Uh, no. The rubbery figures the federal health minister uses to crow about his bulk-billing incentives melt under the pressure of close scrutiny.
Recently, I’ve been thinking about the bulk-billing initiatives in general practice and wondering how bulk-billing practices manage it.
There’s not a chance I could keep my practice running on bulk billing alone. However, it’s hard to avoid the branding on GP practices and the MPs dancing with their enormous green and gold Medicare cards, because they feature on every platform I see.
I have to hand it to the federal government media team, its consistent messaging is impressive.
There has been much crowing about the 3500 practices that are now bulk billing, but it doesn’t seem consistent with what I see in the community, so I thought it was time to do some digging.
The federal health minister, Mark Butler, announced the bulk-billing practice incentive program as part of the 2025-2026 Budget. In that budget, he quoted the objectives of the Medical Benefits Program, one of which is to “deliver a modern, sustainable Medicare Benefits Schedule (MBS) that supports all Australians to access high-quality and cost-effective professional services”.
The rhetoric around this program is that re-design of the MBS to include bulk-billing incentives is the mechanism through which GPs are able to secure financial sustainability in their practices while providing “free” services at the point of care.
“A full-time bulk-billing doctor a couple of years ago in the city was earning about $280,000 a year after they paid their practice costs,” Mr Butler told the ABC.
“From this week, they’ll be earning $415,000 a year, doing exactly the same work, seeing exactly the same number of patients, because of our bulk-billing investment.”
Setting aside the assumptions underpinning that figure, I was curious about which practices could make it work. The current government is absolutely convinced it is possible for everyone.
When justifying the letters from local MPs encouraging GPs to bulk bill, the minister had this to say:
“Of course local MPs are speaking to doctors in their communities about the benefits of bulk billing,” he told newsGP.
“Doctors and practices are moving back to bulk billing because it works for patients and it works for their practices.”
Well, not for everyone, it seems.
The data
The government has provided a helpful list of bulk-billing practices that are “free” at the point of care.
But are they able to be “free” due to the MBS changes?
I was curious, so I thought it was worth checking. Thank you to the wonderful colleagues who helped me check every single entry on that list against their websites and publicly available data.
It’s slow, tedious, slightly mind-numbing work, so I’m sure there are few people who would bother.
I confess, I am only up to 1000 random practices from the list, which is about a third of the total, but this is what I’ve found so far.
At least a quarter of the practices aren’t relying on bulk billing
The list contains at least 190 Aboriginal Health Services, which are supported through a variety of state and federal grants. Health services are “free” at the point of care, but not because the MBS is now viable, but because it’s been topped up.
This group also contains 14 headspace centres, which aren’t really general practices, and have their own funding.
Thirty-eight clinics have grant funding from state, federal or local grants, and philanthropic funding.
A few clinics on the list have closed, and a few still list themselves as mixed billing.
Some of the clinics, including a few in the ACT, have been supplemented with large sums of money – Mark Butler’s $10.5 million to “influence the market” and encourage ACT GPs to, well, behave.
There are some practices in there that aren’t really general practices. They are purely telehealth, or focus on one issue like treatment for sexually transmitted infections or they are after-hours only or they are nurse-led clinics.
These services may well provide a useful service, but they are not generalist GP practices.
Related
What about the rest?
Of the 750 remaining practices where I can’t find grant funding (and I’m sure some of them have local or state investments), there is a variety of different types of practices that have taken up the initiative.
About 300 practices are corporate. Interestingly, none of the corporates have converted all of their practices to universal bulk billing. Assuming the corporate overlords are better at estimating when bulk billing becomes financially beneficial, I assume the bulk-billing initiatives are not advantageous for everyone.
Many of the clinics, about 100 in my sample, are solo doctor practices.
Few practices have registrars but there seems to be a disproportionate number of international medical graduates. Perhaps this is because the areas with bulk-billing practices are often regional or in urban centres that have greater cultural and linguistic diversity, like western Sydney. It is heartening to see so many clinics advertising their bilingual, and often multilingual, doctors.
Most have a non-bulk-billing source of income. They do procedures, including dermatology clinics, or occupational health. I’m not sure whether there is cross-subsidisation going on, and if so, whether procedural practice makes bulk billing possible. Either way, it’s not exactly “universal bulk billing”.
Some of these corporates have an urgent care clinic right next door, and given the funding invested in those, I suspect the GP practices are reaping a few of the financial benefits which help to keep the doors open.
Of all the practices that do bulk bill, 59% of the GPs are male. Given 49% of the total workforce are male, that looks like a significant shift. There are plenty of reasons why women GPs, with their longer consultations on average, may not be able to make the bulk-billing model work.
I’ll keep going on this database, but it looks like the MBS is not the reason that many of the GP clinics are managing okay. I suspect there is a lot of money propping many of them up.
I also wonder what will happen when all this largesse is over. An incentive is not a promise, a contract, or even a commitment, and a grant runs out. Once this commitment is over, and the grants fizzle out, I suspect some of the clinics will reshape into single-disease entities, like menopause clinics, or drag the community back to an expectation of co-payment.
And I wonder, will it all be worth it?
We know generalist practices save lives, but the pressure on generalist GPs is immense. It is easier, more lucrative and definitely less stressful in the current climate to focus on one issue – allergy, or endometriosis, or urgent care.
The thought of being in a clinic where you are seen as a “specialist” rather than “just a GP” must be attractive.
However, we are burning through our generalists and replacing them with little bits of care. In the end, that is always more expensive, less effective and less efficient.
I’ll keep going through the data, and seeing what I can find, but at the moment, saying bulk billing “works for patients and practices” is an overreach by the minister.
What is working is a substantial, often underground, propping up of practices supported by the substantial pester power of MPs and their constituents.
Which is not the same as saying that the MBS supports universal bulk billing. And, by the way, the ATO figures show an average male GP income of $226,927 and average female GP income of $171,087.
That’s a 26% pay gap. I’m not sure where the $280,000 came from, or the $415 000 but the data disagrees.
Isn’t data a wonderful thing?
Professor Louise Stone is a GP in Canberra and an academic at Adelaide University. A collection of her research, policy and teaching materials can be found at drlouisestone.com.
