Why the AMA isn’t just calling for indexation this budget

5 minute read

It’ll take more to fix the MBS than just money, the powerful federation has argued in its pre-budget submission.

GP remuneration doesn’t just need a boost – it needs an overhaul, the AMA has argued in the GP chapter of its 2024 federal budget submission.  

It has just three asks of the government: continued implementation of Strengthening Medicare, a leave scheme for registrars and the re-establishment of a BEACH-style data collection project.  

The association’s pre-budget submission was released to coincide with a meeting of leaders from more than 50 medical colleges and associations to discuss priorities for reform across the sector.  

“We’re here to talk across the breadth of the health system and pull out those systemic issues that the government needs to address so that we can all work together on more collaborative projects across the medical workforce,” AMA vice president Dr Danielle McMullen said. 

Health Minister Mark Butler was among the attendees at the Canberra meeting.  

If it is alignment of priorities that the AMA is after, its budget submission certainly seems to have achieved that.  

Just like fellow peaks RACGP and GP Registrars Australia, the AMA has called for a portable leave scheme for GP registrars in an effort to neutralise the pay cut for junior doctors leaving the hospital system. 

The proposed scheme, which is only outlined at a high level in the budget submission, would allow registrars to take paid parental leave, long service leave and study leave.   

It estimates this alone would cost $101 million over the next four years, or around $18 million in the first year and $27 million every year after that.  

This comes in slightly less than the RACGP’s proposal, which cost about $31 million per annum, but more than the GPRA vision of an independent, self-sustaining industry endowment that would cost just $42 million over 10 years.  

The RACGP also suggested one-off payments of $32,000 to first-year GP registrars to soften the blow of coming off a hospital salary, which would set back the government by about $44 million per annum. 

The AMA’s submission included funding for a GP registrar “salary boost” – which would appear to perform the same function as the RACGP payment proposal – but was pegged at costing around $20 million per annum.  

Dr McMullen, who is a GP in Queensland, said it had become increasingly clear over the last few years that addressing the income gap between GP registrars and their hospital-based counterparts was urgent. 

“Successive reviews – whether it was our review, the college’s review or even the government’s upcoming review – have all shown that we’ve got a GP workforce shortage,” she told The Medical Republic.  

“And we know that there has been an underfilling of the AGPT program positions for some years now, so we really do need to invest in the next generation of GPs.” 

Intriguingly, the AMA pre-budget submission did not put a specific dollar amount to Medicare reforms, despite including a call for continued implementation of the Strengthening Medicare Taskforce recommendations.  

“The AMA has been advocating for increased Medicare funding, as the MBS no longer bears any relationship to the actual cost of providing services to patients,” the submission read.  

“Additionally, the AMA is currently undertaking a project to redesign the general practice consultation items, as the current consultation item structure is no longer fit-for-purpose.”  

The project won’t be released publicly until later this year. 

Dr McMullen said member feedback had indicated GPs wanted to see a complete overhaul of MBS items, rather than piecemeal indexations.  

The fundamental issue is that the time-based items disincentivise long, complex consults.  

“The government has said they’re seeing an increase in Level C and D consults, which reflects what we’ve been telling them for a long time – that care in general practice is getting more complex,” Dr McMullen said.  

“Patients need more time with their doctors, and we know that patient rebates for those longer consultations are not the same as shorter ones. 

“That has impacts on out-of-pocket costs for patients and for the doctors who rely on those rebates it has an impact on our income as well.  

“It’s also where we think the gender pay gap comes into general practice, because the average length of a consultation for female doctors tends to be longer.” 

In other words, funding without reform would not fix the systemic issues in Medicare.  

The third and final ask from the AMA was to re-start the BEACH data collection project. 

It estimated that it would cost about $4.5 million each year to collect data from 1.5% of Australia’s GPs. 

This is slightly different to what the RACGP called for, which was a Medical Research Future Fund-administered program projected to cost about $2.4 million. 

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