To find the reason, we need go no further than the dentist who charges $50 for you to walk in the door and, more often than not, another $50 to do whatever needs doing in the 15 or 30 minutes you might be there.
A plumber, vet, electrician or builder will charge about the same. The appliance repair person charges even more.
So where do doctors fit into all this? Australians were told over 20 years ago that 'Medicare' would finance doctor's fees and it would be funded out of taxation. Doctors were told that bad debts would be a thing of the past and that they would be paid promptly for their services at 85% of an agreed or 'common' fee. Successive governments of both persuasions have supported Medicare and actively encouraged bulk-billing. To this day the 'phone information line will only give information if you state that you are bulk-billing the patient. There was no arbitrated mechanism for annual fee adjustments and only on government largesse were rebates increased, at ever decreasing increments. Anyone who expected otherwise was foolish indeed.
Differential fees were introduced for doctors who jumped onto the Vocational Register. It offered a temporary relief from financial ruin by paying an extra $2.50 per consultation for bulk billed customers and refunded the extra money to those privately billed.
Doctors' practices were examined more closely than any other worker in the land. How long we spent with individuals of certain ages and sexes ... what tests we ordered ... what drugs we prescribed. All this without our consent ... even those who never bulk billed were drawn in. Now we have ludicrous committees trying to assess our 'work values'. Practice incentives have been thought up by bureaucrats with no detailed knowledge of the supposed deficiencies of general practice. As an example, it was felt that all doctors should do house calls and, along with after hours care, this is written into the agreement to be on the Vocational Register. Are patients not the best arbiters of who is a good doctor? We do it for vets and dentists, knowing little about those fields, but knowing what we want as consumers.
GPs used to work on the same street corner for 40 years and more for two reasons: There was demand for their services ... and they earned a decent income in the process.
Now traditional general practice has become unviable. This has not happened because of the supermarket revolution elsewhere. People are not demanding big medical clinics ... but they are there and they can survive better in a cut-price atmosphere. Alternative pursuits, some very valid additions to practice, can help pay the bills. These are many and varied ... acupuncture, hypnotherapy, laser treatments, drug group counselling sessions and other pursuits.
Who do we have to blame for all this? Ourselves, or our immediate predecessors to be more accurate. Any group which accepts government money must be prepared to die. Like soldiers. That is what happened to nursing homes. A perfectly viable, profitable and expanding industry for an aging population has been stifled to death thanks to government interference. Restricted subsidies and uniform regulations for nursing homes have turned a varied and free environment for our old folk into a uniform, regimented and unfriendly set of small, safe bunkers. Only the seriously rich can expect adequate retirement care.
So to the solution ... if it is not too late. I suggest that GPs do not do anything relating to a new matter for less than about $50. This is comparable with the minimum fee for many other professionals such as plumbers, vets, dentists, decorators, etcetera.
Even if an old patient just wants 'a certificate', they need to be told that they are also expecting the service which backs up that certificate, such as a history, physical and record in the medical notes. They may need their blood pressure measured. It is now widely recognised that visits to the GP for unrelated causes are important points of intervention, including blood pressure, smoking, drinking and diet just to name the most obvious. With the history known there could be Pap tests, thyroid, work related illnesses, chest X rays and a myriad of other areas which may need attention.
If the patient only gets $21 back from Medicare that is not the doctor's business. Most patients assume that doctors make lots of money and that they pay dearly in their taxes to ensure this is the case. They may not know that GPs mostly earn very modest incomes. Most specialists and employed doctors have kept their income parity, having had strong lobbies to look after their interests. GPs lobby groups have consistently acted against the interests of their constituency and continue to do so to this day. The AMA and GPs College have both failed dismally while the latter has facilitated much of the erosion to doctors' independence.
Most workers in the position doctors find themselves today would use strong-arm industrial tactics with no holes barred. Do Australian GPs have the will to take on this fight? If not, it means that the Australian public can bid farewell to the old family doctor forever. What is your strategy?
