Who gets to decide the value of care?
GPs say they “will not forget” the insult of bulk billing campaigns run by the current federal government, calling the social contract governing general practice “broken”.
So said AMAQ board director and GP Dr Alison Green, to much applause, at The Medical Republic’s Burning GP conference in Noosa on Saturday.
“The moment that the social contract broke – well, a big crack [was put] in it, probably the final crack – has been the waving around of the card, the pictures in front of the giant Medicare card, and the ‘ask your GP why they are not bulk billing you’ messaging through social media,” she told delegates.
“We will not forget.”
Responding to a question on whether salaried positions were becoming more attractive to GPs, Dr Green said she had been “surprised” at the suggestion that she should switch to bulk billing.
“The federal health minister [was] instructing me, as a cradle to grave private billing GP in the complexity swamp, [saying] that I should start bulk billing all my patients, even though he knew that my income would drop between 25% and 30% by doing that,” she said.
“I was not going to be better off, and I was very surprised that he would suggest that I, in my private business, in my consulting room, should take a hit.
“I think that, faced with that really incongruous suggestion that was frankly insulting to the vast majority of GPs in this country, you could see why a salary and less ambiguity could be appealing.”
“And I choose to have a salaried role as well, and that’s been in various settings from time to time. But it’s a choice, and I will not look favourably upon anybody who suggests that I should be paid a salary by the government.”
Speaking on the same panel, GP researcher Professor Louise Stone, whose work has focussed on complex patients and the pressures facing female practitioners, said the government had failed to properly value the work of general practice.
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There’s fast care, cheap care, and good care, she said.
“[The government has] incentivised fast, and it must believe that financial incentives work because otherwise it wouldn’t do it,” she told delegates.
“Therefore, there must be a reason why they think I’m eight times less valuable than a flu vaccine. But let’s not go there.
“So, they’ve got fast. They’ve got cheap, because they’ve got control of Medicare billing. And they use media to shame and to use other mechanisms that, in other settings, might be called abusive, like gaslighting.
“And they now run AHPRA … so therefore there’s this really nice thing you can do where you can make GPs work fast, and you can regulate them into working ‘good ’, which means you end up getting compassion building up the gap, and I think that is unethical.”
The government still has a chance to turn the situation around, she said during an earlier session.
“Who gets to decide the value of care?” Professor Stone said.
“Now, if you want to use yesterday’s data to look at today’s problem and decide what tomorrow might look like, and say, ‘well, we treat to the average’, that’s great for the average.
“One lot, they’ll get good care. This lot will get worse care – not even equal care, worse care. If I start using white male guidelines for black rural women, I can almost guarantee you I’ll make it worse.
“Now, who are you going to trust to say that that person who walked out of my room got a good service? You’ve got to trust someone.
“You either trust the behavioural economist, damn their eyes, or you’ve got to trust, I don’t know, me or the patient or something.”
Burning GP 2.0 was held at Peppers Noosa Resorts and Villas on 26 September 2026.
