What’s a GP worth?

Some thoughts and common misconceptions I’ve been faced with:

1.”You guys must be rich with all the referral commissions you get”

Me: Referral commission?

Patient: Yeh, every time you refer us to a specialist, what’s the percentage you get?

No, we don’t get a commission. We refer you so you can get further, more specialised help that GPs are not trained to provide.

2.”You guys must be on a ridiculously high pay rate from the government”

No, we don’t get paid per hour by the government. We get paid by the patient when we offer a service. If we don’t see patients, we don’t get paid. There is a misconception that we are government workers who get paid by Medicare.

How Medicare works is: Doctor bills the patient; patient requests Medicare for a rebate (they ask the government to give the patient some money for an eligible service) to help them with their doctor’s fees. Previously, patients had to physically present to Medicare and submit their claim for the rebate. But now, thanks to the convenience of electronic transactions and EFTPOS and customer service at a general practice, the practice performs the transaction for the patient. Meaning, the money from Medicare is automatically deposited into the patient’s elected account.

If the doctor accepts that rebate as the full fee for the service, then it is called Bulk Billing. Since the patient didn’t have to pay a cent from their pocket, nor go to Medicare to claim a cent, and everything was performed by the practice staff itself on behalf of the patient, the patient is often lead to believe that a visit to the GP is free. That healthcare is free. That doctor’s are laughing millionaires who are being showered in gold and jewels by the government per hour. Nothing could be further from the truth.

3. “Are you just a GP or are you a specialist?”

GPs ARE specialists. The Specialty is called General Practice, and to be accredited as a Fellow of the Royal Australian College of General Practitioners, one must undergo specialist GP training and pass exams. GPs are considered “Specialists in Life”. GPs deal with a broad spectrum of clinical problems, that will often not be attended to by other specialists. For instance:

– Tell the cardiologist about your leg abscess and what do they tell you? Sorry, go see your GP.

– Tell the breast surgeon about your headaches what do they tell you? Sorry, go see your GP.

– Tell the respiratory physician about your breast lump and what do they tell you? Sorry, go see your GP.

– Tell the dermatologist about your heart problems and what do they tell you? Sorry, go see your GP.

– Tell the plastic surgeon about your erectile dysfunction and what do they tell you? Sorry, go see your GP.

– Tell the psychiatrist  about your concern for a skin cancer and what do they tell you? Sorry, go see your GP.

– Tell the orthopaedic doctor about your fear of chlamydia and what do they tell you? Sorry, go see your GP.

– Tell the neurologist about your desire to lose weight and what do they tell you? Sorry, go see your GP.

– Tell the GP about a random health topic and what do they tell you? You’ve come to the right place, let’s see what I can do for you. If it needs evaluation or management by another specialist, let’s refer you on.

The point is, other specialists are fantastic at their service and have all been trained with a basic Bachelors in Medicine/Surgery degree, and completed an internship and more. However, they are not all trained to deal with anything and everything. It’s not that other specialists can and will do everything a GP can do plus more. It’s not that GPs are “just GPs” and specialists know more than “just GPs” – it’s that other specialists are trained to provide a service in that specific specialty. Will you trust a haematologist to discuss contraceptive issues with you? Or a cardiothoracic surgeon to discuss management of your pregnancy issues? No! Likewise, GPs are trained to be your first port of call for any issues concerning your health (as long as they are not an emergency), but not to offer highly specialised care.

GPs are expected to know about and perform 90% of the work, but are remunerated 10% of it! Need a $20K breast job done? No problem. Want to fork out $70 for a standard GP consultation in spite of getting $37.05 back from Medicare? No way, that’s exorbitant!

4. “GPs are only there because they couldn’t get into a specialty”

There are many brilliant GP colleagues of mine who would have made excellent surgeons or what not that the community perceives to be mountains above GPs, however, they went into general practice for a variety of reasons. For instance:

  • Flexible work hours – therefore helping with their family situation or lifestyle choice.
  • Opportunity to assist with a variety of clinical situations and not be limited to one specialty.
  • Regular patient contact for ongoing care.
  • Ability to assist with multiple special interests and procedures.

