457 doctor flood blows out Medicare

By Leith van Onselen

Mike Moynihan and Bob Birrell from the Australian Population Research Institute have released a new report entitled “Why the public cost of GP services is rising fast”, which pins much of the blame for soaring Medicare costs on a blow-out in the number of doctors, which has easily out-paced growth in the population.

This massive oversupply of doctors is being made much worse by a conga-line of overseas trained doctors (OTDs) that enter Australia to work in a regional area only to then move to the already-oversupplied city once their mandatory term is up.

The below extracts explain what has happened.

Since 2004, successive Australian governments, ignoring advice at the time from the Australian Medical Workforce Advisory Committee (AMWAC),2 have taken as their policy starting point that there is a shortage of GPs. These governments have responded by increasing domestic medical training and facilitating an open program of OTD recruitment. Despite mounting evidence to the contrary, belief in ‘doctor shortage’ has developed a life of its own…

The number of GPs per 100,000 people in Australia far exceeds international benchmarks, especially in Anglophone countries. According to independent Australian assessments, by 2005 on this metric, there were already more GPs than was consistent with good medicine. Since then, as the following tables show, the number of GPs per 100,000 has increased sharply in metropolitan areas and even more so in some regional areas…

ScreenHunter_13258 Jun. 01 08.27

Given present policy settings, this oversupply will get much worse as many of the OTDs required to serve in undersupplied areas finish their service commitment and move into already oversupplied metropolitan or regional areas. Then to fill the gaps created by their departure, their employers recruit yet more OTDs to replace them. There will also be a flood of new Australian Trained doctors (ATDs) into the GP workforce. They can practise where they please which, if past experience is a guide, will mainly be in metropolitan areas…

As is shown in Table 2, which tracks the statistical record over a longer time period, the number of GPs per 100,000 and bulk-billing rates bottomed out in 2003. This outcome was a consequence of policies carefully designed to limit the number of GPs during the 1990s. This advice was based on the AMWAC and AIHW studies referred to above. By the early 2000s, these consequences had prompted a public outcry as bulk-billing rates declined and regional and outer metropolitan areas struggled to recruit GPs. The then Coalition Government, and governments since, responded by increasing the number of medical school places and by facilitating the recruitment of OTDs.

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As shown above, the number of doctors in Australia rose by 47% in the decade to 2014-15, around 2.5 times the 19% growth in the overall population.

Moreover, much of this growth has come from OTDs, whose numbers have ballooned-out by a whopping 111% over this period. Most of these doctors are also practicing in over-supplied metropolitan areas, not areas of shortage:

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The purpose of the OTD promotion policy was to get more doctors into underserviced areas, particularly RA 2-5 areas. But Tables 4 and 5 show that most of the extra OTDs, by 2014-15, were practising in RA 1 areas.5  Of the total increase in OTDs (6,946) shown in Table 3, 4,520 were practising in RA 1 areas and 2,426 in RA 2-5 areas.

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What has happened is that there has been a gradual leaching of OTDs into RA 1 areas where there is an ample supply of doctors, as well as into the more attractive provincial cities such as Ballarat, Bendigo and Shepparton in Victoria, where the situation is similar…

Alarmingly, the report notes that OTDs are not only responsible for much of the doctor oversupply, but also the blow-out in Medicare rebates:

The OTDs influx is therefore responsible for most of the growing oversupply of GPs in RA 1 locations. They are also responsible for most of the increase in Medicare service costs. By June 2015, for all of Australia, OTDs made up 39.7 per cent of the workforce but received 49.8 per cent of total rebates. In RA 1 areas they made up 38.1 per cent of the total workforce and received 47.6 per cent of services paid for by Medicare.

And the situation is only likely to get worse:

[OTD] numbers have been rising at up to 17.2 per cent per annum since 2010. Some 53 per cent of these OTDs were located in RA 1 locations and the rest in RA 2-5 locations…

There are no rules stopping OTDs who jump the stipulated hurdles from moving, no matter how oversupplied their chosen location is. The second is that most GPs of whatever background prefer to locate in the big cities because of family preferences, proximity to top schools for kids, opportunities for research and the desire to be near family and ethnic community in the case of many OTDs.

