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Play a straight bat on health

In a hard-hitting speech to launch the AMA Federal Budget Submission 2003-2004, Association President Dr Kerryn Phelps said the Government had 'dropped the ball' on health.

Calling on the Federal Government to make health policy its major domestic policy priority, she said major work is needed to address doctor shortages, medical indemnity, the Pharmaceutical Benefits Scheme (PBS) and equitable access for all Australians to affordable quality health care.

Trainees left high and dry

AMA President Dr Kerryn Phelps has called on the Royal Australasian College of Surgeons to place a moratorium on the four-year cut off the College has imposed on basic trainees.

The College proposes to remove any basic trainee from its training program who does not secure an advance position in 2003.

Up to 600 doctors will be competing for 185 advanced posts this year, leaving many who meet College standards without a future.

Bulk billing awaits a decent burial

Bulk billing is dead: AMA President Dr Kerryn Phelps says the latest GP bulk billing rates from the Health Insurance Commission (HIC) confirm its demise, with the rate falling to 69.6 per cent -the lowest in more than a decade.

December 2002 quarter HIC figures show bulk billing dropped 1.6 percentage points in the December quarter over the previous quarter - a total fall of 5.6 percentage points in 2002, with a 4.3 percentage point drop in the past six months.

New drink-spiking threat

The Australian Federal Police say a new drug, potentially more powerful than Rohipnol, is becoming popular in nightclubs nationwide.

Gamma hydroxy butyrate (GHB), 'Liquid E' or 'Fantasy', has been targetted under the AFP's Operation Skeet along with Ecstasy and prescription drugs used in drink-spiking sexual assaults.

On political deafness . . .

Noted Access Economics Health Economist Roger Kilham says in its pre-Budget submission for 2003, the AMA has pointed to areas of health spending where extra funding is needed.

Without seeking to pre-empt the conclusions of the recommended white paper on GP financing, the total cost of the AMA's proposals is of the order of $2 billion a year.

The Government will prefer that households find that extra money - some will be able to, others will be hard stretched. Equity issues will become more of an issue in future.

INSIDE

A post-GP era: chilling vision of a brave new world?

Canberra GP Dr Peter Main is studying interactive artificial neural networks at the University of Canberra. 

He says that in a post-GP era, many people will access primary health care like today's remote rural Australians, soldiers in combat and astronauts in flight.

Some may remotely access a Computer Supported Medicine' (CSM) general practitioner via a personal medic. The lucky ones may be diagnosed and treated via a well-trained traditional healer or medic with a CSM-interface, in contact with a GP.

Regardless of one's view, trends evident today promise there will be no personal contact with general practice for many people.

From the President - Say goodbye to bulk billing

Dr Kerryn Phelps

When I speak to my GP colleagues about the aftermath of their decision to shift to private billing and charge a co-payment, they say the most common reaction they get from their patients was: 'I wondered what took you so long!'

The tide has well and truly turned, and for good reason.

The cost of practising medicine - led by the escalating cost of medical indemnity insurance - has taken away the incentive for many doctors to continue practising. Worse, it is turning students away from the profession.

Patients now understand why they are being asked for a co-payment and they accept it. To them it is much more important to have the security of a local doctor and pay a bit more for their health care than suffer the fate of many communities which are seeing their doctors retire or leave, never to be replaced.

It is a shame that both the Government and the Opposition are policy-free zones when it comes to solving the doctor shortage crisis. Yes, the 'doctor shortage crisis'. This is the real story now - access to a local doctor. The bulk-billing debate is old news. It is now an issue between the Government and patients.

Doctors are moving on. When you look at how successive Governments have failed to increase the Medicare patient rebate, it is easy to understand why. Whether the neglect of Medicare was by stealth or ignorance does not matter anymore.

The move to private billing is gaining pace and is in my view irreversible - despite what Kay Patterson and Stephen Smith may claim. They doth protest too much, methinks . . . and promise too little.

In 1991, the Medicare patient rebate for a standard GP consultation was about $20.00. Today it is $25.05. That is approximately a 25 per cent increase in the rebate.

Over the same period, the cost of running a medical practice has increased by 40 per cent.

It just doesn't add up, does it? What other small business in Australia has been forced to operate in such a false and unfair economy?

GP bulk-billing rates fell below 70 per cent in the December 2002 quarter, the lowest level in more than a decade.

The rate dropped 4.3 percentage points in the second half of 2002, with a fall of 5.6 percentage points over the whole year.

Feedback from doctors and communities indicates that in real terms, the rate is much lower and will get even lower very quickly.

In short, my colleagues, bulk billing is dead.

Many of you already have made the move to private billing and charge a fee appropriate to your practice and your needs to stay in that practice.

At the same time, you will have in place arrangements to look after your patients with less ability to pay - pensioners, low-income families, the disadvantaged and the chronically ill. You have a system beyond the comprehension of our politicians and health bureaucrats.

For those of you who are still bulk billing and suffering because of it, it is time to place a real value on your skills and experience. It is time to realise your worth in the same way that your patients realise your worth.

You are more valuable to them if you can stay in practice where you are now. They can't afford to lose you.

Those that can afford to pay a bit more to see you will do so in the understanding that Medicare does not cover your costs and provide a reasonable living in line with your years of education and level of responsibility. They understand, too, that you will need to be able to afford to retire one day.

In the time-honoured tradition, many of you will still continue discount your fee for those you perceive to be genuinely disadvantaged.

Australia is on the verge of the greatest medical workforce shortage in recent memory.

It is up to individual doctors to make individual choices about their futures and about the health needs of their communities.

You have to make big decisions now to ensure your future and the welfare of your patients and your community.

Given recent exchanges, we know for sure that in the foreseeable future you cannot look to either the Government or the Opposition for answers.

Dr Kerryn Phelps is President of the Federal AMA.