The General Practice: Health of the Nation report closely reflects the state of general practice. General practice is the most accessed sector of the healthcare system and is foundational to its entirety. Therefore, the health of Australian general practice is essential to the health of the Australian nation.
The annual RACGP General Practice: Health of the Nation report shines a light on Australian general practice by summarising point-in-time data and year on year trends from a range of government and stakeholder publications and a specially commissioned survey of GPs. The report examines areas such as general practice workforce, the main reasons people visit their GP and general practice funding.
Each year, RACGP members select a topic of interest for the report. The sixth annual General Practice: Health of the Nation report topic of interest is the ‘sustainability of general practice’. This report highlights several concerning themes relating to general practice sustainability, such as unsustainable workload, burnout, mounting administrative burden and inadequate remuneration. This report presents evidence of these pressures expediting the forecasted general practice shortage, as more GPs, including younger GPs, reduce their hours and express their intent to retire early from general practice.
GPs in Australia are under extreme pressure in their roles, exacerbated by the COVID-19 pandemic and recent natural disasters, including bushfires and floods. Almost three in four GPs (73%) reported they have experienced feelings of burnout over the past 12 months. Burnout among medical professionals is not new, it is an international phenomenon with 97% of doctors across various countries reporting that they have felt burned out at some point in their work life.1 However, the pressures of the past few years, particularly because of the COVID-19 pandemic, have exacerbated feelings of burnout among the profession.1 This additional pressure is confirmed in this report, with GPs who are finding recovery from the pandemic/disasters more challenging significantly more likely to report feelings of burnout.
For the first time since the Health of the Nation survey began, ‘managing workload’ has overtaken ‘managing income’ as the highest-ranked challenge reported by the profession. In addition to the global pandemic, this can be partially attributed to an emerging theme related to the administrative and regulatory burden GPs face in their roles. Nearly two-thirds of GPs surveyed identified ’understanding and adhering to regulatory changes’ as a challenge. This is concerning given that administrative work (as well as quality improvement and patient coordination activity) is largely unpaid time for GPs, as only time spent with a patient generates a Medicare rebate.
Almost half of GPs surveyed reported that it is financially unsustainable for them to continue working as a GP.
Despite increasing financial concerns, many GPs choose not to charge their patients an out-of-pocket fee over and above their Medicare rebate. The report shows that the primary reason GPs choose to bulk bill is because their patients cannot afford to pay.
Annual Medicare data from 2021–22 demonstrate that there has been a decrease in the proportion of services bulk billed nationally. This is despite several factors that are likely inflating bulk billing figures, including mandated bulk billing of COVID-19 vaccinations and increased cost of living, where GPs and practices feel they have no choice but to absorb more costs to provide affordable care to their patients. This is a clear indicator that GPs and practices are finding it increasingly unsustainable to provide care, coupled with reports that more GPs are moving to a mixed billing model of care (where they bulk bill some patients and not others).
Only 3% of GPs stated that the current Medicare rebate is sufficient to cover the cost of care. When asked about the current fee GPs charge (patient rebate plus out-of-pocket cost) for a level B consultation, 69% identified it was too low. GPs with relatively higher fees were far more likely to state that their fee accurately reflected fair remuneration for providing the service.
Another issue impacting increased regulatory burden and workload stems from Medicare complexity and the increase in the government’s Medicare compliance activities. More than three-quarters of GPs reported that ensuring compliance with Medicare takes time away from patient-facing care, and 61% reported that the complexity of Medicare is something that worries them outside of their work day. Government Medicare compliance activities are having a disproportionate negative effect on patient access to and affordability of care. While only 23% of GPs reported that they had personally experienced one of the government’s Medicare compliance activities, 47% of GPs indicated that they either avoided providing certain services or avoided claiming patient rebates, despite providing services out of fear of Medicare compliance ramifications.
The increasing administrative and regulatory burden is also impacting the sustainability of Aboriginal medical services. GPs working in these services are often paid a salary, but are still subject to the increasing Medicare regulatory burden and compliance activities and the time it takes away from providing clinical care.
For the sixth consecutive year, GPs reported that mental health issues were the most common reason for patient appointments. Mental health, particularly youth mental health, was also the patient health issue causing GPs the most concern for the future. GPs are carrying a large share of the mental health workload, with 38% of GP consultations incorporating a mental health component,2 and patients reporting they are more likely to see a GP for their mental health concerns than any other healthcare professional. The report also presents evidence that the amount of mental health work undertaken by GPs is significantly underestimated in Medicare statistics.2
General practice is unsustainable, and without immediate policy intervention, the health of the nation will suffer.
With the existing challenges of being a GP now compounded by the pressures of COVID-19 and other recent natural disasters, the proportion of GPs considering imminent retirement has increased significantly in 2022. One-quarter of those who responded to the survey stated that they plan to retire within the next five years, an increase from 18% in 2021. In real numbers, that is more than 7500 GPs. This will worsen already worrying workforce projections that predict a deficit of 11,517 GPs by 2032.3 The report presents evidence that unsustainable workload and burnout among the profession is contributing to early retirement. General practice clinics are already affected by this general practice exodus, with an increasing proportion of practice owners reporting that sourcing and retaining GPs is a key challenge. This year 70% of practice owners have indicated they are concerned about the ongoing viability of their practice, an increase from 54% in 2021.
1 HIMMS and NUANCE Communications. From overload to burnout. What clinicians think. 2021. [Accessed 1 June 2022].
2 The Navigators and GPMHSC. Delivering mental health care in general practice. 2021. [Accessed 1 June 2022].
3 Deloitte and Cornerstone Health. General practitioner workforce report 2022. 2022. [Accessed 20 June 2022].