Third, and very importantly, there are still lucrative jobs being offered. This is particularly the case for corporate practices. More of these are starting up because corporates with big money backing are in the best position to invest in new clinics. Corporates have been offering highly lucrative contracts on the condition that those employed accept their style of medicine. This is high throughput and depends on the availability of bulk billing. It is notable that advertisements for such contracts dropped off in the brief period that the Coalition Government was proposing a copayment. After this proposal was abandoned, advertisements for staff again proliferated…

There is no end in sight. With supply well ahead of population expansion, the competition for patients is set to get worse. In the case of the recruitment of OTDs, the Government has taken no notice of the GP oversupply. It continues to allow employers to sponsor new OTDs to DWS locations. So, when OTDs leave, many are being replaced. In 2014-15 there were 1,132 OTD GPs sponsored on 457 visas and in the first six months of 2015-16, another 582. Also, the Australian Government has left GPs on the Skilled Occupation List of occupations that are eligible under the permanent-entry skilled migration program. Hundreds of OTDs are being granted such visas for service in DWS and hospitals each year. Again, once they have completed their service requirements, they can practise where they please.

For those wondering why, with so many GPs already in Australia, some employers continue to sponsor more, it is partly because of the vacancies created as OTDs move out of DWS and partly because GPs employed on 457 visas are central to their business model. Those on 457 visas have to serve in the practices they are sponsored to and, as a result, can be paid very much less than ATDs or OTDs who do not have to practise in DWS locations…

The consequences of which are a continued blow-out in bulk-billed GP visits and Medicare funding costs:

As noted, by international standards the ratio of doctors to Australia’s population is already high. And, as documented, it is on course to get higher. This is the main reason why the share of GP consultations that are bulk-billed has increased from 68 per cent in 2003 to 84 per cent in 2014.10 It is also the main reason why, as Table 2 shows, the number of services per patient has steadily increased across Australia since 2003.

It could be argued that, with more GPs available, more patients have availed themselves of their services with resulting better health outcomes. A more likely interpretation of the extra services provided is that, because of competition for patients, GPs have managed their practices so as to ensure that they reach a target income level.

They are in a good position to do so because the almost universal availability of bulk-billing means that patients do not have to dip into their pockets. GPs can, for example, engineer extra services by recommending various tests for possible illnesses, and then prompt patients to return to discuss them. For corporate practices, where the GPs engaged are encouraged or even expected to deliver an identified income stream, such ‘management’ practices are highly likely to be utilised. Table 6 shows how Medicare funded tests per capita have risen over the past ten years.

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A situation where GPs have to chase patients is not conducive to good medicine. GPs need assurance of a reasonable patient load in order to exercise discipline over patient expectations for medication and maintain professional standards. If GPs could be induced to serve where they were needed, this would encourage better medicine and slow the growth in GP costs to the taxpayer.

This will mean, as a minimum, cutting back on OTD recruitment and no further expansion in domestic medical training for the immediate future. (Alternative models of delivering GP services also need to be considered.) The government should also refuse to grant provider numbers to GPs (whether OTDs or ATDs) where the locations are already manifestly oversupplied. It would not amount to conscripting GPs to serve where they are needed. Rather, it would simply inhibit them from locating where they are not needed. As indicated, the Australian government already does this for newly arrived OTDs. They have to serve in DWS locations.

Yet another 457 visa rort rears its ugly head.

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Unconventional Economist
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Comments

  1. what is also blowing out healthcare is people attending an ’emergency’ department with anything but an emergency eg a sprained ankle, a cough etc…I know many emergency dr’s that state that 30% of their workload is this, and unfortunately EVERYTHING needs to be checked out

    that’s why we should have a copayment of say 20 bucks for emergency visits like the kiwis do

    additionally most of the ‘dr at home’ who do housecalls now would be foreign trained

    I also know of gp’s who regularly bring nanna in every week for a ‘chat’ about their health…talk about over servicing

    most medicos do a sterling job though in the face of overwhelming public demand

    • Ronin8317MEMBER

      Indeed. I think GP who open after hour to treat non-emergency cases but charge ’emergency rate’ should be banned from bulk billing.

