News

Media Conference - Dr Kerryn Phelps, AMA President - AMA GP Workforce Survey 2001

Dr Kerryn Phelps, AMA President, with AMA Victorian President, Dr Mukesh Haikerwal, and

Melbourne GP, Dr Michael Daly, Melbourne, 24 May 2001

PHELPS: Hello everyone. Thank you very much for coming. I'm joined by AMA Victoria President,

Dr Mukesh Haikerwal, and GP, Dr Michael Daly. The average doctor is consulting 120 patients a week. The AMA is conducting an internal workforce survey and we have found very strong evidence of a hardworking, fully stretched under-awarded workforce. And after the inadequate response to the problems in general practice in this week's Budget, there will be changes in general practice. We look like, in the Federal Budget, that the patients of GPs have been offered a laughable 75 cents for a standard rebate increase over the next four years and the bonus prize being more administrative hoops to jump through to treat patients with chronic disease such as asthma and diabetes, which GPs are already doing extremely well. The AMA will continue to lobby the Federal Government for appropriate patient rebates. The reality is that the Government's commitment to maintaining strong public health insurance systems is just not there. Part of the solution lies with GPs themselves who will have to review the high number of face-to-face consultations in higher through-put practices and, if they want to be able to practice quality medicine, they are going to have to ensure that they charge the fees that ensure they can stay in practice. What this will mean is increased patients gaps, and quality care is paramount. I'm happy to take any questions.

JOURNALIST: 75 cents for a patient. That's almost $100 a day. Isn't that enough?

PHELPS: $100 a day? A week.

JOURNALIST: Sorry, $120 a week - you're seeing 120 patients a week. Making an extra $6000 a year?

PHELPS: Yes, that's for the practice. Now, I think you have to make a very clear distinction between income going into a practice, which is basically a small business, employing staff and paying costs like telephones, mortgages, leases. It would be paying for equipment, accountants and the cost of compliance for the GST, for example, for a GP has increased practice costs by that amount already, just in this past year. So, an increase of $6000 to a practice would not even cover increases in practice costs. It will do nothing to alleviate the marginal liability of a lot of general practices, particularly the ones that bulk bill.

JOURNALIST: The study shows that GPs are seeing 123 patients a week. Has that number gone up?

PHELPS: We haven't done a study like this before. The AMA has commissioned this study because we were very uncertain, in fact quite cynical about the sorts of studies and the sorts of responses that we were seeing. The AMA was fairly cynical about some of the numbers that were coming from Government about the numbers of patients that doctors were seeing. And it really puts a lie to the average of 6-minute medicine. In fact, GPs in this country do practice quality care medicine. They do spend time with their patients. It's just becoming increasingly difficult to do so. And, certainly, practices that bulk bill will be finding it virtually impossible to continue that practice without a major revision of the Medicare Benefits Schedule.

JOURNALIST: So what are you saying? Are you saying that doctors are going to have to see more patients more quickly? That time that they give face-to-face is going to be shortened even more?

PHELPS: That's been happening with bulk billing because we know that the patient who sees a doctor and the doctor bulk bills, that doctor receives just a little over $23.00 for that consultation. Now, it is, you know, basic economics that you cannot run a practice on that kind of income to a business. And, so, what GPs are going to increasingly be doing, and in fact, the third quarterly fall in bulk billing figures is actually proving this - the GPs are increasingly turning away from bulk billing and having to charge an appropriate fee for their services. With the Government failing to respond to this problem in general practice, it will mean that patients' gaps for general practice services will increase. What we don't want to see is patients being unable or feeling unwilling to attend a doctor for their medical problems because they can't afford it.

JOURNALIST: Dr Phelps, what's the link between the number of patients per week and the actual fee for doctors received?

PHELPS: Doctors work for fee-for-service and if that fee-for-service is linked to Medicare you can see that, you know, you just need to do the numbers. And, an average of 123 patients per week, if you're looking at a standard consultation bulk billed of $23.45 the numbers just don't stack up when you're looking at paying staff, paying for consumables, you have to pay for, you know if somebody comes in with suturing, for example, you have got to pay for all of the materials for that. You have to pay for the premises to be cleaned. You have to pay your accountants to look after your accounts. But there are enormous practice costs which have been increasing way in excess of the CPI for many years.

JOURNALIST: But wouldn't you need more doctors to in fact see more people and give them longer period consultations?

PHELPS: Unfortunately, longer consultations become even less economically viable. And that really does need to be addressed. But it can't be addressed just in amending the consultation …… structure. We also have to see the implementation of the Relative Value Study (RVS) findings which was a six-year joint Government and AMA study looking at the real value of medical services and we do need to see the implementation of that so that patients are not going to be increasingly out of pocket.

