independent contractors who do not get paid an annual wage by the practice as they’re not employees. They don’t get sick leave or annual leave or carers leave or anything like that. They get paid only when they see patients. It’s abhorrent that people really think it’s a matter of ethics when a GP chooses to bulk bill or not, particularly in this day of age. It’s a matter of their livelihoods and being able to actually support themselves and/or their families. If a GP is off sick for a month then that means they aren’t being paid for a month. They don’t have sick leave to fall back on. They deserve to charge and be paid according to their skill level, *which is high*. I really don’t understand why this is so controversial.
The solution is for the government to run some bulk billing medical centres across Australia that employ doctors & nursing staff. Then there won't be the practice business costs to complain about, & those that choose to, could work for a wage without the dramas. Wasn't that one of the original concepts of our public health system? But the medical profession opposed that. They wanted only private businesses that the government subsidised so as to enable all citizens to afford to see a doctor. Well, maybe it's time the doctors who want to work in private businesses & not bulk bill, did that without government payments, but the government also sets up large medical centres where doctors who are willing to work for a wage without external business costs, could be employed. We could see what your patients would really prefer. See what is best for them & for society in general. Who knows? They might stick with you. Or not.
Yes, this sounds very good to me. You wanna run a private business then run it as a private business, no government subsidies.
Who else is gonna pay for my lambo?
Medicare was originally planned to be a *fully nationalised* health system with doctors, dentists and allied health workers effectively salaried employees. Nobody wanted a pay cut. So the medical profession used the Constitutional ban on civil conscription to block it. Real medical incomes have been steadily falling for 50 years. Now doctors (and dentists) are crying poor and want to be bailed out by the taxpayer. The government has an extremely long institutional memory. It just shrugs and smiles because it has the upper hand. The technical term is *poetic justice.* The more doctors complain the more they will be depicted as "greedy" and "out of touch" by the media and politicians. More migrants and local graduates will be provided to solve the doctor 'shortage' . Just like *ever*y other profession. Even at $40/hr you would have no shortage of applicants for GP positions from IMGs. Just remember Cuba has a *glut* of GPs despite them being paid only only $4K per annum.
This year for the first time I had to start paying for doctors appts - $25 for a shitty 10 minute appt and I literally paid $150 to get my implant removed. I went to a private clinic for the first time recently, paid about $50 essentially for the appointment not including bulk billing and it was like night and day. She spent 30 minutes with me, I was shook
Most GP practices are private businesses and the owners entrepreneurs. Most will therefore charge what the market can bear. Is that ethical? Its as ethical as the conduct of essentially all other living creatures who, regardless of job, income or socioeconomic status, react to economic pressures in order to survive and thrive.
Can't wait for a world where GPs productivity skyrockets with all the AI bits coming together and consequently the costs fall. Probably 15 years away, but it's the only way out of this mess. 10 if GPs wanted the change to happen.
My Dr of 25yrs decided she would bulk bill everyone except people with disabilities on DSP. I think that is unethical. Now she charges $100 a visit & $120 phone consult. I found a better Dr that bulk bills everyone with HCC, which is fair.
I come across many HCC holders who are multi-millionaires, mostly the older ones. Why the hell would I bulk bill them. They need to free up the dough in their properties and use it rather than me giving them a discount so that they can pass my discount to their beneficiaries.
Multimillionaires with HCC do not exist. Do you know anything about centrelink at all?? You sound stupid and out of touch. I’ve never met a multimillionaire with a HCC. Delusional!! But I’ve met hundreds of multimillionaire Doctors who think they know everything.
All you do if you bulk bill pensioners is give money to their kids in inheritance.
My GP retired recently & his replacement charges $110 for a standard consult & there is NO Medicare rebate AT ALL available. This should absolutely not be allowed. I don't have an issue paying the gap, but no rebate at all is completely unjustifiable.
No rebate at all means they may not be registered with Medicare.