      • Spot on.
        This is just another side of the endless Skills Shortage Myth that now has become an industry and vested interest and political force in itself. The trouble with medics and the private health industry is that they can always find something wrong with patients that needs treatment, so we are moving towards America’s over medicalised, situation step by step, until the state can no longer afford the cost. Oh, what a nice scam.

    • drsmithyMEMBER

      Why are people going to emergency departments for non-emergencies ? Because they don’t know any better ?

      • -misguided attempt to deal with lengthy waiting period for the GP, or deal with some GPs brief opening hours?

        In other words, sheer desperation?

      • Could there be a link between private not covering excluding many things that aren’t emergency related?

    • talk about over servicing

      most medicos do a sterling job though in the face of overwhelming public demand

      Part of that “sterling job” is to help create the “overwhelming public demand” through over diagnosis and over treatment. The health industry is turning into an out of control juggernaut that is bleeding the country more and more as time goes by. Vinay Prasad writes about the growing excesses of the medical industry including the growth of unproven and outrageously expensive treatments (more the USA than here, but we’ll get there): http://www.vinayakkprasad.com/news/

  2. The Patrician

    Has anyone used that “24/7- 100% bulk billed – House Call Doctor” service?

    • I have a family member who uses one. I live in a regional area so I was surprised the first time I learned there was such a thing as house call bulk billed GPs for non-serious illness. I guess it makes some sense though. A GP office filled with every variant of illness going around is probably more dangerous than a doctor going door to door.

    • Yep – it’s awesome.
      They come to your house, no waiting room. Bulk billing is just icing.
      Bit of a lucky dip, but so far the doctors have been no less knowledgeable. Actually, as the high fee charging surgery we also go to doesn’t always have the doctor you ask for available, and you frequently end up with a trainee, the actual medical knowledge has been better on the average.

      After reading the comment by LSWCHP below I’d like to point out that the waiting time is usually longer than 2 hours, it’s just not as inconvenient as you’re at home and can convalesce in bed or otherwise get on with your day. My benchmark is that when I make an appointment for the fee charging clinic, I still usually have to wait half an hour to an hour when I arrive on time.

      • The Patrician

        Thanks Robert.
        I haven’t used it but if it is anywhere near as good as you say it has to be a step forward in health care on a number of levels.

    • The bulk billed home doctor service is also blowing out medicare. A Doctor friend re-posted this on her facebook page a couple of weeks ago

      Do you or your family/friends use an After Hours home doctor service?

      I’m sharing a post from a colleague explaining some of the issues with these businesses.

      “I know we all love the convenience of a bulk billed doctor directly to your door but I wanted to tell you a little about these companies ( and I know a little as I used to work for them).

      Every time the home doctor comes to your door they bill an ‘urgent after hours’ attendance number to Medicare. This costs approximately $130 – $150 billed directly to the tax payer (us).
      A normal bulk billed GP consult costs around $39.
      There is a ‘non urgent’ number that these companies could use which is around the $40 mark however they choose to bill everything as ‘urgent’ in order to maximise their profits. This is why they only operate ‘after hours’ and not during the day.

      There is also a training loophole where these companies are allowed to act as ‘remote trainers’ for huge numbers of overseas trained doctors who aren’t yet properly qualified GPs. That means that often the Dr who sees you is an RMO or registrar who’s never worked in a normal practice. They’re delighted to be earning $80 a call seeing mildly unwell children and people with the flu instead of training in a normal practice for less money. There also happy to give you whatever you want as they need to get out the door quickly and onto the next $140 call.

      One of the biggest frustrations I found when I worked for them was that they really weren’t equipped to deal with anything other than minor complaints which could have waited until the next day. We were specifically told not to order blood tests or imaging as there was no facility to follow these up. Anyone who was more than slightly unwell was sent straight to emergency for further management which meant a double bill to Medicare.

      Over the last two years the increase in these services has more than tripled the amount of money being spent after hours to over $250 million yearly. Half of this goes to the dr and half to the faces behind the company. None goes back into healthcare.

