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Six-minute hold-up in the clinic

By Michael Keane - posted Wednesday, 28 January 2015

The capitulation by the government to the naked self-interest of the Australian Medical Association regarding changes to GP funding not only reaffirms the premier protection racket of the AMA but is also a profoundly disappointing missed opportunity to encourage desperately needed innovation in healthcare delivery.

Instead of the commentariat blindly accepting ludicrously ­unfounded and cataclysmic rants by GPs who seek to defend their six-minute-medicine business model, the media should foster long overdue debate about the use of highly trained and talented paramedical professionals for task substitution. If medicine can be done in six minutes, it can be done by someone else.

If a history, examination, assessment and treatment (including reasonable thinking time, discussion of options with the patient, and maybe looking things up to confirm the first opinion) can be performed in six minutes, it must be a highly standard, obvious and routine clinical encounter. This could be triaged and/or performed by trained non-doctor professionals at less cost, freeing up GPs for more complex tasks.


It is preposterous that 10 minutes is considered a prohibitively long time for a consultation, considering all the disease and treatment interactions that need to be weighed by a doctor, especially with the increased prevalence of chronic disease and an ageing population.

It is patients from lower socio-economic areas who have more chronic disease, more lifestyle factors that need modification and less adherence to medicine for whom complex consultations of at least 10 minutes would be beneficial. Surely, conditions that are so obvious that the patient has no need of complex instructions and have no significance for the patient's other health conditions, and which can be dealt with in six minutes, should be rare and a small fraction of a GP's work. So a reduction in rebate should have little effect.

In general, healthcare demand is relatively inelastic, so a small increase in the supply of approved practitioners means a big decrease in the price they can charge. So it's no surprise many healthcare lobbyists want to restrict supply and prevent task substitution under the highly disingenuous premise of protecting patients' safety.

Unfortunately, many of our highly trained, dedicated and talented allied health and paramedical professionals have also tried to protect their turf from below, rather than pushing to break the glass ceiling above.

But if patients had to face some of the cost of the AMA protection racket there would be far more support for politicians who have the courage to take on the AMA and who call for reasonable task-substitution.

For instance our highly train­ed pharmacists could do some of the routine renewal of repeat prescriptions. Many routine follow-up visits could be handled by paramedical staff.


Nurse practitioners are highly trained and Australia is now in the early stages of unleashing very talented physician assistants. Examples abound, including in my field of anaesthesia. We want innovators and talented drivers of best resource allocation. New entrants should be rewarded well and we should not protect dinosaurs from competition from capable professionals.

Many six-minute medicine consultations consist of GPs rubber-stamping the requests of patients highly educated in their condition. We could give more autonomy to patients, instead of insisting they wait for hours in a 24-hour clinic to see a doctor they have never met before.

There has been a push since at least the mid-2000s to reform these outdated turf-protection rackets - efforts uniformly and vehemently opposed by industry groups, especially the Australian Mafia Association (whoops, Medical Association).

The AMA boasts that it "tirelessly lobbied the government to amend their proposed Medicare changes" and gloated that the government's "announcement cements the importance and influence of the AMA". What happened to being an altruistic body of professionals dedicated not just to promoting the wealth of doctors but to ensuring the best allocation of scarce taxpayer dollars in the interests of the nation's health?

Amid the debate about co-payments and price signals, many AMA union heavies as well as academics ideologically opposed to any health-related patient contribution make claims that "the evidence" shows that co-payments will be detrimental.

As I discussed in an article on "Copayments and the evidence-base paradox"in The Medical Journal of Australia, co-payments will likely have positive and negative effects. The system in which a co-payment would operate is highly complex and unpredictable and "the evidence" quoted is often dubious. Therefore, to contend that some how the "evidence shows" that copayments should be abandoned is rubbish - as naive as believing that the answer to life, the universe and everything is 42 (from The Hitchhiker's Guide to the Galaxy, for those too young to remember).

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This article was first published in The Australian.

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About the Author

Dr. Michael Keane is Adjunct Associate Professor with interests in ethics, human factors engineering, health economics and substance abuse; adjunct lecturer in public health; specialist anaesthetist.

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All articles by Michael Keane

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