JOURNALIST: Will you be urging doctors to move away from bulk billing?

PHELPS: Doctors are making the decision to move away from bulk billing. There have been three successive declines in bulk billing rates. I believe, now, with this budget, GPs will see that they have been abandoned by the Government with respect of the MBS and that they will move away from bulk billing in increasing numbers. I think we will see acceleration in that decline.

JOURNALIST: So what's actually happening, when you say that rebates aren't enough, so are your going to have your time with patients …… your practice?

DALY: Sure. Well, I suppose over the last ten years I've seen an increasing demand on my time other than time for clinical duties in terms of paper work and accreditation and other requirements. I've found that I've just had to wear too many hats. I'm not only the doctor, but the practice manager, the IT support person, the bookkeeper, the complaints officer and the staff trainer. Of course, I come from a solo practice background and I was in a practice in North Melbourne until last month - I was in North Melbourne for 13 years and the precipitating factor for my departure was my staff member giving notice to me and I realised I just didn't have the resources to retrain a new person. I've been hanging on for probably up to two years and ultimately, I knew I had to face up to a decision like this, but it's not easy to close a practice either - that was quite an effort and I was actually sick for two weeks after closing it down. I found that I had no money for more capital works, like a lot of my colleagues. A second-hand dealer valued the furniture in my surgery for $250. But, unfortunately, he lost interest so I ended up giving a lot of it to St Vincent de Paul.

JOURNALIST: How does all this reflect on the care that you've been able to give patients? What's the average sort of time have you been able to spend with patients?

DALY: Well, I practice according to the MBS which allows me to give up to about 20 minutes for a Level B consultation, which remunerates me for about $23.00. But, what I'd see in my pocket after my expenses might be about a quarter of that. I found that I wasn't able to afford the necessary specialist services to help me, for example, in doing my Business Activity Statement (BAS). I and my staff spent 50 hours doing the second BAS and as a result of that I wrote to John Howard and the Health Minister and really didn't get much of a response and really no relief for subsequent BASs. But I felt if I'd placed that in the hands of my accountant that would have been another day or two that I'd be working for free while I paid him for doing my BAS. And I also felt that I needed to make a statement that general practice was sick by closing my practice. Now, I've been cognisant of the need not to disadvantage patients because I do work in a low socio-economic area and I'm continuing to visit and also taking on more patients who have wanted home visits and I also found it difficult to merge with other practices because of my interest in treating patients with drug and alcohol problems.

JOURNALIST: Dr Phelps, can I just speak to you on a separate issue?

PHELPS: Are there any more questions on the general practice issue, first?

JOURNALIST: I have one. In following the Budget the information is that GPs incomes are actually going to increase by $13,900 a year when you took into account the increased rebates for long consultations and mental health consultations. $14,000 would seem like a good pay rise in one year?

PHELPS: It's smoke and mirrors. We've had an assessment done by Access Economics which indicates that the rise for the average general practitioner will be between $4,000 and $6,000 and that most of that, if not all of that and more, will go into increased practice costs. That $13,900 figure is a furphy and quite often, what will happen for GPs who do pursue these separate funding streams will be that they have to replace one revenue stream with another. As you heard from Dr Daly, you can't go spending time setting up diabetes registers and doing the administrative requirements for this funding without taking your time away from your patients. If you're already working at absolute capacity - there's only 24 hours in the day. And, so, realistically we couldn't expect practices to be achieving more than $4,000 to $6,000. Even if our practices get that money it's going to be well and truly lost in GST compliance costs and other expenses.

JOURNALIST: Michael Wooldridge personally attacked you over comments you made about cholesterol-lowering drugs. What's your comment?

PHELPS: I think you'd have to say that the Minister must lack confidence in his Budget announcements if he has to resort to personal attacks.

JOURNALIST: Are you going to do anything about it?

PHELPS: I have already referred his comments to our legal advisers who have been in touch with his office demanding an apology.

JOURNALIST: Has he apologised yet?

PHELPS: No. He hasn't apologised yet. But I'm waiting in expectation.

JOURNALIST: So will you sue if he doesn't apologise?

PHELPS: My lawyers have been instructed to progress the matter if he doesn't apologise?

JOURNALIST: How do you find those comments? Are they personally damaging to you?

PHELPS: They are potentially personally damaging. Fortunately, the ABC was able to offer me time to respond to those comments. In particular, he said that I had media qualifications but no specialist medical qualifications and I was able to say that I actually sat the exams for the Fellowship of the Royal Australian College of General Practitioners which is a specialist qualification in general practice and I advise my patients every day of the week about their risks of heart disease in context with their cholesterol levels.

