I didn’t swear an oath to be a charity

6 minute read

And other things we still have to explain to the ‘greedy doctors’ crowd.  

Early this month I was invited by Nine newspapers to write about the proposed reform to Medicare by the two premiers of Victoria and NSW and did so.  

In the piece published on 5 January I outlined why more Band-Aid policies and solutions would miss the mark, and why an overhaul and proper structural reform of Medicare, now 40 years old and not fit for purpose in a changing health demographic, needs to happen.  

I received many responses and I’d like to reflect on some of those.  

On my Facebook page, a man argued that apparently doctors take an oath of some sort to practise social responsibility, which means not expecting to be paid more than a blue-collar worker.  

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On Instagram the Betoota Advocate, a satirical publication I follow and normally enjoy, took to kicking GPs with this post. The story received mostly negative comments, and it was heartening to see that at least the Betoota’s readership is beginning to understand (finally!) how small privately owned businesses such as general practice run, and what we GPs have been facing since Labor began the Medicare freeze in 2013.  

There were, however, also the usual people who insisted on the usual greedy GPs trope – not to mention people continuing to refer to the patient Medicare rebate as GP pay.  

The Medicare rebate is the patient rebate; it is the amount the government insures us for, as patients, when we need to see a doctor in the community. It is NOT the doctor’s wage or pay. We as patients assign our rebate to the GP when they agree to bulk bill us, i.e. it is a no-gap consultation.  

If the public has an issue with GPs charging a gap, it is their responsibility to lobby their MP and the government to do better and to improve patient rebates and thereby, access to GPs.  

Obviously we do not take an oath of poverty or to be a de facto charity for the government when we enter medical school; nor do we swear we will not charge, or that we will subsidise patient fees from our own pockets. Yet many of us seem to believe this is indeed the default and often act in ways that ultimately do not serve any of us in the long term.  

This kind of thinking puts the responsibility of fixing the current healthcare access crisis in the laps of GPs, who are small business owners, not government employees.  

Do we have a social responsibility to agitate for better to protect the most vulnerable and disadvantaged among us? Absolutely – but that is a social responsibility on all of us, not just doctors and definitely not just GPs. 

If we as a society truly buy the greedy doctors trope, why aren’t we demanding that non-GP specialists also subsidise patient fees out of their own pockets? What about dentists, lawyers and other high-income earners? What about free or subsidised housing by the construction industry, given the rental crisis in major cities? 

By continuing to quietly subsidise the true cost of health by bulk billing all patients long after it was feasible to do so, general practice has inadvertently protected and rescued the government from its obligations.  

Now the people are angry because they never saw it coming, after 40 years of being able to see their GP for free whenever they want. 

It’s an unpalatable change and one that has caused a lot of ire and accusations of greed because it’s easier to blame the messenger than focus on the real problem: governmental failure to support equitable access to healthcare in the community. 

Many colleagues, especially females, are leaving general practice for good, some to retrain in another speciality, or leaving clinical work altogether. Others, like me, are doing ED locums since EDs are increasingly flooded with GP presentations due to lack of access – and finding working conditions far better than working in a bulk-billing practice.  

We need to educate those willing to listen on these points:  

  • Your anger over the gap fees to see your GP is valid, but it is misdirected. Your patient rebate deficit is due to governmental failure. If it is important to you, then you need to lobby your MP and the government to improve that. 
  • Your GP, by finally developing healthy boundaries in order to salvage their own sanity and small business by charging appropriately, is not greedy.  
  • GPs, like all other doctors in the field, have a right to earn what is industry standard for us, and to be well rested and to feel safe at work from abuse.  

Given the vast chasm that now exists between the current patient rebate ($39.75) and the true cost of that service ($86) I do not see a future in which most of us will be able to access or offer bulk billing routinely ever again; but I’d like to see equity whereby the rebate is raised for all of us so our gap fees aren’t as high and the bulk billing incentive is raised equivalent to a no-gap fee rate to enable the most vulnerable to be seen for a low/no fee.  

Our health literacy as a nation is generally poor, and until this crisis, it is now clear that the vast majority of Australians including MPs had no idea of how our health system works, where our health dollars via the Medicare levy go, and how little of it is actually used to fund our rebates to access healthcare in the community.  

With change and discomfort comes opportunity. Colleagues who have moved to mixed and completely private billing are finding there is no pushback and life has hope again.  

People are realising that abusing us won’t get us back in our box.  

We reap what we sow. It seems, as a nation, we forgot somewhere along the way that the GP is a human being too, who is tired of being used and disrespected and treated as a charity and who can and will leave if they’ve had enough. That time, it seems, has come.  

Dr Imaan Joshi is – at heart – a Sydney GP; she tweets @imaanjoshi.

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