The list goes on.

5. “GPs should be free”

Whether you’re a pensioner or you don’t work or you simply don’t wish to pay or what not, let me ask you this.. when was the last time you went to a hotel, had a meal, and cussed them out when they slapped you with a bill? Or to a supermarket, and tried to walk out with a trolley full of groceries without expecting to pay? Or to a real estate agent and demanded a free roof over your head? Or the water company to not bill you for water usage? Yes, food, water and shelter are all necessities too.

Have you ever asked an electrician to do up some wires without expecting it to cost anything? Or an accountant to do your tax return for free? Or expect a free car from the dealership? Or a plastic surgeon for a free face lift?
So why GPs?!

Did you know that the GP only gets a cut of the service fee? Even if Medicare only gives $37.05 for a standard consultation, up to half of that (or more) may go towards other expenses, such as staff wages (e.g. reception, administration, practice nurses etc.), rent, utilities, cleaning (e.g. linen, rooms, clinical waste etc), medical software, Computers/printers/phones/IT, Stationary, Insurance, legal fees, medical equipment (e.g. sterilised forceps, electrocautery etc.), treatment items (e.g. medical grade sterile waterproof dressings, cleansing solutions) etc etc. The practitioner (doctor) then has their own professional expenses, such as indemnity, medical registration (almost $700/year), course fees (in the thousands), personal debts, conference fees, professional body subscriptions etc. etc.

None of that comes free. There is zero assistance from the government.

A proper consultation should include a comprehensive service. A GP should have a glance over the patient’s file (which may or may not be poorly documented or organised) for an existing patient coming in, review recent correspondence and investigations, preferably prior to the patient coming in. The consultation should follow the standard medical format of a greeting, history taking, clinical examination, possible office tests (e.g. urinalysis), an assessment of the presentation, including consideration of differential diagnoses, and a management plan, including investigations and treatment – both immediate, long term and preventive strategies. Emergencies must be quickly recognised and referred to the hospital emergency department. Patients should be educated about their condition, and appropriate follow up or referrals should be arranged. All this needs to be clearly documented. As you can see, there is a lot of work that goes into a proper consultation, which is not really feasible in a 5 minute consultation. There is a lot of work that goes on behind the scenes (such as documentation, and reviewing and faxing correspondence, organising team care arrangements etc) that may be classified as “billable” hours or services by other professions.

General practice is a business – one which offers a service, like any other business.
If patients can’t accept this, they have the option to sit in the public emergency department and be triaged as category 4-5 as appropriate, and potentially wait for hours, and unnecessarily clog up the system and burden taxpayer funds.

What’s the solution? Treat General Practice as you would any other business service. If you feel that the government has a responsibility to offer this service for free, then you write to the government and request that. GPs are not government representatives, and do not receive any perks from the government. They have no reason to absorb the cost of their own service at their detriment.

In summary, pay up, or wait it out. If it’s an issue, raise it and write it out.

Message to bulk billing GPs. Please have some respect for yourselves, your peers, and most importantly, your patients’ health. Look around you and note what people around you charge. A massage may be $100; a 30min job with the hairdressers may be $70; a call-out fee for an electrician may be $100; a real estate agent in Sydney may make $16,000 off a sale in less than a week; a patent lawyer may charge $600/hr; a 15 minute check up with a dentist may be $250; a 30min physio appointment may be $100; an hour with a psychologist may be $150; 30min with a Diabetic educator nurse may be $120 etc etc. How many of them have overheads which are more expensive than yours? Do you really value yourself and your patient’s health to be just $37.05 (without the overheads, taxes etc.)?

Engaging in competitive practices against your peers by underselling yourself and undervaluing the profession is dangerous to patients and the profession. Rapidly churning through patients with an incomplete consultation or clinical justification is not only undesirable for a patient’s health outcomes, but may land you in trouble for mistakes or negligence. I urge you not to undermine the medical profession or bring the GP specialty into disrepute. Writing up GP Management Plans for every Tom, Dick and Harry who doesn’t have a chronic disease is an unscrupulous practice and cannot, and should not be supported.

6. Lastly, what do you think a GP consultation is worth?

More to come..