JOURNALIST: He also said that your comments would worry people unnecessarily. Do you agree with that?

PHELPS: I think patients who have high cholesterol and are worrying about how they can afford their statin drugs might be more worried than about the comments I have about whether the Government's decisions were based on economics rather than on proper clinical guidelines. If you look at the cholesterol-lowering guidelines from the National Institutes of Health from the United States you will see that their international opinion is showing a far more aggressive approach to lowering cholesterol to protect people here from future heart disease. Our concern is that taking money away from subsidies for cholesterol-lowering drugs today, will we be facing problems with heart disease in those same people in 10 or 20 years' time?

JOURNALIST: How would you describe your reaction regarding Mr Wooldridge?

PHELPS: Has he lost his medical degree, too?

JOURNALIST: Can you actually speak to him on a … you know?

PHELPS: Well, I think it's very much on the public record that the last meeting the Vice President of the AMA, the Secretary General and I had with the Minister was far from cordial. In fact, if was threatening and rather abusive.

JOURNALIST: On whose side?

PHELPS: His side, his side. We were perfectly polite, as always. And so, the Minister has had problems all along taking any constructive advice as some sort of personal criticism on him. I would reiterate today that the advice that the AMA provides to the public and to the profession on their behalf is based on sound clinical evidence and based on the wishes and the opinions of the medical practitioners of this country and, if the Minister doesn't like hearing that, then that's a problem because if you're only listening to groups that you fund or if you're only listening to groups who agree with what you have to say, then you're not going to be getting the right answers for the health system of this country. Therein lies the strength of the AMA.

JOURNALIST: Have you been forced to speak to the Prime Minister about concerns of the medical profession rather than speak to the Health Minister himself?

PHELPS: Yes. We've been having discussions with the Department of Prime Minister & Cabinet in the lead up to the Budget. I also had a meeting recently with the Prime Minister where I outlined our concerns about the health system generally, and about a number of specific issues, and received a good hearing. I've also had discussions with Kim Beazley and with Jenny Macklin and I have meetings coming up in the coming weeks with Simon Crean and Natasha Stott Despoja. So the Minister really, I think, is doing his Government injustice by not heeding the words of the AMA.

JOURNALIST: This is on a separate issue again. With relation to insurance companies not covering people who suffer from depression, what's your opinion on that?

PHELPS: I think this is a major roadblock on the road to improving mental illness in this country. We are encouraging people who have experience of depression, who have symptoms of depression and anxiety to go to their GP and to talk about it and to seek help and, if appropriate, to have counselling, and, if necessary, antidepressant treatment. Insurance companies who are excluding people from insurance policies on the basis of a past history of quite often, transient depressive events are, I think, undermining that good progress we've made in mental health in Australia.

JOURNALIST: Is it a growing public health issue?

PHELPS: It's a growing health issue because people are actually heeding the problem and presenting to their GPs. And there isn't an increase in depression in the country, but, there is an increase in people who are attending their GPs appropriately for management of that depression. It's only some time later when doctors have to write out a report to their insurance company which has the permission of the patient, of course, to do that, that patients are finding that they're excluded from life insurance policies and other insurance policies on the basis of that fact that they were diagnosed with depression sometimes years before.

JOURNALIST: What does that mean to the patient, then?

PHELPS: I think it could actually be a roadblock to patients deciding to go and speak to their GPs appropriately about their depression and I think that it's something that we need to really take an urgent look at and see if we can find some way around that.

JOURNALIST: Will you be addressing it?

PHELPS: We will certainly be addressing it. The AMA will be seeking discussions with the insurance industry and with the Government about this issue, because I think it will become a growing issue as more people who have presented for depression realise that they've been excluded from insurance.

JOURNALIST: What impact will the difficult relationship the AMA now seems to have developed with Dr Wooldridge on the way you handle your strategies for promoting health as a major issue to the Federal Election?

PHELPS: We will be providing constructive criticism, advice and positive comment about what's happening in our health system, where appropriate, and the AMA has tremendous support from the medical profession - recent studies have shown that 90 per cent of GPs, particularly, supporting the direction and the comments of the AMA in regard to general practice issues. We will continue to do that and we will not be intimidated by comments made by the Minister or anybody else.

Ends

Media Contacts

Federal 

 02 6270 5478
 0427 209 753
 media@ama.com.au

Follow the AMA

 @ama_media
 @amapresident
‌ @AustralianMedicalAssociation