Payroll tax effect on vulnerable patients

Transcript: AMA Queensland member Dr Matt Young speaks to media

Subject: Payroll tax

Interviewer: So, Dr. Young, having had a look and understood what you do about this new interpretation of the payroll tax, what do you think it will mean for your practice and your ability to do those extra services that you do out in the community?

Dr Matt Young: We run a pretty unique practice here in that we're a busy general practice here in Inala. We're dealing with a lot of people that are sort of struggling financially, and any sort of payment that may need to be passed on to them is going to really have a significantly detrimental effect on their healthcare.

One of the unique things about our practice is that, although we are based here in Inala, a couple of our doctors go out in a Kombi and we run a Kombi clinic. The gist of the Kombi clinic is that we treat homeless people, disenfranchised people, people that are on the margins of society that might be struggling to access mainstream medical services, and we test them specifically for Hepatitis C. So, Hepatitis C is a disease that's running rampant with IV drug-using people. The rates of hepatitis C in those communities are anywhere between 10% or 20%.

Hepatitis C is an awful disease because... it's an awful disease in one way, it's a great disease in another way. It's an awful disease in that 30 per cent of those people are going to get cirrhosis, and about five or six per cent are going to get liver cancer at long term, and that doesn't provide you with a great out outcome, obviously. The great thing about Hepatitis C is that it's unbelievably easy to treat and cure. The fundamental problem is that people don't get diagnosed. People that aren't accessing mainstream medical services on a regular basis and getting tested don't get that diagnose with Hepatitis C, and so they miss out on lifesaving medication. And that's just an awful travesty and a tragedy. And obviously, as I said, the people that are mostly afflicted by Hepatitis C, or significantly afflicted by Hepatitis C, are people that are homeless, living on the streets, have used drugs in the past or currently.

They're the people that are going to really suffer even if anything happens to our ability to provide them with the Kombi clinic. I suppose, we work on a pretty skinny margin. Most of the work that we do with the Hep C Kombi is funded by charitable donations and including some windfalls we've had from the state government. But if we have to start paying a GP tax on that, then that severely jeopardises our ability to continue, or we have to pass the cost onto the patients, and these people are struggling. They're flat out putting a meal on the table for themselves and their families. Some of them do live in bus shelters, in parks and on park benches. And even a gap payment of $10, $15 will prohibit them from seeing a doctor.

What a tragedy it is to see someone, a young person, they might've used IV drugs a couple of times in their youth. They're sitting there in the prime of their lives, just going through a bad spell at the moment, and 20 years time they get cirrhosis and then liver cancer and die from a disease that is entirely diagnosable by a finger-prick test, a finger prick-test that take literally couple of seconds. We can have a result to them within a couple of minutes. And if they've got Hepatitis C, we can give them a script right there and then and say, "Mate, you go to your chemist, it's subsidised." They're going to pay about $6 or $7 for a month, it's a two or three-month course, and you could be cured. Not improved, not made a bit better, you can be totally cured and avoid all those hideous ramifications down the track. So, we are really concerned about the financial implications of this GP tax and our ability to continue to do that. If money gets tight, then, obviously, that charitable arm of our practice is going to go by the wayside. People are finding it hard to make ends meet, they're going to really, really struggle, and that's awful.

Interviewer: So, I guess for a clinic like yourself here, in the bricks and mortar clinic that is purely bulk-billed... So, for a lot of people, they're already paying gap, and you can make a case that a few extra dollars is not that noticeable, but for a purely bulked-billed clinic, if you have to start to find that five per cent, 10 per cent extra elsewhere, that's going to be the difference between coming to the doctor or maybe staying at home and suffering in silence.

Dr Matt Young: Yeah. I've already had quite a number of my patients asking me this last few days, "What impact is it going to make on our practice, and are we going to continue to bulk bill?" And there's a lot of head-shaking going on and I'll say, "But god, I don't really know. I don't know what the outcome's going to be." And there's a lot of pain in a lot of faces, you know what I mean? They're concerned, they're worried. We've built up a lot of relationships here; Tony and Barb, and myself and Joss, we've been seeing patients here for 10, 20, 30, 40 years between us. And to lose that relationship, that trusted relationship, that those patients have established with us will be really tragic.

And so, they'll either stop coming in the early part of a disease and come at a later part when things are not curable, potentially, or they go somewhere else that does bulk-bill, but the writing seems to be on the wall, that a lot of practices and amongst my colleagues, I've had a lot of conversations, the whisper is that: most people can't continue to function if this tax comes in, in a bulk-billing way. So, the only other alternative for people is to start going to the hospital, and that's what all my patients keep saying, "Well, I'll just have to go to the hospital instead." And fair enough, they've hired another 830 interns this year, but I wouldn't want to be an intern starting with this flood of patients that is going to come in, if this tax comes in.

And plus, I suppose, patients that I've been seeing for 25 years or 30 years and have a well-established relationship with, they trust me, I love treating them, I know all their background, I know all their diseases, and then all of a sudden they're fronting up in the emergency department to a young doctor who doesn't have that knowledge of their past history. You can't possibly expect the health outcomes to be anywhere near as good, I would think.

Interviewer: I don't know if you... that close, but if you do... But essentially you've been paying payroll tax for your staff, but it's been your understanding and you just haven't had to pay it for the doctors that work in this practice, that's how you've been operating?

Dr Matt Young: I think the general understanding has been exactly that, mate. We pay the payroll tax on reception, manager, nurses and junior registrar doctors that are in their training sort of schemes. But GPs have been exempt from that and that's what's going on for decades, the time that I've been a GP anyway.

Interviewer: Yup. No one's ever come questioning that? You've never had complaints?

Dr Matt Young: No.

Interviewer: No one's ever said, "You're doing the wrong thing."

Dr Matt Young: No, no, never.

Interviewer: So, all you're asking is just to keep going the way it had been for past few decades?

Dr Matt Young: Absolutely. Yeah, it's not broken; don't try and fix it. And I suppose the real victims here are... We're a first world country, and I think you judge a society by the way they treat their least fortunate. How do you treat your most vulnerable people? That's how you judge how evolved a society is. And if you are going to create a two-tier health system where people that are well off are getting well looked after, and people that can't afford it living in some kind of medical scrap heap, then that makes me a little bit embarrassed to be a Queenslander, and I'm never embarrassed to be a Queenslander.