Dr Kerryn Phelps, AMA President, with Nick Papas, Radio 3AK
PAPAS: Next, let's talk about doctors. When you go to the doctor, and no doubt you go to someone who you trust, often enough it's your local GP. And up until a few years ago they might have even bulk-billed. You would hand over your Medicare card and they'd run it through some sort of a machine, and that would be the last you'd know about it. Then things changed, and there started to be a bit of a gap, and it used to cost you a little bit extra. Nowadays, I think it can cost well in excess of $10 or more, I think, and sometimes the doctors might bulk bill your children. But, of course, that's happening less and less as well. Federal Health Minister Michael Wooldridge today, according to this report I'm looking at, blasted the Australian Medical Association after its President, Dr Kerryn Phelps, said the Government was to blame for the reduction in bulk-billing.
Dr Wooldridge said that the AMA's sustained campaign to destroy bulk-billing was spectacularly unsuccessful and he has accused the AMA of using dodgy figures and dodgy assumptions to gain pay rises of $100,000 for all doctors. Well, they're unfortunately fighting words which is yet another nail in the coffin of the relationship between the AMA and the current Federal Health Minister. Dr Kerryn Phelps, President of the Australian Medical Association joins us to discuss these comments. Good afternoon, Dr Phelps.
PHELPS: Good afternoon, Nick.
PAPAS: It seems to be a very topsy-turvy relationship and really it's not such an issue is it? We don't care how you both get on your Association and the Federal Government. We want results as patients, don't we?
PHELPS: Yeah, I think you know the patients that I see every day just want to know that they've got a health service that they can feel secure with and that their gaps are not going to be too large. And that's really what the AMA's been saying all along.
PAPAS: Let's just analyse this quickly. First of all, if I go to my local GP and he applies a standard rate to me for a standard consultation, how much am I going to be able to pocket, generally?
PHELPS: Well, it varies depending on where your doctor's practising and what their practice costs are likely to be for that area and, you know, a number of other variables. But if they're bulk-billing, the doctor's receiving $23.45 as full payment for that service of a standard consultation, which is average 15 minutes.
PAPAS: Yes.
PHELPS: They could be charging anything from - if they're privately billing - from say, $35 to $50. So it would be the difference between that and $23.45.
PAPAS: Yes, and people get surprised by that. And sometimes it's a big issue if you're a pensioner or someone who's struggling, that sort of money if you say, have to visit with a couple of kids two or three times in one week it can put a real dent in the budget.
PHELPS: Doctors tend to discount those people in any case, whether they privately bill or not. If they are genuinely disadvantaged or chronically ill or people who do have a number of children who are all sick at the same time. I mean, most doctors are pretty generous in terms of goodwill and patients who can't afford to pay the full amount.
PAPAS: I certainly agree with that. I must say that's been my experience and doctors are often seen to be gaining incomes. If people just multiply the number of services per day, which might seem high but, of course there's a lot of expenses to run a practice and people simply don't think about that, do they?
PHELPS: No, they don't. And the expenses have really gone up very dramatically over the last ten years, and particularly the last few years there's been a vast increase in the amount of red tape, and GST compliance alone is looking at about five per cent additional cost for GPs.
When you look at increased staffing time, extra time for the doctors to comply, extra management and extra accounting costs, so just that in the last 12 months there's been quite a large impost in terms of bureaucracy for the average GP. And it's not just that, it's about award wages for staff, it's about the cost of medical supplies coming into your practice, and it's about making sure that you're up-to-date with your IT, which has been very much a new wave. We've got accreditation costs that have been imposed on the last few years. I mean, a practice of, you know, four or five doctors, you'd be looking at over $5,000 just for your accreditation visits.
PAPAS: Now, that's where you have to go somewhere and be effectively tested, is that right?
PHELPS: What accreditation is, is where the accreditation body actually comes into your clinic and has a look at your systems and has a look at your equipment and your facilities and the way you run the practice, and then accredits the facility itself…
PAPAS: Okay.
PHELPS: …not the knowledge per se of the doctors. That's a separate issue, called continuing medical education, which doctors do, unpaid, as part of their improvement in their knowledge base every day of the year.
PAPAS: Now, Dr Wooldridge says that your claim that there are now under 70 per cent of doctors bulk billing is inaccurate. Have you surveyed doctors or are you working off Medicare figures or how …?
PHELPS: There are a number of different types of figures that you can get, and certainly Dr Wooldridge has been quite happily using statistics and we're not quite sure where he's pulled them out of. And you know, in particular…
PAPAS:… organisation to government for a period of months. It just seems that of all the health ministers around the country, he's the one who seems to like a fight.
PHELPS: Yes he does. And I don't think that it's in the best interests of the public for me to be drawn on it, to be honest. I think we've just got to stick with the facts. And the facts are that patients are increasingly finding that their doctors are saying to them, "we're changing our billing practises because we can't afford to continue to bulk-bill. Because, the rebates that we're accepting on your behalf just aren't enough for us to keep making a decent living and running our practices and paying our staff and our rents and everything else".
And that's fine, I mean but the Government has to come clean and say "look, you know, patients are just going to have to pay out of their pockets because this is all the Government's prepared to pay". And the medical profession will simply accept that. But to try and say that doctors are sticking their hand out for taxpayers' money is ludicrous. Because we're talking about people who are independent practitioners running their own businesses and the Medicare rebate is the patients' insurance rebate.
PAPAS: That's right, it's what we pay our taxes for. I wish government departments and the Government would occasionally recognise that this isn't government money, it's our money out of our taxes.
PHELPS: It is. It is. And I think it's up to the public to decide how much they want of their taxpayers' dollar paid into health. And we're not talking about money going into doctors' incomes. What we're doing is talking about the rebates that patients are going to get back to keep their gaps to a minimum.
PAPAS: Well, that's important isn't it? It's not increasing the income, unless, of course, the rebate goes over your standard rate of whatever it is, $42 or so…
PHELPS: Unless you're bulk-billing, frankly.
PAPAS: Yes, yes that's right.
PHELPS: It won't make any difference to doctors who aren't bulk-billing.
PAPAS: Alright. Dr Kerryn Phelps, very kind of you to join us this afternoon. You're President of the AMA, and always make yourself available as often as you can and it's great for the listeners of Talk 1116 to hear what you've got to say. Kerryn Phelps, thanks for talking to us.
PHELPS: Thank you, Nick.
Ends