The Federal Government is very concerned about the growing practice of private health insurance being charged by public hospitals for treatments that should be free, according to the Minister for Health, Greg Hunt. Figures released (Dec 2017) by the Australian Institute of Health and Welfare (AIHW) show that state governments and hospitals are continuing to actively encourage patients to use their private health insurance to boost hospital revenue. Continue reading “”
Dr Edwin Kruys*
General practice has been sitting on a goldmine of digital data, locked away on hard drives in our practices all over the country. And while we were busy looking after our patients, others have quietly started mining it for us. Continue reading “What to do with GPs’ mine of data”
From 1 December, Australian women will benefit from a new and more effective screening test for cervical cancer — it’s more accurate and requires testing less often. The new human papillomavirus (HPV) test will prevent up to 30 per cent more women from developing cervical cancer because it detects HPV, an early risk indicator for cervical cancer. The current Pap test detects cervical abnormalities after they occur. Continue reading “New cervical cancer screening test”
By Dr Bill Coote* , a former federal health minister advisor and former AMA secretary general, breaks down the forces reshaping general practice.
Last week, economist and serial health policy commentator Stephen Duckett told a Senate committee: “Every galah in every pet shop is talking about primary care payment redesign to reduce the emphasis on fee-for-service payment.” Continue reading “Primary care: pitfalls for GPs and practices”
Dr Ian Kamerman*
Let’s be quite clear. The move by the Department of Health to return general practice training to the colleges is a good thing. This is in fulfilment of their obligation to the Australian Medical Council.
This is, after all, what colleges are supposed to do, and now the general practice colleges will join their fellow specialty colleges.
However, my concern is that this may also signal a reduction in government engagement and its resourcing of general practice training.
What message is government sending?
There is no more money. The primary care bucket is now essentially capped and we will not see shifting of dollars into primary care from other buckets. Despite all the evidence in the public health arena, we will not see dollars move from the hospital system to the community sector.
Well, some may say, the patients can pay more.
Yes, they can. However, the world economy is now stagnating with almost universally low wage growth. The silver lining is that there is minimal wage growth for our staff, but one can predict that patients will be holding onto their money more tightly.
But wait! There’s more! And more!
What has the government done over the last few decades? Increased medical school output, while maintaining medical migration. We have spent significant resources training large numbers of doctors. What have we got for that investment?
Well, to start with, we have flooded the specialist market. Look at the surgical specialties. More and more doctors are spending longer and longer doing unaccredited surgical terms waiting to get onto a training scheme.
Many have masters qualifications. When they finally get through, if they get through, each will expect theatre time and patients.
We can run through the specialties and see the numbers flowing through to fellowship. The problem being that a number of them fall by the wayside. The personal dismay, the individual financial toll, and the cost to the taxpayer is significant.
Each specialty training pathway is filling up. With more interns, residents and registrars, and new models of patient care, there is less clinical exposure at all levels of training. New fellows are no longer ready for independent practice and all that entails. General practice is also filling up and the problem is that our appointment books frequently don’t.
As the numbers swell, and the economy tightens, and property prices increase, we have downwards pressure on general practice billings.
With lack of growth we will also have fewer GPs being able to afford retirement. The Medicare slow thaw is setting a low floor price for an average consultation and my feeling is that this will also lead to a reduction in the floor price of general practitioners.
Where does everyone go?
We are in the midst of the tsunami of graduates. Where are they all going? Many are still in the hospital, especially in emergency medicine. Even the less-popular specialties, such as psychiatry and paediatrics, are now filling.
Here are my workforce planning questions that many are too afraid to answer.
• Does every medical graduate have the right to enter the specialist training of their choice?
• Does every medical graduate have the right to specialist training?
I would suggest no. So where does that leave us?
General registered doctors with varying levels of experience. Traditionally these doctors have worked as CMOs and locums, but surely these jobs will dry up as well. I think these doctors will all find a new home in general practice. It just won’t be general practice as we know it.
And what do we have entering the scene, just as we are reaching a capacity constraint? The Health Care Home. A great idea, reasonable evidence, but woefully underfunded.
The model used for funding works most efficiently with employed doctors. It just might be that we will see Health Care Homes set up, with fellows as consultants and employed general registrants as community-based CMOs.
The pay will not be great because the funding is just not there, but one can see that a tipping point will arise, in the not too distant future, where this role takes off in much the same way as the after-hours doctor model did.
What has this got to do with GP training changes?
I am concerned that government may, at a time with large number of doctors in the marketplace and with significant economic restraints, push registrars and practices into a larger degree of self-funding. While I feel that registrars will begrudgingly pay more for their training, I doubt many general practices will pay to participate in GP training.
If we get to a situation where registrars are competing with CMOs for positions in the general practices of the future, they will have to do it on price as well as skills.
This is just one risk of the department of health handing over responsibility for GP training to our colleges. It allows deniability. The minister will be able to say: “This is not my concern.”
I just hope that I am wrong.
* Dr Ian Kamerman is long time GP supervisor, past president of RDAA and GPSA, and a current director of GP Synergy
Republished with permission of http://medicalrepublic.com.au/
More Australian patients are visiting their GP without having to pay, with the bulk billing rate for the September quarter increasing to a record 85.9 per cent.
This is the highest bulk billing rate ever achieved for a September quarter – and significantly higher than Labor’s 82.2% when they were last in Government, according to Health Minister Greg Hunt.
“We’re spending more than ever before on Medicare – with record funding increasing each and every year from $23 billion in 2017-18, to $24 billion, to $26 billion to $28 billion in 2020-21,” he said. “Spending under Labor was $19.5 billion in 2012-13.
“Last financial year, Australian patients received an additional 21 million bulk billed GP visits compared with Labor’s last year in Government in 2012-13 – an increase of more than 20 per cent.”
Australians are increasingly facing ‘diagnosis creep’, where disease definitions are widened and people are unnecessarily turned into patients, experts say.
Dr Ray Moynihan (PhD), senior research fellow at Bond University, said expanded disease definitions were often decided upon by panels muddied by conflicts of interest, and had the potential to be harmful. Continue reading “Diagnosis creep: people made patients unnecessarily”
The Federal Government will invest a record $24 million to support landmark research into cardiovascular disease by The George Institute for Global Health. This is National Health and Medical Research Council’s third largest grant ever provided for medical research in Australia and the largest investment in research on cardiovascular disease – a disease which many Australians do not know they have. Continue reading “$24m: largest heart research grant in Australia”
Hundreds of new junior doctors will experience work as a general practitioner in regional and rural Australia, thanks to the second round of the Federal Government’s Rural Junior Doctor Training Innovation Fund (RJDTIF) announced (Nov 2017). Continue reading “Funding for young doctors in rural areas”
In the recent New Zealand election campaign, one policy united parties from all parts of the political spectrum – their intention to reduce the fees patients pay for GP practice services. The only difference was by how much fees were promised to fall and which groups within the community would benefit from increased subsidies. Continue reading “NZ: reducing GP fees not so simple”