If you want the business side of your practice to thrive without driving yourself into the ground, then how you identify yourself matters.
Thirty years ago, after a presentation I gave at the RACGP, a GP warned me that medicine and business mix like oil and water.
Today, with a new RACGP president, a new RACGP Victoria chair, and standards that finally recognise independent doctors, general practice can prove him wrong.
What GPs want is simple: the freedom to choose how they practise, who they care for, how they charge and how they live.
Oil and water
Quality care needs administration, and Medicare does not fund it. Rooms, staff, IT and compliance are paid for one way: out of patient fees.
So owners and practitioners do a polite little dance over who pays the bank surcharges, the payroll tax and super on contractors, and the latest form in triplicate. Nobody is the villain, but a thousand paper cuts still sting, and each one draws money from front-line care.
What GPs really want
Making the business side of the practice thrive does not mean working less hard. It’s about less red tape, and more time doing what you enjoy.
If that is what you want, how you identify yourself, personally, professionally and with the tax man, has never mattered more. It shapes your income, your clinical freedom, and your life. A modern practising life should deliver:
- Freedom, meaning clinical autonomy and setting your own fees, not having the practice set them for you.
- Flexibility in hours, services, and fees.
- Sustainability, so you still love medicine in 20 years.
- Choice of the patients you see and the care you provide.
- A lifestyle with time for family, friends, and yourself.
And let’s be careful what we ask for: there is no bottomless pot, and every government dollar comes with conditions. The only thing truly finite is your time, and how you spend it doing what you enjoy most.
Three pathways: choose yours with your eyes open
Every GP works within a business. The question is how much of it you run, and how much control you keep.
| Pathway | Clinical control | Time on admin |
| Employee | ★★☆☆☆ | Close to none |
| Contractor | ★★★☆☆ | A small share |
| Tenant doctor | ★★★★★ | As little as 5% with smart systems, up to 20% |
- Employee. You keep your clinical judgement, but the employer sets fees, hours, billing, and patient mix. The practice runs the business and is paid from the funding your clinical work generates. Suits full-time clinical work, with certainty and simplicity.
- Contractor. Clinical autonomy is king, and you keep it. The practice sets fees, billing (such as bulk billing) and the type of work, corporate style. A service fee goes to the practice, and a larger share flows to you. Suits almost wholly clinical work, with a little more income.
- Tenant doctor. The highest rated and most rewarding. You set your fees, your billing, and your services. You run your own practice business and keep the return on both clinical and admin work. Suits full freedom and control, if you are willing to invest the time.
Related
Every pathway is a legitimate choice. The trick is matching it to your goals. Want to maximise earnings and freedom as an employee? That is like buying a reliable family sedan and expecting it to win at Bathurst, or at The Bend.
Why do tenant doctors rate five stars?
Because it is personal. Patients want their own doctor, not a new face every visit, and you get full clinical autonomy in a practice that is truly yours:
- You are the brand, and you set your own fees. Your own website and name and build a personal connection that usually supports a premium fee. Because you genuinely advertise yourself as independent, clinical autonomy is far easier to demonstrate.
- You keep your goodwill, and can take it anywhere you please.
- You choose your patients, and refer out what you are not comfortable with. That is ethically right.
- You share care with like-minded, complementary, co-located practitioners in a grouped service facility.
- You are tax friendly. Properly set up, your BAS and tax returns show a genuine business, not a contractor liable for payroll tax or super. Smart systems, such as a legally tax-compliant service fee calculator, keep it that way and can cut your admin to as little as 5%.
Thirty years on, my answer to that GP is the same. Oil and water don’t mix, but with the right structure they don’t have to.
For smart practices, there are far more opportunities than problems. One hint: if you are not bulk billing, charge properly for medical consumables. People happily pay for what they can touch and feel, and that income cuts practice overheads or, for tenant doctors, service fees.
