4.4 Remuneration

Remuneration remains the area of greatest dissatisfaction among GPs, with 45% reporting ‘maintaining income’ as one of their top challenges as a GP in 2020.⁵

One in four GPs (25%) are dissatisfied or very dissatisfied with their remuneration, compared to 8% of other medical specialists and 20% of hospital doctors not enrolled in training (Figure 50).

40%

of GPs report maintaining income as one of their top challenges ⁵

GPs are less satisfied with their remuneration than other medical professionals — *Data representing less than 5% is not labelled
Measure: Responses to ‘Please indicate how satisfied or dissatisfied you are with each of the various aspects of your work as a doctor?’
Base: Total survey respondents, n = 3077 (GPs); n = 3578 (other specialists); n = 894 (hospital doctors not enrolled in training)
Data source: University of Melbourne, Monash University. Medicine in Australia: Balancing Employment and Life (MABEL). Data from MABEL Wave 11 survey. Melbourne: MABEL, 2020.

Some GPs, particularly in remote areas (43%), report that they are very satisfied with their remuneration.³² GPs in inner-regional areas are the next mostly likely (27%), followed by outer-regional (25%) and major cities (20%).³² This may be due to variation in cost of living across locations, as well as patient mix, and higher incentives available in rural and remote areas.

One-third (31%) of GPs working as locums report being very satisfied with their remuneration, with salaried employees the next most satisfied (27%).³² GPs who are a principal partner of their practice, or an associate, are the least likely to report they are very satisfied with their remuneration, at 20% and 18% respectively.³²

GPs who report that a majority of their patients have complex health and social problems are less likely to report high rates of satisfaction with their remuneration.³²

It is important that GPs are able to maintain a mix of patients and presentations

This relationship may be reflective of the falling rebate value for longer standard consultations (for example MBS items 36 and 44). The Medicare rebate that patients receive is far lower (per minute) if they spend more time with their GP – as would be needed to discuss complex health and social care needs (Figure 51).

GPs treating patients with more complex health and social problems also spend more unpaid time undertaking care coordination activities.

Considerable unfunded time may be spent seeking links with other local agencies, and information to assist social prescribing, to improve the social support for their patients. This is reflected in findings that awareness of community supports available to patients is the fourth most commonly cited challenge for GPs (refer to section 5.1).

Studies have shown a link between patient complexity and GP burnout. Rates of burnout can be almost twice as high among GPs caring for the highest number of patients with multimorbidity, compared with those caring for the lowest number.⁵⁰

It is important that GPs are able to maintain a mix of patients and presentations to support their own wellbeing and ongoing sustainability of their practices. Recent moves to redirect ‘straightforward’ healthcare services, such as immunisations, minor procedures, and repeat prescribing, to other health professionals has implications for patient safety and continuity of care, as well as GP wellbeing.

The patient rebate per minute is far lower for longer consultations — Measure: MBS item values, divided by duration of consultation (minutes)
Data source: Department of Health. MBS online: 1 May 2020 Medicare Benefits Schedule. Canberra: DoH, 2019.

Eighty-four per cent of GPs report they are paid by a proportion of their patient billings, while 9% are paid an annual salary or wage.⁵

GPs aged <45 years (88%) and metropolitan GPs (88%) are more likely to be paid by a proportion of billings than those aged ≥45 years (82%) and regional/rural GPs (76%).⁵

GPs who are practice owners are less likely to be remunerated through a proportion of billings than non-owners (Figure 52). One in four GPs who are practice owners report they are remunerated via other means, including wages, a fixed hourly or daily rate, proportion of business profit, income after expenses, or partnership distribution.⁵

The majority of GPs are remunerated by proportion of their billings — Measure: GP responses to the question ‘Which statement best describes how you are remunerated at your main practice?’, split by GP practice ownership status
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

5. EY Sweeney. RACGP GP Survey, May 2020. Melbourne: EY Sweeney, 2020.
32. University of Melbourne, Monash University. Medicine in Australia: Balancing Employment and Life (MABEL). MABEL Wave 11 survey. Melbourne: MABEL, 2020.
50. Pedersen A, Nørøxe KB, Vedsted P. Influence of patient multimorbidity on GP burnout: A survey and register-based study in Danish general practice. Br J Gen Pract 2020;70(691):e95-e101

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4.4 Remuneration

Figure 50. GPs are less satisfied with their remuneration than other medical professionals*

Figure 51. The patient rebate per minute is far lower for longer consultations

Figure 52. The majority of GPs are remunerated by proportion of their billings