Female GPs say health insurance reimbursements are ‘inadequate’, pressure to bill patients en masse adds to emotional exhaustion

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For two years, Sarah McLay dipped into her personal savings, sacrificed take home pay and ran her central Queensland medical practice with a loss of “several hundred thousand dollars”.

Regardless of the hours Dr. McLay worked or the patients she saw, the numbers didn’t add up.

“We were really subsidizing public health care,” Dr. McLay said.

“Nothing is ever truly free. Everything costs someone something.”

Most patients probably don’t think about the finances of a medical clinic – and that’s assuming you can get into the waiting room in the first place.

Yet the financial strain is part of a hidden toll that Dr McLay and other GPs say disproportionately affects women and adds to skill shortages as exhausted doctors leave the profession.

A financial and emotional gender disparity emerged because female GPs tended to see more patients requiring longer consultations.

Dr. McLay says Clermont will not have a permanent doctor if it is forced to close its clinic.(Provided)

“Yes, I went into medicine because I wanted to help people, but I can’t change the reality that our Medicare reimbursement is actually totally insufficient to pay our bills,” Dr. McLay said.

“I can’t keep sacrificing and suffering because the government doesn’t appreciate what we’re doing.”

More lucrative short dates

GPs at all levels said they struggle to provide care with Medicare reimbursements that have not increased with inflation.

Louise Stone, a GP and medical educator in Canberra, said short consultations received a higher discount per minute than longer appointments.

Dr Stone said she would “save four times more” by making back-to-back vaccination appointments than a 40-minute consultation for someone with mental health or chronic physical conditions.

On top of that, Dr Stone said GPs also face long waiting times to find patients with specialist help beyond the mental health help they have been trained to provide.

“That’s what I hear from other GPs across the country: the patients you take home in your head and worry about, you can only do so long before it starts to have an impact on your health and well-being when there is so much we can’t do,’ she said.

“Living with this stress of watching patients we care about not being able to get the services they need, it ends up wearing you down a lot more than working hard.”

A 2021 survey of 846 GPs by the General Practice Mental Health Standards Collaboration came to similar conclusions.

A woman with short brown hair pats a small white dog on her lap
Dr Richmond says cutting his hours was the only way to cope with the emotional and financial cost of GP.(ABC Capricorn: Michelle Gately)

The survey found that while male GPs carry out 49% of all consultations involving mental health, this represents only 32% of their weekly consultations.

This is compared to 47% of female GP weekly consultations regarding mental health.

“Women GPs therefore have the potential to feel pressure on their time, income and emotional well-being more intensely,” the report states.

“Many GPs feel the same”

For Rockhampton-based Vicki Richmond, the only way to avoid the “enormous” personal demands of GP was to work part-time.

“Over the years, I think, I often felt it was a personal weakness on my part,” she said.

“Why couldn’t I cope? Maybe it was something about me.

“More recently I have recognized that in fact my experience is not mine and that many, many GPs feel the same way.”

Dr Richmond said more recognition of the problem was needed.

“Feeling every day like you’re not able to accomplish what needs to happen because of all these other pressures, not to mention my own pressures of having to go home, cook dinner, and pick up my kids. at school,” she said.

“That’s a lot to bear, isn’t it?”

Growing doctor debt

For Dr. McLay, who has his own practice in Clermont, cutting his hours was not an option.

The only solution she saw for the growing financial hole and mounting pressure was to be candid with her community.

Dr. McLay recorded a video and shared it on Facebook, explaining why the clinic could no longer bill for mass appointments.

The reaction was mixed.

Dr McLay said some colleagues had warned her to keep quiet and avoid appearing ‘greedy’, while some community members explained they didn’t have the money to pay up front .

But she said most people had a new appreciation and understanding of the system.

“It’s heartbreaking because you just want to say ‘Of course’…but, ultimately, if we continue like this, we’re going to have to close this business,” she said.

“So this town won’t have permanent doctors.”

Calls for fair discounts

The Royal Australian College of General Practitioners (RACGP) is calling on the federal government to create fairer discounts for mental health appointments.

RACGP rural chairman Michael Clements said it would help GPs while giving patients better access to care and reducing pressure on hospitals.

A man in a suit and tie with a slight smile, graying hair at his temple.
Butler says the task force on strengthening Medicare will look at potential reimbursement increases.(ABC News: Che Chorley)

Federal Health Minister Mark Butler said the average cost of GP services had risen by 60% over the past decade.

In a statement, Mr Butler said the government had committed to investing nearly $1 billion, which included the Strengthening Medicare Task Force to examine potential increases in reimbursements and other improvements.

GP practices can also apply for funding to improve equipment and staff skills under a $220 million grant scheme.

While Dr McLay and Dr Richmond admit there is no silver bullet, both believe that seeing the human beneath the profession goes some way to helping GPs feel valued.

“Nobody goes through the harrowing, difficult experience of college and then all the special training that follows because they want the money,” Dr. McLay said.

“We all got into medicine because we care about people and we care about outcomes.”


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