      This obviously means that there is significantly less funding to hospitals and healthcare nationwide.

      I understand that it’s convenient for you to have a dr come straight to your house.
      There’s definitely a place for this but I really don’t think we should be using it like we’re dialling for a Chinese takeaway.
      It should be reserved for those too frail to get to a surgery or for urgent assessment when ED is the next step. See your GP during the day or go to an after hours centre for minor complaints and scripts. I promise you’ll usually get a much better qualified doctor.

      If your matter isn’t urgent please request that the doctor uses the non urgent item number when billing Medicare and ask to see evidence of this.

      I’m not trying to tell you what to do, I just want to make you aware of how the system works.
      It irritates me so much that these companies are ripping off Medicare in order to line their pockets when we’re already so short of funds.”

      https://www.facebook.com/photo.php?fbid=10153269959931572&set=a.10151067081066572.426848.728776571&type=3

  3. I lost my regular GP about 18 months ago so I’ve been using the local super clinic for a while.

    Despite claims of an excess of doctors, the place is chronically understaffed, and I’ve never spent less than 2 hours waiting, and on a couple of occasions I’ve waited 4 hours. Many people get turned away by the receptionists later in the evening, as the queue is too long. The place is always packed because it bulk bills and I expect that they don’t give a shit about long queues because they’re making out like bandits anyway. In fact, one of the GPs from the clinic featured in a sex related malpractice suit a while ago, and his income was reported in the paper as being over $600K, which seems pretty damn good for a suburban GP.

    All of the doctors at the clinic are foreigners…African, Asian and Indian. In general they seem to know what they’re doing. Almost all of the patients are also foreigners. You’ll hear every language on earth being spoken, including English occasionally.

    Receptionists won’t advise when pathology tests are available, so you have to wait in line for hours to see a GP hoping that your results are back. If they are not, you get bulk billed for a standard appointment that takes one minute to say “Come back tomorrow”. Maximising cashflow is the aim of the game.

    Overall, it’s ok for the treatment of minor ailments, except that our apparent oversupply of doctors hasn’t affected this practice, and their obvious focus on throughput and cashflow is a turnoff.

      • ACT. I dunno where all these bloody surplus doctors are, because they’re not here. My experience has been long waiting times at ED, long waiting times at big clinics, days to get an appointment with a GP practice and practices not taking on any more patients because they can’t deal with their existing patient load. It’s pretty rubbish.

  4. fewlishMEMBER

    Yet another example of public largesse providing private profits (think HECS/FEE HELP/ Vocational Training disaster) – great idea, poorly implemented and without proper oversight to mitigate gaming of an important public service.

    You only have to swing out my way (middle western melbourne) to see bulk billing clinics appearing at almost epidemic levels – the fact that these practices outnumber McDonalds at easily 6 to 1 within 4 kms of my current location shows the level of profitability in providing a ‘free’ public service

    Add to this a year with a baby and the sheer number of visits to our local GP (I would say around once a fortnight on average – since childcare started perhaps once a week (!) multiplied by the new families in our area and its easy to see a fool proof business model. I can personally vouch for overservicing, such as follow up visits, which on the surface appears to be a good thing, but lets face it you can hear the public change falling into the jar every time the doctor (usually OTD) recommends coming back ‘in a few days’ for follow up – and don’t me started on the antibiotic prescriptions

    OTD in my eyes is fine, and in our experience can be as good as any ATD (especially in lessening the real reason for a lot of the visits – the mummy guilt/worry factor) – however you get the feeling these new clinics may be taking a leaf from the 7/11 model in terms of their staffing mandates.

    • In my area we have too many massage / nail parlours, too many real estate agents, and too many doctors clinics.

