The number of GPs in Australia is falling in real terms, as more and more medical graduates choose specialisations over general practice.
A major report from the Melbourne Institute of Applied Economic and Social Research has found that, while the number of new GPs in Australia is growing relatively slowly, for every new GP there are nearly ten new specialists.
Professor Anthony Scott, who leads the team behind the report, says the trend could prove expensive in the long run, and has implications for patient care.
“If we don’t have enough GPs, patients will end up in hospital more than they should,” he says. “If patients can’t get in to see their GP they end up in the emergency department, where they’ll be seen by specialists.
“Specialists tend to do more procedures, which means more expense for the public purse. Potentially, patients may also end up receiving unnecessary treatments.”
The ANZ-Melbourne Institute Health Sector Report is the first major health check of general practice in Australia. It uses data collected through Medicare and the Institute’s Medicine in Australia: Balancing Employment and Life (MABEL) survey, which has been running for 10 years and includes data from over 10,000 doctors.
The results suggest general practice is still relatively unattractive to medical graduates, says Professor Scott.
“Money does matter,” he says. “Specialists are paid two-to-three times what most GPs are, and that’s the route junior doctors want to take. Often it is those who can’t become specialists that move into general practice.
“Unfortunately, it’s seen as second fiddle to specialisation, in terms of reputation and earnings.”
And while GP earnings are increasing above inflation and at twice the rate of real wage growth, their work satisfaction is going down – a trend researchers have observed since the introduction of the Medicare fee freeze in 2013.
The fall in morale among GPs may be the most notable impact of the fee freeze; there is no evidence to suggest patient fees are increasing or that the standard of patient care is declining. Nor has the freeze reduced GP earnings. In this context, the most likely explanation for the rise in GPs’ earnings is more efficiently managed practices.
“Falls in job satisfaction suggest decreasing morale which can, in turn, reduce the attractiveness of general practice as a career for junior doctors and compound difficulties in recruitment,” says Professor Scott.
“If this continues it could also drive more GPs away from being practice owners and encourage them to retire earlier than planned, creating issues for retention.
“It is likely practices are improving their business processes, and the co-location of services that pay rent, like pathology clinics, are contributing to their bottom line,” says Professor Scott.
“But this pressure for clinics to run efficiently, along with ongoing negative media and a perception that government policies are targeting general practice, may be contributing to GP’s declining rates of morale.”
Another trend identified in the report is the likely increase in corporatisation of general practice, as smaller, doctor-run clinics are bought up by corporate entities.