Let’s stop justifying our incomes

6 minute read

GPs are the only professionals expected to subsidise their patients from their own wallets. We need to shake off the guilt.

Last week, the RACGP held a crisis summit in the ACT to address the challenges currently facing general practice.

What came out of it was tweets like this one which I shared to my twitter feed:

In response, I had a follower comment: “I’d love to have the problem of earning only $175k a year!”

Of course patients see only the big number and don’t see how much of that goes towards the cost of providing our services. The decimation of general practice over decades is, I believe, partly due to well-intentioned GPs continuing to subsidise patients’ care and masking this fact from them. Therefore this year, when many of us began charging gaps for the first time, there was widespread confusion and outrage, as I’ve written about before, and the usual accusations of #greedyGPs.

The focus shifted rapidly to how much the average GP makes, and how that is far and away beyond what the average Australian makes and therefore we are charging simply to line our own pockets, etcetera.

Here’s my problem with thought processes like this.

We have many other professions, including many non-GP specialities, who no doubt earn more than the average GP (which, by the way, is not the same as the median GP, but that is a thought for another day). Ditto barristers, lawyers, dentists. They all charge fees, and gap fees. I don’t really hear much of an outcry about how much they make, or accusations that they are greedy, or should bulk bill, or that they “signed on to serve”. I’ve known of people, including doctors, who’ve had to take out second mortgages on homes due to the costs of legal bills in divorces and other proceedings, but we accept this as the price.

People want to be able to see a GP quickly and for free, and they’re confused as to why they can’t.

The real reason: lack of adequate funding of the patient Medicare rebate by the government until it is worth only 47% of the actual price of the service.

What the public thinks: “GP pay” is more than adequate and greedy GPs just want more money to fund their already lavish lifestyles and unfairly disadvantage the most vulnerable in our community.

It’s a handy red herring for politicians who want to dodge the cost of reform.

I invite people to consider why we, as a society, accept that non-GPs and other professions earn far above the wage of the average Australian, and aren’t called greedy quite so viciously and in public, but there is an expectation that our GP can and should literally give us money out of their wallet because anything less is greedy.

Because hardly anyone else bulk bills, or sees patients for free (e.g. physio, psychologist), many people end up seeing their GP to patch things up. By shielding the patient from the true cost of that service, we have continued to enable a broken system for another day.

Those of us who say “no, sorry that does not work for my business” are labelled as greedy and difficult and the GP who does an hour’s work for $39.75 is labelled a hero.

I feel when we start to justify why we might bill $175k a year, or what that work entails, or how much of that is management fees, indemnity etc., we are essentially justifying and apologising for our qualifications and our work, instead of rerouting the conversation back to the actual topic at hand: “The prices of services are currently $86 for a standard consultation because the government has failed to match your rebate contribution to the true cost of my service. If I accept your rebate as full payment at $39.75, I’m effectively discounting my services by 53%. Which of my staff shall I let go in order to do this?”

That is the true point, which gets missed because we get dragged into a discussion about how much money we make which then evokes shame, embarrassment and comparisonitis.

So many of us at present long to simply get a lower paying job with minimal responsibility that could never harm or kill someone, and switch off. Ironically, to read the internet warriors, we already have that job: being a GP is so easy, “anyone could do it”, patients could “just google it and save yourself the expense”, and “that is why they are just GPs, not specialists”.

When someone asks you for $5 on the street, it’s ultimately your choice to give or not and you don’t get abused for saying no.

To me, when someone books to see a doctor in a clinic where fees are advertised, and then asks to be bulk billed at the end, this is asking the doctor to literally reach into their wallet and pay the difference of $46.25 for them.

If you are someone who will find the $5 every single time you’re asked, then you are a far better person than I am. But most of us would not do that. So why is it fair to expect your GP to do that, not just once a day at their own discretion, but many times?

As for the people who say “I pay enough in my Medicare levy, GPs should be free to see” – 7.4% of the health budget pays for healthcare in the community, which includes seeing your GP. The rest is spent, I assume, largely in hospitals, which is the most inefficient and expensive way to seek healthcare with poor continuity for longterm outcomes.

The population that Medicare was introduced for in 1984 is not the population we are dealing with today; needs have changed with the increasing burden of chronic illnesses (now add long covid) as have patient expectations.

Shaming GPs for wanting to generate enough revenue to pay wages and make some profit is a cheap way to distract attention, but it will not solve anything.

It should not be on any of us to continue to subsidise universal healthcare for oblivious patients. That we have done so is now coming back to bite us – we should have passed on the true costs when the freeze began in 2013.

We need to find the courage for the change we want, and begging government for more money is unlikely to help. The only people who can help us is ourselves, by individually and collectively doing what feels wrong, uncomfortable and scary: we need to charge most people money.

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

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