  5. This seems to be a report sponsored by the AMA. Hold the number of doctors graduating and practicing down to keep their incomes up and then by association prestige etc up. This is a travesty. There should be a quadrupling in doctor numbers especially in hospitals. They should never work for than a 10 hour day so to reduce errors of doctors working 16 hour days and making mistakes that are to hard to hold them accountable for. Reduce their incomes proportionally as they wrecking they work harder and longer than the rest of the working population and thus justify their average incomes of 500k+. Open universities for anyone to enter medicine but keep standards for passing very high. That will allow those with a passion to help others enter the profession instead of those who enter medicine because of the incomes it provides.
    More doctors, means less waiting lines in hospitals. Means more collaboration between them selves and thus better patient outcomes rather than the specialist God complex most of the elitist specialists have that they simply don’t deserve.
    Medicare needs to be reformed to reduce costs. The advice is one large structural change and i am for a nominal charge to see a GP or emergency care to stop the visits by those who simply use a doctor visit as a social exercise.

    • The Patrician

      +1 As long as standards are maintained, I fail to see how having more doctors is a bad thing.

      • …espcially as our ageing population means the medical workload per 100 people is on the rise.

    • KategedMEMBER

      4x the number of doctors in a hospital equals 1/4 of the training experience. It’s an apprenticeship for a long part of the career. Be careful what you wish for.

      • By implication, your suggesting that fewer doctors seeing more patients assists their development and as such the care the patients early on in a doctors career get is lower than those in the later part of their career!!! Then the training regime needs to change but i know more heads solving a problem is better than a few heads and i mentioned higher collaboration between them for that reason ( yes that requires change in culture and management as it does in banking or law or any other profession ) and we now have training aids and technology to help that which was not available 10 or 15 years ago. I don’t believe more doctors will lead to worse outcomes, quite the contrary i think outcomes will markedly improve. Also for context, i have had family in and out of hospitals with cancer and or auto immune disorders and i have been less than impressed with the knowledge of the specialists attending to my family ( trees these were difficult cases). In one case we got a diagnosis only after pushing three specialists to talk to each other as the family member had symptoms that crossed their body and in the end an ENT specialist called the diagnosis which belonged in the rheumatologists area but it was an up hill battle and put my family member through pain and allot of frustration for us. And had we not pushed, i hate to think of the outcome. I don’t think our experience is unique. I want to see far more specialists in the hospitals.

    • KategedMEMBER

      There is higher supervision early in their career which is gradually reduced. If you’re happy to have someone treat you who has watched a video or played on the simulator then go for it. Along with collaboration, education and audit of outcomes, seeing volume of cases is critical to learning clinical medicine.

      • We’re obviously not going to agree so let’s agree to disagree but as a parting comment i also am a strong supporter off technology in medicine. I look forward to the day where diagnosis is substantially computer aided and eventually surgery conducted by robots ( not remotely controlled by humans but fully autonomous a bit like driving cars ). At that point, I’d be happy with doctor numbers falling. Remember to anyone who is not a doctor, medicine is not about objectivity, not a case or patient number – it’s about life, yours, mine and our families. Good health should not be a privilege it should be an absolute human right – globally! If your a doctor or health professional – i mean no offense. I understand your perspective but i think there are answers to your concerns if change is welcomed.

    • drsmithyMEMBER

      The advice is one large structural change and i am for a nominal charge to see a GP or emergency care to stop the visits by those who simply use a doctor visit as a social exercise.

      Do you have any actual data on how many low-income people are using “a doctor visit as a social exercise” ? Because I’ve been waiting for somebody to provide some every since this whole co-payment idea was floated.

      • “a doctor visit as a social exercise”

        A notion that can only be floated by someone who has never visited a busy doctor, or sat in a suburban GP’s waiting room.

      • No i dont. I don’t think anyone is recording this information. So how do I know. I have friends and family that are doctors and so am familiar with the unemployed and lonely elderly patients visiting them and also the gaming of the system to get patients to come back for check ups since their payments are not being indexed. Now i can’t prove this and I’m not going to name names. I work in financial services and morality is a lost notion in this self obsessed world we live in so not having a go at doctors or health professionals. This stuff is endemic around us in Australia, government, construction, you name it but this probably always been the case, in the time our egyptians and Romans alike. Anyway to topic that’s why the co-paymemt was 7 dollars and not 50-70 dollars which you pay when you go to a doctor in NZ. The seven dollars is just suppose to take some cost pressure out of the GP payments system while leaving care being affordable for all. Yes we can argue that those on minimum wages struggle but instead of bashing a co-payment we should address how to get people of minimum pay jobs or increase the number of doctors to bring down their pay which is just economics 101. Time to quit this here and leave it to the politicians.

