The case of the vanishing GP

I took my grandchildren to the museum recently where they looked with curiosity at a relic that existed only 20 years ago - we viewed a hologram of a GP’s surgery from the year 2008. Typically, they thought I was very ancient to have actually visited a GP who knew me personally, knew my ailments and was subsidised by the federal government to provide healthcare.

Now in 2028 those who can afford it can go to a full fee paying clinic where they receive some of that personal attention. However, these clinics are few and far between as GPs are scarce.

In 2028 those people - the aged, low income and chronically ill - who need that personal care formally given by a GP can sit for long hours in crowded public hospital emergency rooms or even die without treatment. At each visit they see a different doctor who reads the brief medical notes: but is no continuity of care.

Is this little journey into fantasy fiction just nonsense? Well, given the current state of primary healthcare, I wonder.

Our Prime Minister has promised he will fix the health care system in Australia. He has promised that “the buck stops with him”.

At a recent COAG meeting Prime Minister Kevin Rudd and Nicola Roxon, Minister for Health and Ageing, gave money to the states to address the efficiencies in the public health system i.e. the hospitals. However, one of the problems for the hospital system is the increased numbers of people attending emergency units. The 2007 Australian Health Ministers Survey noted that 75 per cent of people attending emergency departments did so directly because of poor access to GPs.

In Queensland, Stephen Robertson, Minister for Health, attributed a 4 per cent increase in the number of emergency department patients at the Princess Alexandra Hospital to a shortage of GPs.

The problems associated with a shortage of GPs - a federal responsibility - are transferred to the hospital system - a state responsibility. This is particularly a problem in inner city areas and rural areas.

It is difficult to address public hospital efficiencies without addressing the issue of access to GPs. We are aware of the difficulty that rural people experience in accessing GPs and as an attempt to rectify this, the previous federal government created areas designated as “district of workforce shortage” (DWS). It is only in these areas that overseas trained doctors (OTDs) are allowed a provider number which gives them access to Medicare. They are allowed to work between 8am and 6pm. OTDs are able to be employed out of hours in other areas.

The reality is, however, that many inner metropolitan medical practices are also experiencing problems employing doctors.

One of the reasons GPs are a vanishing profession is that many medical students no longer see general practice as a desirable career. GPs work long hours and are poorly paid, largely because the Medicare rebate no longer reflects the true cost of a consultation. The GPs we do have are ageing.

It is probably because of these problems that many doctors are moving their clinics to “specialities” such as weight loss clinics, skin clinics, wellness clinics, vitamin therapies and so on. These cater for a niche market, mostly do not bulk bill or provide general practitioner services. Even so, the Department of Health and Ageing classes these places as GP clinics when looking at ratio of population to doctors.

As part of the solution to the health system, the Prime Minister has committed the federal government to establishing super clinics. These are planned for outer metropolitan or rural areas. They will not address the problem of the shortage of GPs in inner metropolitan areas.

The vision for these super clinics is that they will house GPs as well as allied medical professionals. The federal government is offering “incentives” to doctors to work in them, thereby putting them in direct competition with private practice GPs. In reality the government has to find the GPs first. The Australian Medical Association (AMA) has lodged a submission to the federal government pointing out the concerns (The Courier-Mail, March 14, 2008).