The GP workforce could be on the brink of collapse and unless the government takes substantial action to fix the issues, Australia will have a shortage of 11,500 family doctors in ten years, according to the latest Health of the Nation report. A consequence that will profoundly impact the health of the population, according to Dr Magdalena Simonis, Federal Council GP Representative of Australian Medical Association (AMA).
Dr Simonis, a Greek Australian general practitioner based in Melbourne, was recognised this year with the Patrick Pritzwald-Stegmann award, which is presented to a doctor who has made an exceptional contribution to the wellbeing of their colleagues and the community, and she was a finalist for the Women’s Agenda Leadership Awards.
She spoke to Neos Kosmos about the complex issues GPs are facing, problems that are increasingly felt in the community, as patients find it harder than ever to book an appointment with their family doctor.
One-in-four General Practitioners will retire in the next five years across Australia, according to a survey of 3,200 GPs.
Taking into account the steady decline in the number of medical graduates who are choosing general practice as their profession (from 50% twenty years ago to 12% today) Australia will be facing critical shortages in the near future.
Dr Simonis explained that there are a number of reasons that have led to this crisis.
“There was a 10-year Medicare freeze, which affected general practice profoundly. Our earnings are directly linked with the Medicare rebate.”
She also explained that there is an ageing population developing more complex problems.
An additional strain to the system is an ageing GP population, where the predominant number of GPs in the community are in their 50s, so they’re looking to retire and might even bring their retirement forward, because of what they experienced during the pandemic.
Though GPs love what they do as a whole, Dr Simonis said that they have felt unsupported and their work unrecognised by the government.
Dr Simonis argues that funds are generally diverted to the hospitals, and not to primary care, without fully understanding that general practice is really the gateway to the tertiary health system.
“If we are supported to do our preventative care well, then we can support the entire health of the nation by protecting the hospital system from overload.”
General practitioners as a whole are agile and really responsive to the needs of the community, as was seen from the start of the pandemic when they were examining patients with symptoms of coronavirus in their clinics’ carparks.
“But it takes a lot of effort. Because they have to use their own resources. So the running of the practices becomes quite labour intensive, and costly,” said Dr Simonis.
She explained that during the pandemic GP practices did not receive adequate PPE, whereas the hospital services, all the first responders, the nursing staff, received all stock up front. Even running COVID vaccination programmes out of their practices has actually been at a financial loss.
Another issue Dr Simonis identified is the lack of understanding of the issues GPs face, such as the recent decision to cut down on telehealth access. This, Dr Simonis believes, will have a serious impact on their work.
“I have patients who live remotely, and working mothers with children and carers and people who also need to access their doctor who don’t drive, or are elderly. Certainly everyone prefers face to face, but COVID hasn’t left our communities, and we still have vulnerable patients. Why should they face the extra risk of being exposed through travel?”
“Health economists make it very clear that supporting primary care is the way to go,” she said, and added that “even the World Health Organisation is encouraging the instalment of primary care in developing countries. Greece has now got this on their agenda because they understand that if you don’t have a GP, your primary care or your preventative health needs are not being met.”
If there is a lack of preventative care, and if patients do not have access to their GPs due to shortages, they will go to a hospital emergency department.
“The cost of a hospital attendance for access to emergency, is $600 to the taxpayer. Also if a patient who has been discharged from the hospital into the community sees their GP within two to seven days of discharge, they are 70% less likely to be readmitted into hospital. The cost of readmission is $1,200.”
What GPs are asking for
In early October, shortly before an emergency GP Summit called by the RACGP in Canberra, the AMA released a plan outlining practical and workable solutions to alleviate the pressures GPs are facing.
Dr Simonis emphasised how crucial it is to give incentives to medical students to choose the GP profession. As it stands today, their income is reduced when they move from hospital training to working in a GP practice and they lose many of their entitlements.
Dr Simonis als argues that it is essential that the Medicare rebate increases.
“The core of the health system is based on this government based funding of our healthcare and it is paid for by the taxpayer. And that needs to be distributed towards primary care in a way that demonstrates how much we protect the rest of the health system from being overburdened. We also need to look at funding for GPs in nursing homes, and to help provide nurses in general practice to ease the workload of family doctors.”
However, Dr Simonis is hopeful. She says that the Federal Minister for Health, Mark Butler, has been really receptive in wanting to understand the problems better.
“This is probably one of the best things that we’ve experienced in a very long time. What this particular health minister has done is he’s spending four hours a month until the end of the year, with a team of GPs to strengthen Medicare.”
These ‘Strengthening Medicare’ meetings are aimed to identify the big issues of the primary care sector and how to fix them, and there will be a more concrete outcome, she said, after the end of this year.
The role of the General Practitioner in the community is much broader than what is formally recognised .
“A research paper demonstrates that of all the health professionals, GPs are the most trusted in the community. If you look at the statistics, for family violence, for example, nine out of 10 women will tell their GP about it if they are asked.”
Another critical work of GPs is their contribution to the mental health of the nation. Even though it is never itemised as a mental health consultation it’s embedded in what they do.
“You end up talking about their mental health because they bring that up, and it is part of their chronic disease which causes mental, emotional, financial burdens.”
At the end of the day, Dr Simonis says “We want our practice and our profession to thrive. Not just to survive. Because this is where the health of the nation can really be impacted. In the primary care level. Going to a respiratory physician for a bout of bronchitis is excessive. You don’t need to do that. You need to be able to see your GP to be able to have that managed. You need to have stabilised asthma. That doesn’t happen through seeing your respiratory physician. That happens at the primary care level.”
*Dr Magdalena Simonis is an Associate Professor in the Department of General Practice at the University of Melbourne, an AMA Federal Council elected Gp Representative, and member of the RACGP Expert Committee Quality Care