  6. Tassie TomMEMBER

    I’ve got a couple of comments about the article:

    1) Regarding the “GPs to population” and “services to population” ratios, it ignores that the population has become older and sicker in that time. A “GP services to population aged over 60” ratio, although still crude, would probably be more informative.

    2) I don’t like “6-minute medicine”, but we’ve created that by not indexing the Medicare rebate properly. A lot of fee-for-service things have not kept place with inflation but total income has kept pace due to productivity improvements. For example, a farmer growing a tonne of wheat can do it much more cheaply now than 120 years ago now that they don’t have to plough with oxen, hand reap, and hand thresh it before bagging it up. So although a tonne of wheat would be cheaper now in real terms than 120 years ago, the farmers’ incomes may not have dropped.

    The only way a GP can improve productivity is to compress their appointment time. Guess what? – they might actually need 15 minutes to sort out all the issues. So one appointment becomes two appointments. The patient doesn’t really care as long as they’re not out of pocket.

    Now we have an 8-year Medicare freeze. Does the government expect an 8-year freeze on the wages of receptionists and practice nurses, on the prices of practice rent and consumables, on the wages of lab technicians in pathology labs and of radiographers in radiology suites?

    • ‘Doctors dispute claims of a GP glut…… ELEANOR HALL: We’ve been hearing for years about a shortage of doctors in Australia.

      Now the Australian Population Research Institute is warning that there is an oversupply, and that this is driving up Medicare costs.

      But the GP lobby contests the findings, saying while some cities may be oversupplied, there is still a shortage of doctors in rural areas and that the key issue is how to even out the distribution…

      ….A granddad will see a GP as many times in the year as his granddaughter’s netball team will altogether.’

      http://www.abc.net.au/worldtoday/content/2016/s4473388.htm

      Seems more about nobbling Medicare (like ABC, etc.) under the guise of neo lib inspired cost savings, in addtion to the more ideological or neo con, i.e. medical care only encourages poor people, oldies and immigrants to live longer…..

  7. Jobs and Growth, Jobs and Growth, Jobs and Growth

    Jobs for foreigners
    Growth of property prices

  8. A doctor glut is not a good thing. Unlike other professions, a medical degree is not useful for anything outside of medical practice. Ask your selves would you employ a doctor to do anything other than doctoring? They can generate business for themselves quiet easily so medicare will always blow out and if we end up with so many that some are underemployed or unemployed then we have a major resource allocation problem owing to the sunk costs in training and opportunity cost to the individual & the economy. Also scope of care is more complex, more shared care with specialists. The GP business model is changing now they don’t rely on bulk billing or even private billing for income, they join in groups build super clinics and charge way above market lease rates for pathology & radiology providers who will occupy premises in the clinics and receive referrals. Some of them also start charging specialists % of specialist fees in return for exclusive referrals…much of the power relationship comes from the obsurd referral system where if u must get a referral from a GP to see a specialist if it is to be medicare rebated.

    • Surely GPs receiving a payment for a referral to a specialist must be illegal? Though I suppose that like you’ve said the payment might be taken up in other forms like above average “rent” for co-locating in a medical centre. If there really are such kickbacks going on this should be reported to the authorities and media as a huge moral wrong.

  9. so cost of health care goes up because we have oversupply of overseas doctors?
    something is wrong here, shouldn’t large oversupply cut cost by providing more competition and lowering the price?

    it looks like market forces don’t work again

    • You’ve nailed it- it’s a massive bullshit beat up.

      If 100 people are sick, there will be 100 visits to doctors offices and 100 claims for Medicare to pay. It doesn’t matter one bit (from a Medicare cost perspective) whether there are 10 doctors in the suburb and they each serve 10 patients, of if there are 140 doctors and 40 go without any work while the others see 1 patient each. Medicare still pays for 100 appointment.