RACGP benchmarking puts medical supplies at about 1.92% of gross patient fees. For a GP billing, say, $600,000 a year, that is around $11,500. Recovered properly from privately billed patients, it is worth almost two percentage points of service fee. That solves the very problem we started with.
Do the numbers. You may be pleasantly surprised.
No one can be there 24/7, so attract like-minded doctors who value balance: in life, and in their books. The first keeps you well. The second keeps your accountant and the tax man at a comfortable distance.
410%: the changing face of general practice
My late father was an Indian doctor. He told me I would need to be 110% better than the local bloke. With respect, Dad underestimated. It is closer to 410%, and there is still no item number for the extra 300.
Few know that road better than Dr Sam Shahin, an immigrant, former GP, and former client of ours who owns The Bend, South Australia’s Supercars racetrack. He built a fuel business first. So much for oil and water.
Overseas-trained doctors are the face of rural general practice, and many towns would have no GP without them. They deserve more than a visa and a consulting room. They deserve a welcome.
A GP once told me patients kept politely asking for “one of the usual doctors”. Another country practice solved that puzzle in one Friday night.
Their new GP, a hardworking Indian doctor with a British accent that kept the locals guessing, gave away free tandoori chicken to the whole town. People came for the food and stayed for the yarn. Somewhere between the second serve and a debate about how hot is too hot, “the new doctor” became “our doctor”.
No speeches, no brochures, no committee. Any practice can do it:
- Introduce new doctors at a barbecue before they start.
- Have a respected local GP hand over patients.
- Help them belong through clubs and community groups.
- Ask the local council to sponsor the barbecue. Whenever I have had a doctor recruitment problem, councils have been a real asset.
- Invite the local media and your local MP.
You would be surprised how easy it is.
Dr Raman has made international medical graduate pathways a priority. The college can lead with policy. Every practice can lead with a welcome.
Congratulations, and thank you
Congratulations to Dr Ramya Raman, RACGP President from 19 November 2026. A practice owner, vice president and WA chair, she knows general practice from every angle. Her message, “a strong health system needs strong general practice”, is one we can all get behind.
Congratulations too to Dr Emmanuel Anthony, new chair of RACGP Victoria, who brings fresh energy and a deep commitment to doctors’ health. Thank you to Dr Anita Muñoz for six outstanding years as Victorian chair, to outgoing president Dr Michael Wright, and to the many GPs who have reached out to me over the years and gone on to serve on state faculties and the national board.
Your work has delivered real wins:
- New standards that recognise independent doctors in practice, not just employees.
- Payroll tax relief for Queensland GPs, with the push now national.
- $660 million for GP training, a record intake, and Rural Generalist Medicine recognised as a specialty.
To Dr Raman, Dr Anthony, and the board: you take office at a seminal moment. I would like to share a framework for a new vision with the college and its members, with six priorities to carry it forward:
- Champion freedom to choose, for doctors and patients.
- Build on the new standards in every conversation about payroll tax, Medicare, and funding.
- Ease the thousand paper cuts. Bank surcharges, contractor payroll tax and super, and red tape are not adequately funded. Every dollar they take comes out of quality care, and the pressure lands on patient fees.
- Get the bulk billing settings right. With payroll tax relief tied to bulk billing and the new assignment of benefit rules biting from July 2027, bulk billing is becoming a stick as well as a carrot. Higher incentives will not cover the cost.
- Welcome overseas-trained colleagues, in policy and in every town.
- Back every GP’s choice, and keep asking what GPs want.
David Dahm is a chartered accountant and registered tax agent specialising in medical and allied health practice advisory since 1992. This checklist is drawn from a longer article, “Make More, Do Less: What GPs Really Want” on the Health and Life website. You can refer to the originating Claude chat here. This article is general in nature and does not constitute legal, tax, or financial advice. Every practice should obtain tailored advice from a qualified lawyer and a registered tax agent before acting on the matters discussed.
