Media release – Andrew Wilkie, Independent Member for Clark, 7 March 2022
Medicare rebate rise key to curing GP crisis
Independent Member for Clark, Andrew Wilkie, has joined Royal Australian College of General Practitioners (RACGP) Tasmania Chair Dr Tim Jackson to talk about the worsening GP shortage in Tasmania and what needs to be done to fix it.
“My office is being contacted constantly by sick people unable to get an appointment to see a GP, let alone one who bulk bills,” Mr Wilkie said. “Indeed the peak body for general practice, the RACGP, says there are currently more than 60 GP positions vacant across the state including 19 in local government areas in Greater Hobart.
“Inevitably patients who can’t see a GP in a timely fashion wind up delaying treatment until they land in the emergency department or go without care altogether. Moreover, ED waiting times in Tasmania are already well below acceptable levels, so clearly something’s got to give.
“Without serious reforms in the primary healthcare system, including a long-overdue increase in the Medicare rebate, the situation is only going to get worse. Until the rebate rises, making healthcare affordable for patients and ensuring GPs achieve pay parity with colleagues working in hospitals, the GP workforce will continue to contract, sick people will continue to wait longer for treatment and the already overloaded acute-care system will bear the burden.”
Dr Jackson said there had not been enough investment in the general practice workforce, which had led to many communities facing severe shortages of GPs, particularly rural and remote areas.
“The lack of resourcing has led us to the point where only 15 per cent of final year medical students in 2019 listed general practice as their first-preference speciality future – the lowest number since 2012,” he said. “We must reverse this trend immediately, because everyone in Tasmania deserves access to first-rate general practice care, no matter their postcode.
“Tasmania, just like many other parts of Australia, is at a critical juncture when it comes to the GP workforce and the choice in front of us couldn’t be more stark. Governments can continue on the current trajectory and we will see more and more communities under-serviced by GPs who are spread too thin. Or governments can put general practice on a more sustainable, long-term financial footing including increases to Medicare rebates. If we change course, the task of attracting junior doctors to this career path will be made so much easier.”
Media release – AMA Tasmania, 9 March 2022
GENERAL PRACTICE – THE PERFECT STORM
AMA Tasmania welcomes MP Andrew Wilkie’s announcement earlier this week on the state of play of general practice in Tasmania, particularly shining a light on the growing shortage and calling for the long overdue Medicare rebate rise.
Dr Helen McArdle, President AMA Tasmania, said, “We see the perfect storm brewing in general practice in Tasmania with rising costs, more complex cases, a sicker older population, attraction, and recruitment at an all-time low, and lack of pay parity with colleagues in the public system and other specialities. Very few GPs can afford to offer bulk billing, and many practices have closed their books. General practice vacancies across the state are rising exponentially, combined with a falling number of young doctors applying for the general practice training, so patients are left behind. As a result, Tasmanians are getting sicker and delaying care until they require an urgent visit to the emergency department for assessment.”
Government investment in this area has not matched the increase in costs and demands, with rebate freezes and inadequate indexing contributing to the lack of financial support in providing high-quality care.
Greater flexibility is needed in the current models, with many programs and incentives not likely to impact for years.
General practice needs the support and mechanisms to evolve as the community needs change. But at the same time, there is a desperate need to make changes now.
Unless significant amendments are made, the future of general practice in Tasmania is not sustainable. The already overburdened public hospital sector will be overwhelmed, and the community’s health will deteriorate even further.
We know the COVID-19 pandemic has shone a light on the inadequacies of the public hospital system. However, it has also highlighted the long-term under-resourcing of general practice. Reinforcing the AMA’s long-held view that general practice is at the centre of patient care. Still, unfortunately, it has also “shone a light on the significant challenges faced by GPs” with successive governments failing to address resourcing. With fewer young doctors choosing the general practice pathway, depleting an already stretched and overworked system.
“People can’t get into their GPs, and GP remuneration is rubbish for an exceedingly difficult specialty. Young GPs are leaving or going part-time and older GPs are leaving the sector earlier than planned because it is not worth the stress of remaining in a system that does not work.
Our general practitioners are at the front line of healthcare with many risking burnout. They are the people we turn to first when we are sick. They are also a workforce in crisis and need support to manage the increasing demand for their services on less and less returns.
The Federal government must increase the Medicare rebate to keep healthcare affordable for Australians while also ensuring that doctors are commensurably paid to their hospital counterparts to keep this pathway attractive for new medical entrants. We risk losing our critical general practitioner workforce if we do not do this.
The minimum conditions of employment for GP registrars mean that they can expect to be paid far less than their public hospital doctor counterparts. Since 2015 the number of applications for GP training places has almost halved, and there has been a drop in the number of first-year GP training posts filled. Similarly, there has been an overall decline in medical students expressing interest in a general practice career at graduation. In 2019, only 15.2 per cent identified general practice as their preferred specialty for future practice. This is despite Australia now graduating around 3700 medical students each year.
Dr Helen McArdle added, “we would like to see the federal government agree with the Tasmanian government to fund a ‘single’ employer model for GP registrars in Tasmania, designed in consultation with the profession, to deliver improved remuneration and employment conditions for GP registrars that achieve pay parity with their public hospital-based colleagues.”
Medicare rebates once covered 85% of the AMA recommended fees, which is now well below. The Federal government must increase the Medicare rebate to keep healthcare affordable for Australians while also ensuring that doctors are commensurably paid to their hospital counterparts to keep this pathway attractive for new medical entrants. We risk losing our critical general practitioner workforce to higher-paying medical specialities if we do not do this.
While the Medicare fee-for-service model must remain the central funding pillar for general practice, primary prevention and managing more complex chronic conditions require supplementary funding.
Increasingly, the AMA is hearing of GPs electing to retire earlier than initially planned despite shouldering the guilt of knowing there may not be a replacement for them.
The culminating pressures of longer hours, difficulty in recruitment, increasing costs, pay parity, and more complex patient demands push them out the door earlier.
Aside from the pay parity issue and the stalled Medicare rebate, the Modified Monash Model is an area, particularly in Tasmania, which would benefit from an overhaul, alongside the implementation of other measures such as real-time ICT connection across the entire system, GPs role in maternity care, and establishment across all regions of Tasmania of the successful Urgent Care Centre New Zealand model that provides low-level GP emergency care after hours and for a short stay if required run under a cooperative model of GPs in the local community.
General practice is the humble foundation of a world-leading health care system providing exceptional care and coordinating access to the rest of the health system.
General practice desperately needs help now to avoid patient care across Tasmania suffering.