    • The market, such as it is, works as it has been designed. A growing over supply of practitioners able to charge a floor price set by the government. Over 80% charge the floor price despite it declining in real terms over the last few years with the MBS freeze.
      As for the 100 sick people needing 100 consults only- wel that is nonsense.
      Practices need rooms, secretaries and have overheads before obtaining a salary. More practices mean more expenses. This means more need for revenue. Not too difficult to generate unnecessary follow up if so inclined.
      Too few doctors and the protectionist cry goes up. Too many and it’s over-servicing. Take your pick.

  10. Socialised medicine always results in a crisis.
    At least we’re not as bad as the NHS in Britain.

  11. Having done an Engineering degree, I only took a semester course in economics, but I’m going to sue to get my money back. That supply and demand thing was clearly rubbish.

  12. I have been trying to get an appointment at my local medical clinic for about 5 years. everytime i call up i get the same response they are full up and not taking on more patients. I keep having to look further and further from my house to find a clinic that isnt booked out, so i dont know where this blow out in doctor numbers is occurring. I would suggest its more likly because clinics are barn yarding older patients and having them keep coming in for monthly check ups for no reason. Thats what i have seen happening. The docs build up a stable of older patients who have nothing wrong with them other than they are getting older, get them to come back every month for a “checkup” regardless of how they feel and they bill them. They just keep recycling the same stable of patients every month and fill up thier appoints with these easy patients.

      • I would suggest its more likly because clinics are barn yarding older patients and having them keep coming in for monthly check ups for no reason. Thats what i have seen happening. The docs build up a stable of older patients who have nothing wrong with them other than they are getting older, get them to come back every month for a “checkup” regardless of how they feel and they bill them. They just keep recycling the same stable of patients every month and fill up thier appoints with these easy patients.

        Because the majority of GPs (to the extent there is a systemic issue) have nothing better to do than unnecessarily bring in healthy old patients to the detriment of actually sick patients.

        Because GPs don’t care about making people well, and only on ripping off the MBS.

        Of course, based on your comment, you’ve been privy to the patient’s appointment or their health record, so are well positioned to make this assertion.

        It might just be me, but this assertion doesn’t stack up.

      • So where are all the altruistic non money centric GP’s you claim exist, when remote communities are crying out for doctors and the best that can be done is get the occasional one out there for short periods and needing large perks or remuneration to do so, on top of what is billed to medicare ?
        You think doctors dont want to earn large amounts of money.
        You dont think they would like to do so with the minimum amount of effort required just like every other person would. Geez why people put doctors on some kind of altruistic pedestal is beyond me. Of the few medical people in my social circle , only one of which is a GP, i know for certain the reasons they went into medicine are a technical interest in the subject and money they make from it. Im sure in public they say they want to help people. But in the quiet hours after a few beers thats when the truth comes out. One guy i know is a blood cancer specialist who could work in WA and make about 300k per year. But he dosnt. He prefers to work 6 months a year in the USA consulting at Columbia University and touring the USA giving lectures on their behalf. And he earns close to A$ 600k per year for that.

    • This is kind of an odd comment – all my now deceased grandparents ended up seeing GPs more than once a month because they all had multiple chronic illnesses that required management in one form or another. It seems at least plausible that the increase in morbidity with age means that theirs is a highly common experience.

      My feeling is that in this day and age, there would be very few people of any age who would return to a doctor at that frequency without believing there was a real medical reason to do so, and it seems more common to believe one is healthier than is actually the case rather than the other way around. Even most retirees have somewhere they’d rather be than a doctor’s waiting room.

      Finally, if desire for money has really over-ridden one’s ethics to this extent, it seems just as profitable to become the doctor who gives easy pain killer scripts or always endorses the WorkCover claim – and then the patient will be strongly incentivised to play along.

      • Report suggests that Medicare is being used to attract dodgy OTDs to work in Australia?

        I recall a similar article some years ago from same people and surprisingly seems to ignore demographics, i.e. ageing population with more ailments, injuries, illnesses etc., but we have not seen anything yet as the baby boomer bubble hits the same sweet spot.