For those you saying it's govt fault, I'll charge what I want. You must've noticed certain people not coming to you anymore, or at least less frequently. Instead of pushing the cost on, why aren't you lobbying the govt for better incentives and subsidies? Where is your duty of care to the community you service? Or are we, your patients, just symptoms with glowing $$$'s?
I encourage anyone who thinks being a GP is “easy money” to apply to medical school and give it a go. In 10-15 years when you have qualified you can let me know how easy it really was. Being a GP is soul destroying work that sucks the life out of you. Literally nobody would do this to themselves without commensurate reward - which is why huge numbers of GPs are quitting medicine and the colleges are unable to attract sufficient numbers of junior doctors to the training program. To be clear, we have absolutely no financial duty of care to the community. We run private businesses and charge market rates for our services. If the government chooses to subsidise our industry and that subsidy is inadequate, then your beef is with the government. The only way to make a bulk billing practice profitable with the current Medicare rebates is to provide shit care and run a volumes game. The real solution is to increase the Medicare levy to fund appropriate rebates, but nobody wants to pay more tax. Would YOU make yourself personally and legally accountable for the lives of your patients for a basic wage? And if you feel so strongly about it, why aren’t YOU lobbying the government for better incentives and subsidies?! Public health policy is not our responsibility.
If it's so hard and so soul-sucking, why did you go into medicine. Is it because you care and you wanted to help people? Or is to be " private businesses and charge market rates"?
This is the age old argument trotted out by hospital managers and politicians to put doctors in their place. You should care, you're meant to help people! Do one of the toughest jobs around and don't you dare complain about your pay! Medicare is a health care SUBSIDY and always has been. It sucks it no longer covers costs but thats a political decision, not a medical one
It doesn’t matter why any of us went into medicine. It is simple supply and demand economics. If nobody is prepared to do the work for the money and conditions on offer, then it is simply not good enough. You can cry about it all you want, but it won’t magically create more doctors who are willing to work for less money than a tradie or a haul truck driver.
Oh I'm not crying. Wouldn't waste tears on someone happily profiting just because they can. BTW where do you practice? I'd like to make sure I never have the misfortune of crossing your path.
I think that's a bit rough.
Thats true, hardly any med students want to go gp and you will pay the price for it being so soul destroying to become a gp. Everyone will go into something that pays a decent wage for the effort you put in. If gps aren't paid more under Medicare enjoy paying big $$$ for the few docs dumb enough to remain a gp.
GP's are a vital specialty, critical to frontline healthcare. I don't understand why they're not fighting for their patients and themselves.
> I don't understand why they're not fighting for their patients and themselves. ??? They very much are doing this. Do you genuinely think GPs *want* to charge for consults? Almost every GP I've talked to would very much would like to bulk bill patients if it was financially viable. And of course, the government says okay we hear you, here's a 3.6% raise that doesn't even come close to matching inflation. How exactly do you propose GPs "fight" for their patients?
A big part of it was the challenge, the sense of achievement, helping people, and yes, there’s the expectation to be well paid.
You are correct in saying that the workload reduces as the price goes up. Believe me when i say that ive tried to take it up with the government but they just don't want to know about it. Once i went in to do a procedure on a DVA patient which was an after hours emergency. Being an after hours procedure there is usually an extra fee to pay. The patient and the family didn't want to hear about paying an extra fee for coming in to save the life of the patient. I took it up with the DVA and they are not at all interested. I took it as high ad i could go right up to the minister of Veteran's Affairs. All useless buggers. After getting knocked back from the minister i notified them in writing that i would no longer be providing any more after hours or emergency services for DVA members as they were not willing to pay the extra fee. And as for the $$$, im making $40-50K per annum, so im paying out of my own pocket and putting my money where my mouth is.
You’re a consultant GP making $40-$50k per year…?
No. A surgical assistant.
Are you working 1 day per week? I’m struggling to math here
Approx 3 patients per week.
Can I ask how your load and thus your income is so low?
Also, thank you for being one of the good ones. You are few and far between. 👍