Dr Kerryn Phelps, AMA President, with Jon Faine, Radio 3LO

Dr Kerryn Phelps is the president of the AMA and joins us this morning.

Dr Phelps, what was said at the meeting yesterday?

PHELPS: We had a far-reaching discussion, and most of it was very fruitful and constructive, I have to say. We were talking specifically about the issues in general practice, and what can be done to arrest the decline in GP numbers, and to try and address the shortages in the workforce, and also the increasing gaps that patients are paying to see their doctors.

FAINE: Doesn't it all boil down to money? If there isn't more money for doctors, they won't do bulk billing, Medicare falls apart, and the whole system grinds to a halt.

PHELPS: Remuneration is a large part of it for general practitioners. I mean, life is tough, and in some areas tougher than others. We do know that general practice cannot bulk bill and survive. It's just not viable to continue to bulk bill and provide a quality general practice service.

And the reason for this is that the Medicare benefit schedule just hasn't kept pace with the cost of running a medical practice for at least the last decade or two. And, it's reached a critical point now, where doctors can no longer absorb the cost by discounting their fees to meet the Medicare mark, which is $24.45 for a standard consultation.

And so the Government is going to have to address this issue, particularly for disadvantaged patients.

FAINE: Any indication from the Minister that the Government will address the issue? So far, until now, she said no.

PHELPS: Well, the Government says that they'll address it, but I think we are fairly far away from a practical way of doing that. There's no question that every piece of evidence points to the fact that the rebates are way too low and need to be increased. Bulk --

FAINE: So, what are you going to do next? Are you going to go … are you going to call for a doctors' strike or not?

PHELPS: Oh, we wouldn't do that. I mean, doctors want to be able to provide care for their patients. What's happening is that bulk billing rates are declining rapidly. I believe that they will now plummet, because the Government has indicated quite strongly now that they are not interested in increasing the rebates for general practices.

So, patients are increasingly becoming accustomed to having to pay a gap to see their GP, and that gap varies anywhere from nothing to a few dollars to up to $25 or $30.

FAINE: So, what are doctors going to do in order to try and make the Government accountable for the gap, rather than patients feeling angry with their own GP?

PHELPS: Well, I think patients will make the Government feel accountable, frankly, because GPs are at a point where they can't absorb the shortfall in Medicare any longer. And I think that patients are really just going to have to understand that the GPs are like any other professional that they see, they have to be able to cover their costs and make a living in order to continue to work. And…

FAINE: So, are you going to embark on some sort of a campaign to inform and educate the public, or are you just going to do it quietly and softly behind the scenes?

PHELPS: Well, it's happening anyway. I think it's important that the public understands why the fees that they're paying their GP will be going up, have been going up.

And it's issues like medical indemnity insurance and the costs of that. The costs of providing services to patients, staff costs, superannuation, workers' compensation, all of the different insurances you have to pay, as well as the cost of actually running your surgery, providing premises, and so forth.

So, all of these costs have to be borne in the fee that is charged to the patient. And ultimately the fees will have to go up, and that's why people will be finding it increasingly difficult to find a GP who bulk bills, because they simply can't afford to keep doing that, and be able to spend time with their patients.

Now, the Government has been talking about providing incentive payments. These are unacceptable to GPs, they've had a gut-full of the red tape that goes with them, and, basically, they don't trust that the Medicare Benefit Schedule, even if the rebates do go up, will keep pace with the cost of providing the services.

FAINE: So, what are you going to do? The Government say they won't put more money in, doctors say they're not going to continue bulk billing, patients are going to be made to pay extra. Where do you go? You're not going to go on strike, you said a moment ago. What do you do?

PHELPS: Well, the State Health Ministers made a unanimous call to the Government to do something about rebates, because they're seeing the pressures on their public hospitals, and their emergency units --

FAINE: Well, that had no impact either.

PHELPS: Well, it didn't have an impact, but ultimately it will. Ultimately the electorate, I think, will give a very strong message to the Government, that they want a solution to this problem. It's --

FAINE: So, you're not going to do anything? The AMA aren't going to do anything?

PHELPS: Well, we're doing what we can to bring the issue to the attention of Government, but ultimately, it's the Government's hands that are on the levers here. We're advocating for patients, because the Medicare rebate is the patients' rebate. The doctor's…

FAINE: Yes, but, but…

PHELPS: …doctor's fee is what the doctor charges.

FAINE: Campaigning to bring it to Government's attention is not what's needed. It's well and truly within their attention. They know all about it, they don't need to be told again.

PHELPS: They do seem to be … need to be told again, because they don't seem to be getting the message that it is actually…

FAINE: No, they've got the message.

PHELPS: …hurting people.

FAINE: They're not going to spend more money on it.

PHELPS: But they don't seem to be getting the message that it's hurting people. And, until they get that message, I don't think we're going to see too much action. People are hurting out there, because they are having to make decisions about whether they see the doctor, based on whether they can afford the gap.

And doctors, by and large, traditionally have subsidised Medicare for people who are disadvantaged. But out there now in Australia, we have eight million people with access to a Health Care Card, so doctors can't even rely on that now as an indication of whether someone is disadvantaged and needs to have their fee discounted.

FAINE: I suppose I'm surprised, Dr Phelps, that you're so clear in what … articulating the magnitude of the problem, but you don't seem to have any strategy, militant or otherwise, to combat it, other than bringing it to people's attention and talking about it, which has not worked in the past.

PHELPS: Well, we know what needs to be done. We've told Government what needs to be done, and ultimately it is now … because it's the patient's rebate, it is between the electors and the Government now, whether the Government acts upon this.

The Government is being told now by every state and territory Health Minister, they've been told by the AMA, that the rebates are pitifully low and need to be addressed. That then becomes a budget issue. And there is nobody that can make the Government spend money where they believe it needs to be spent.

FAINE: But there's no campaign here. The militancy of your earlier and more strident criticisms of the Government seems to have disappeared.

PHELPS: It's not a question of militancy here. It's a question of social responsibility and, I mean, I don't believe that doctors stopping work and withdrawing their services from patients is going to give the right message about the fact that we're concerned about patients not getting services. It doesn't make sense. What we…

FAINE: I wonder if there's some deal here behind the scenes, Dr Phelps. The doctors are getting their way on resolving the insurance crisis. Have you been told not to cause too much of a fuss over Medicare whilst they're fixing the insurance issue in your favour?

PHELPS: I think that's an insulting suggestion.

FAINE: I'm trying to work it out, because you, in the past, have been quite prepared to campaign actively, but not on this issue now.

PHELPS: We are campaigning actively and have been campaigning actively for at least the last two years. But what would you suggest that we do if the Government says, 'we are not going to increase rebates'. What exactly do you suggest that the medical profession does?

We want to continue to provide services to our patients. Are you suggesting that general practitioners working in the suburbs and working in the country towns of Australia, down tools and say, 'you're all on your own'?

FAINE: The AMA is one of the most organised and proficient lobbying organisations in the nation. I'd have thought you'd have had strategies coming out of your ears to get your way if you really, really wanted to elevate this issue to campaign status.

PHELPS: It is a campaign. We have been engaged in a campaign of diplomacy for quite some time. I don't believe it would be palatable for my colleagues to leave their posts in general practice, abandon their patients, and make a statement in that way.

FAINE: All right. I don't want to make you late for your plane, which I understand I'm at some risk of doing at the moment. I'm grateful to you for your time though this morning. It's been very interesting indeed.

PHELPS: Thank you, Jon.

FAINE: The AMA president, Dr Kerryn Phelps.

Ends