        Further, the article does not look at the future trends of ageing population and increased health care, with many doctors leaving the workforce with the baby boomers, worse in regions.

        What are they proposing, stopping OTDs and related who’ve come under independent, specialised skills and temporary or regional visas? Meanwhile, neo libs are encouraging government to nobble and nibble away at Medicare because it does not fit their ideology and they pay too much tax?

        Not unlike UK with Brexit to stop all those ‘immigrants’, when in fact those EU and non-EU immigrants prop up the NHS and accordingly the older generations, needing more health care, but are encouraged to vote out, mad what people think is good for them…… bring on dystopia and chaos…..

      • drsmithyMEMBER

        My feeling is that in this day and age, there would be very few people of any age who would return to a doctor at that frequency without believing there was a real medical reason to do so, and it seems more common to believe one is healthier than is actually the case rather than the other way around. Even most retirees have somewhere they’d rather be than a doctor’s waiting room.

        +1

        The number of ideologues who think medical care is like a massage or a hamburger is staggering.

        I’m sure there are a few people here and there who are wasting GP’s time. I struggle mightily to believe there’s an army of them.

  13. I wonder how many commenters here actually have working knowledge of the health system to the extent their commentary implies.

    And I don’t mean patient knowledge or anecdotal observations not backed by hard data.

  14. The corporatisation of medicine has done far more damage to this country’s finances and people’s disposable incomes than negative gearing, and yet it is barely raised as an issue. It is already shaping up as an imminent social disaster.

    Corporate super clinics, backed by banks, private equity and high net worthers, looking to either reap the inefficiency of the Medicare system, or carefully targeting areas for life-cycle private patients ripe for multi-disciplinary services. This is going to drive both public funding of health care costs and health insurance premiums absolutely through the roof.

    And these clinics are predicated on the rationale that we need to reduce costlier hospital admissions! But at a systemic level, there is absolutely no financial incentive for health care providers to try and make people better. That is their professional raison d’etre, to be sure, but given the corporate structures that will become the norm, and the incentives to service providers, they would be just as happy to see a sicker population, or at the very least, a population that perceives itself to be sicker than it actually is.

    • Insightful comment. The need to pair payments with patient outcomes is a potent discussion point and not simple. Lots of discussion around outcome funding, capitation etc.

      Have you read the recent Primary Healthcare Advisory Group’s report Better Outcomes for People with Chronic and Complex Health Conditions. Worth a read.

      http://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf

      The problem with KPIs like reduced ED presentation or reduced length of stay (system load and cost metrics, not patient metrics) is very difficult to attribute to an intervention, particularly in chronic/complex patients, and especially so if they have comorbidities and have already exacerbated into the top of the service intensity pyramid.

      Patient Outcome and Experience measures could be used in funding in some manner but are in the early stages of implementation and validation in Australia. There is a lot of work afoot in this area.

      Lastly, I am not entirely sure your point about GPs wanting to see a sicker population is true. I work closely with a lot of GPs and yes, whilst profitability (making a living) is a concern, I strongly doubt whether they want to see their patients remain sick.

      The delineation in funding in Health definitely is problematic, and there is probably a better way, but there is certainly a lot of work afoot particular in chronic/complex care to try and improve patient journeys whilst reducing waste and system load.

  15. Jumping jack flash

    The solution to almost all of the problems caused by over-supply in our workforce is to simply send back the hired help when it is no longer required.

    However, while we are more than happy to bring them into the country to help us while we actually need it, and address the problems causing a shortage of locally trained GPs, there is no exit strategy and a “softly-softly” approach to enforcing it, if there even was one.

    This problem is not only for GPs, it is for pretty much *ANY* profession on the mythical “skills shortage” list which has simply turned into a “set and forget” exercise based on 15 year old statistics.

  16. I dont have hard evidence but i only have to listen to people whinge on about their minor ailments and declare they need antibiotics to know their visits to the doctor are social exercises. There’s no reliance on their ability to heal themselves, live healthily, stay away from big pharma, etc etc. and they need an authority figure to tell them they’re ok. If there hasnt been enough drama in their life lately always fun to generate the need for an ambulance. Your tax dollars for their entertainment.