Interview - Dr Kerryn Phelps, AMA President with Tricia Duffield, Radio 2SM - The Federal Government is considering a bulk billing scheme for low income earners

Federal Health Minister Kay Patterson says patients will not be means tested to be eligible for bulk billing. The plan has been prompted by the huge disparity in the rate of bulk billing between city and country areas. Senator Patterson says it's not fair that some people have to pay for a visit to their GP simply because of where they live.

She also says that it's not fair that some areas have so few GPs and that people are discriminated against because of their location. So, what is the future of bulk billing? Can we afford it? Can we afford not to have it? We'll ask those questions in just a second.

Joining me now is Australian Medical Association president, Dr Kerryn Phelps. Good morning, doctor, thanks very much for your time this morning.

PHELPS: Good morning.

DUFFIELD: What is your response to the Government's planned billion-dollar scheme to revise bulk billing for low-income earners?

PHELPS: Nobody's actually seen this plan. And I think that if one of the lessons that has been learnt from the last few years has actually been learnt, it's that you don't put these plans in place without consulting the medical profession first. Because if you don't, it won't work.

DUFFIELD: Right, so have you been consulted in any way about this?

PHELPS: Not at this point.

DUFFIELD: Okay. What is the state of our bulk billing scheme at the moment?

PHELPS: I think it's dead, to be perfectly honest. GPs have been propping the system up for many, many years - and they've really just had enough of government promises and more and more red tape, more and more paperwork. And the Productivity Commission actually yesterday came out with a study that showed that - and I think it's a conservative estimate - $10,000 a year is spent by GPs just trying to deal with the dozens and dozens of government-inspired programs that require red tape and paperwork. What we don't need is more of that.

DUFFIELD: If you had been consulted, what would you have advised?

PHELPS: I don't think that there's any easy or glib answer to that. I think that what we need to do is to really step back and say, "Why has the Australian public for so long believed that health care is free?" It's not. No health care is free. It can be subsidised by the Government. It can be subsidised by the doctor - and indeed that's what's been happening in a blended form over many years.

But, really, it's not free. Either people pay for health care out of their household dollars or pay for it out of their taxes. And it's a matter of how you come to a balance between those two, and make sure that people who are most disadvantaged - that is, people on low incomes, people with chronic illness, indigenous Australians - are able to access health care at an affordable level.

DUFFIELD: But how do we go about achieving that? It's the real 'hard basket' stuff, this, isn't it?

PHELPS: It is 'hard basket' and it's something that doesn't have any quick and easy answers in time for one budget or for an election cycle. I think it needs to be very carefully thought through. The experts do need to be consulted, but at the end of the day we need to recognise that doctors have a very lengthy and intensive training process, that goes now for 10 to 12 years, that they have enormous responsibilities on their shoulders, that they have high expenses in terms of running their practices, and they just cannot subsidise government ideologies and government programs any longer.

DUFFIELD: Now, the disparity between services for rural and regional patients and those in metropolitan areas is one issue that's a big problem, isn't it, in the very short-term sense? What can be done about that?

PHELPS: The shortage of general practitioners is right across Australia. It's not just in one particular regional area. It is certainly worse in more remote Australia, but it is very bad also in parts of metropolitan Australia. We certainly see in parts of large cities, great shortages of general practitioners. So, it's not confined to any one or two geographic types of locations.

And, really, one of the problems is that there has been a contraction of the real number of medical student places, of training positions for doctors over many years. We've been plugging that hole with overseas-trained doctors for a long time now. But that market, too, is drying up because other nations also are suffering a shortage of doctors. And they are looking to Australia to supply them with some doctors, and the flow could well go the other way. That's not going to be the answer.

What we do have to do is take a careful look at how many medical students we are putting into medical school, what specialties they're going in, facilitate their entry into general practice if they are talented and have an interest in that regard. But that's a long-term plan. What we need to do is to look at short-term, medium-term and long-term plans. And in the first instance, the AMA believes the government should be commissioning a white paper on general practice.

DUFFIELD: That's right because, especially as you've said, they're not being consulted in regard to this particular plan. If we are not getting people attracted to the work as a GP, then any plan down the track seems a bit skewed.

PHELPS: I think, too, that GPs are no longer looking to government to solve the problems in general practice. Speaking as a GP of 20 years' experience, I can say it can be one of the most interesting and rewarding specialties in medicine. And yet, one of the problems is that in terms of the difficulties that have been imposed on general practice, it's just made it harder and harder to enjoy the work for many GPs. What we can do is to try and look at ways of taking the pressure off GPs that's been placed by successive government plans.

Every time they think of one of these new targeted incentives, that to me just reeks of more paperwork and more red tape. And GPs just won't wear any more of that. What they want to do is to say, "I'm providing a service to my patients. It's appropriate that I'm paid for that service to my patients." And it's really between the government and the patients as to whether there's any subsidy from government now. One of the strange things about this current system is that you can't insure yourself in other way for primary care.

DUFFIELD: That's right, because that's been the other issue of course - that's been a huge discouragement and a huge burden for doctors.

PHELPS: It has been, and GPs I suppose are - if you look at Australian general practice, the amount that people pay out of pocket for general practice services is minuscule compared to, say, countries like the United States. If you're going to have a system where you have minimal gap payments for primary care for general practice, then governments have to acknowledge that they need to pay what it is worth, to provide that service free of charge to the patient.

But then we have to ask the question, I think - which is more fundamental than that - should people expect to be able to see a doctor free of charge at point of service? It's not free. It's a matter of how much of our taxes we're prepared to put into that service.

DUFFIELD: I know you've got a busy day in your practice, so I'd better let you get back to it. And thanks very much for your time this morning, doctor.

PHELPS: Thank you.

DUFFIELD: Thank you very much, bye bye. Dr Kerryn Phelps, President of the AMA, with some interesting viewpoints there on whether or not we do have too high an expectation of how much we should pay for a visit to the GP.

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