... Not even big money and friendly hours can convince GPs, particularly the younger ones, to commit to the complex care and technological barriers of working in aged care.
Less than 20% of Australians in residential aged care continue to see their regular GP after moving in, and for those who don’t, their health suffers as a result, says new research.
Meanwhile, recruiters for aged care GPs are reporting that not even an annual salary of $300,000 for about two days’ work a week can convince GPs to sign up for duty in aged care facilities.
New Australian research, published in Age and Ageing, found that just 17.3% of aged care residents continued to see their usual GP, 11.3% saw a GP they knew but were not regular patients of, and 71.4% saw a completely unfamiliar GP after entering aged care.
The South Australian researchers studied more than 330,000 residents across almost 3000 aged-care facilities between 2013 and 2019. They wanted to know whether different types of healthcare—especially GP care and preventive services—affected outcomes like mortality, emergency department visits, hospital admissions, falls and fractures, malnutrition, pressure injuries and dementia-related hospitalisations.
What they found was that residents who received more preventive and planned care (like health assessments and disease management plans) and fewer urgent after-hours visits had lower death rates, fewer hospitalisations, fewer falls and fractures and fewer preventable health problems.
Residents seeing their usual GP also had lower risks of ED visits, unplanned hospital admissions, falls, malnutrition and dementia or delirium hospitalisations.
“After care patterns, continuity of care during transition to long-term care facilities was the second most important element affecting ED presentations, unplanned hospitalisations, potentially preventable hospitalisations, hospitalisations for falls, weight loss and malnutrition and dementia-related hospitalisation,” wrote the researchers.
The finding provided “a strong impetus for more investment in ensuring ongoing support from and access to usual GPs and improved health care integration in long-term care facilities”, they wrote.
“It should be noted, however, that this finding also raises concerns about the quality of the primary care delivered by the new GPs and practitioners in this setting.”
It is clear that trying to get “usual” GPs into aged care facilities remains easier said than done, however.
News Limited reported today that medical businesses focused on GPs working in aged care were continuing to have problems recruiting GPs, despite offering good money and enticing hours.
Christopher Malouf, who runs Malouf Family Medical Group, was quoted as saying he was finding it almost impossible to attract GPs.
“The pay is very good, especially in my practice, we offer the doctors 92% of their earnings back, which is the highest in Australia, and I literally cannot get doctors,” he was quoted as saying.
“Even the recruiters are pulling their hair out. We just cannot get them.
“If you work it out, they could earn a $300,000 a year salary for two days a week work and you just can’t get anyone.
“I’ve worked that out on basically how many patients a doctor can see a day.”
Part of the problem is GPs, particularly younger ones, see aged care work as demanding, with the lack of interoperability between aged care facilities, GPs, hospitals and other health systems, being a major bugbear.
“It’s the tech side of it that’s a major issue, the doctors are accessing four different online medication charts, there’s no talking between hospitals and our system, it’s very inefficient,” said Kristin Lyons, CEO of Aged Care GP, which supplies GPs to 100 aged care facilities across Melbourne, regional Victoria and the Sunshine Coast.
“The young ones don’t want to do facility visits during the day and then go home and at 10pm at night do calls and discharge summaries, it’s really demanding on their time.”
The federal government introduced incentives in 2024 to encourage vocationally registered (highly qualified) GPs to work with aged care residents. GPs get a $300 bonus payment each year for every aged care resident they regularly see and the practice gets $130.
But it’s not enough, said Dr Anthony Marinucci, the RACGP’s national chair of aged care.
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“When you throw money at something and it’s still not working, it typically means there’s something else wrong,” he said.
“Even with these really solid pay packets, people are still running away from it because of other issues.
“GPs work in a fee-for-service model and so therefore our payments are really tied to discrete consults,” he said.
“Aged care, the way it sits now, it is essentially continuous 24-7 clinical demand, so there is a model misfit there.
“Any of our patients that we have in residential aged care homes, they have ongoing clinical issues, they may deteriorate overnight, there’s expectations from patients, families and the providers themselves of immediate response.
“And then on top of all of that, we’ve got significant regulatory oversight.
“It really is almost like delivering a hospital or civil service in the community, but unlike hospitals we don’t have rotating rosters, there are no structured after-hours systems,” he said.
“Typically, people that are residents of residential aged care homes are frail, they have lots of medical conditions, they often have advanced dementia.
“It’s essentially geriatric-level medicine at hospital being asked to be delivered in the community.”
Dr Marinucci agreed with Ms Lyons about the technological barriers to recruiting GPs.
“There’s no system interaction, so our electronic medical records often don’t interact with the aged care ones … all of that just compounds to double the work we have to do.”
Meanwhile the research continues to show that older people in aged care do better when they receive proactive, coordinated care from a consistent GP and a multidisciplinary healthcare team.
Read the full research paper here.
