Are GPs doomed to go the way of the dodo? My thoughts on the future of general practice
Unfortunately, I suspect that the independent self-employed GP is the oozlum bird of the medical profession — that mythical creature that flies in ever-decreasing circles until it eventually disappears up its own bum.
I’ve come to this conclusion after pondering three important questions:
- Should there be a future for general practice?
- Is there a future for general practice?
- What will the future of general practice look like?
The answer to the first question is an obvious yes.
GPs are the backbone of our health system, providing 80% of all patient contact but only accounting for 6% of the health budget.
Cheap as chips and very effective! Way to go.
We are the gatekeepers to the expensive specialists and hospitals — not that anyone seems to care.
We provide truly wholistic medicine: mind, body and soul. No-one else does this better than us.
Case in point: one of my patients wanted to go overseas and asked his cardiologist if he was fit enough to travel. This specialist opined that he was. Correction — that his heart was good enough to travel.
I expressed my reservations about the rest of his body.
Sadly, he did not survive the trip.
Is there a future for general practice?
On a cost-basis analysis, no government can afford to do away with general practice, but it is the only area where a government can safely, kick the can down the road. Remember, we GPs have the sucker gene in our DNA.
Training doctors and nurses is expensive, and few medical students see their future in general practice. So, governments pinch doctors and nurses from other countries and empower these cheaper imports, and our pharmacists, to become barefoot doctors to make up the shortfall.
Clearly, Western governments want to take more control over health so they can screw down the costs.
I am a sceptic and believe the recent increase in bulk-billing rebates was more about winning the election than caring for the overworked and underpaid GPs.
The best way to gain control of the health sector is to create a problem and then step in with your own preordained solution. The problem has already been created — an inadequate health budget and increasing disrespect for the work GPs do.
The plight of general practice is clearly demonstrated in the results of a recent Healthed survey of 2000 doctors that revealed 46% of GPs are planning to retire or leave practice in the next five years.
This will further accentuate the problem.
How will the government solve this dilemma? More imports? More nurse practitioners? More pharmacists? Why not graduate more doctors?
Politicians are only interested in power, and the best way to get elected is to promise reduced taxes. But infrastructure and services have to be paid for.
Governments usually prefer to kick this can down the road in order to stay in power, rather than put up taxes in order to provide necessary services.
On this occasion, a sop to GPs via increases in Medicare rebates was necessary to win the election. The government doesn’t really care about GPs, and we have the sucker gene.
What will the future of general practice look like?
There will be a future for general practice, but not as we know it.
The costs and compliance issues relating to general practice are so onerous that small practices cannot survive.
Only large groups of GPs working together can afford the staffing and management needed to exist, let alone make a profit and plan for a retirement.
Realistically, we are healthcare professionals and have no real interest or skill in business management and have no time to run our practices properly.
If general practice doesn’t have a future, why are the corporates buying up general practices? Clearly, they think they can run the businesses better than we can — and they are correct.
Already, the corporates ‘own’ 15% of the GP clinical workforce. Mind you, there are good corporates that run ethical businesses and look after their staff and their clients, but many are profit driven and have a poor workplace culture.
I have worked in most types of practices, and in my dotage I am working comfortably in a private-billing, ethical, medical corporate.
However, the corporates are not interested in small GP practices, whether they are in the city or the country.
If the corporates get big enough and strong enough and lobby hard enough, they will survive, but what about the shitkickers who do the work for them? We will either become employees or subcontractors with less and less control over our professional lives and patient outcomes.
In the end (pun intended)
We have not gone the way of the dodo — yet.
We still exist, but we are looking more and more like the mythical oozlum bird as we fly in tighter and tighter circles…
Dr Craig Lilienthal is a later-career GP in Sydney.
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