What I do for $37: One GP's perspective on impact of Medicare pay freeze




ABC News
17 Feb 2017


When a patient joked that Dr Elizabeth Oliver had just earned "easy money", it hit a raw nerve.

So the Sydney doctor took to her blog.

In her post What I Do for $37.05, she described the health problems she dealt with in a typical day's work and how the Government's freeze on Medicare rebates would ultimately cost the health system more.   

This was because doctors were "time squeezed" and struggling to provide the quality care that could prevent health problems escalating and needing more costly interventions, such as hospital care.
What I can do in an hour

    9:40 - Spend three minutes in silence with a woman with finger marks on her neck to see if today is the day she wants to talk. Talk about her migraines instead.
    9:53 - Insert contraceptive implant into 18-year-old. Provide three years worth of contraception.
    10:04 - Attend to 18-year-old who has now fainted. Answer call from nursing home – three new urinary tract infections, someone is delirious and Bert's family are here from Perth and would like to talk to me about that magnesium. Can I come by at lunch?
    10:10 - Determine whether 89-year-old is fit to drive.
    10:27 - Explain to young man that, contrary to what Dad tells him, men and women can carry STIs, and that discharge should be tested and treated. Screen him for depression. He's not depressed, yet, but he is injecting testosterone into his butt and has a secret abscess he'll let me see.

Some 600,000 hospital admissions a year are thought to be avoidable, and each one costs around $5,000, according to the National Health Performance Authority.

"The point is that GPs are amazing value for money," Dr Oliver said in an interview on RN's Health Report.

"I don't know of any other profession that would accept an eight-year freeze on an increase in their pay."   

The most common consultation for GPs is one that lasts less than 20 minutes. For this they are reimbursed $37.05 from Medicare.

Current and previous governments have failed to increase this amount, which is slated to remain the same until 2020, despite the increase in the cost of delivering services.

This freeze has prompted some medical practices to increase the fees they charge patients and reduce their bulk-billing rates.   

But many argue they can only pass so much onto patients and GPs themselves are left unfairly bearing the brunt of the rest of the shortfall.

"GPs are doing amazing work to save the healthcare system money and to save people," Dr Oliver said.

"[But] the more that GPs get squeezed, the less time they are going to be able to spend with people and healthcare is going to suffer as a result. And so is the budget.

"Sometimes the problem can be solved in, say, eight minutes, and that's great. But sometimes it requires much more than that."
The stress toll

Dr Oliver said if the situation does not change, she cannot continue to work as a GP.

"I'm going to stop doing it if it stays like this," she said.

"I am a good doctor, I have patients tell me that I'm a great doctor, but I'm not going to keep doing it for this amount of pay, and for the drain and the toll that it takes on my life, I can't.

"I spent a huge amount of time and effort and tears and blood and money to become a doctor.

"I'm really proud to be one and I know that it's a fantastic privilege and I love my job.

"But I physically and mentally can't keep doing this under these bulk-billing arrangements and with this Medicare freeze.