Doctors are warning the current funding arrangement for General Practice is unsustainable, and patients should expect to pay more to see a GP, if they can even find a doctor when they need one.
They say a shortage of doctors and nurses is likely to get worse, with many GPs feeling burnt out by their heavy workload.
In her clinic in Campbellfield, in Melbourne's outer north, Umber Rind started charging patients an out-of-pocket fee for a consultation last month, for the first time.
"We're the only essential service that's expected to discount everyone, and we'd love to but we just can't do it anymore," she said.
The clinic now charges patients $30.90 for a standard 15-minute consult. They also receive a $39.10 rebate from the Federal Government per standard consult. That rebate went up by 1.6 per cent in July, after being frozen for more than a decade.
Dr Rind said a 1.6 per cent increase did not begin to cover the other cost increases her practice had to meet — like nurses' wages, rent and power bills.
She said the decision to stop bulk billing had led to some difficult conversations with patients.
"I still will bulk bill people who are vulnerable and things like that, but I think as GPs we shouldn't be the one shouldering that burden," she said.
Dr Rind said she thought that once the clinic started charging fees, it might be less busy. But it is not.
"Our phones don't stop ringing, we've got patients who are coming from far away, even rural country towns," she said.
She said a lack of doctors, particularly in outer metropolitan and rural areas, was to blame.
Challenges finding nurses and doctors
In West Brunswick, closer to the city, Deb Wilson co-owns another busy practice.
She said her clinic had been advertising for a new practice nurse, but a state-wide shortage meant the position was unfilled.
She said that meant GPs were doing more paperwork and phone calls, and had less time to see patients.
"I think that's the other thing with GPs, is the amount of work outside patient face-to-face time," she said.
She urged governments to do more to treat the causes of ill health, including poverty and a lack of housing, that see patients eventually end up in hospital.
"We have a universal insurance system, but not a universal health system."
Her colleague, John Stanton, has been a GP for 47 years, and is about to retire. He's worried there are not enough young GPs coming through.
"When I graduated in 1972 about 60 per cent of medical graduates went into general practice. At the moment it's about 16 per cent," he said.
"So there aren't younger people coming in who'll take the place of people like me who are about to retire.
"Unfortunately general practice is not seen as a place for new doctors to go, it's not financially rewarding, it doesn't carry the status of a specialist working in a hospital.
"That's very sad."
Hard to keep doctors in the outer suburbs
Alastair Stark co-owned his medical practice in Melton, in the outer west, for 15 years, before selling it last year.
He said it was hard to make a bulk-billing general practice in the outer suburbs financially viable.
"Melton is a great place to be, I love working in Melton, it's very varied, but of course there are pockets of disadvantage," he said.
He said that meant there were a lot of complex medical and physical health problems, that take longer to treat. But often his patients cannot afford to pay an out-of-pocket fee.
"To spend that little bit extra time with the patients does cost the practice more."
He plans to keep working at the clinic, but said the biggest challenge in the outer suburbs is recruiting and maintaining staff.
"It makes no sense to me for someone to come to Melton to work harder and get paid less — that's not a very attractive proposition for the younger doctors I'm afraid," he said.
Mental health consults take more time
Shumaila Panhwar said about 80 per cent of the patients she saw in Melbourne's north required mental health care, especially since the start of the pandemic. She said it was hard to see those patients in just 15 minutes.
"It's more complex because you can't do cookie-cutter medicine with mental health, it's not a sprained knee or gout," she said.
She said an increasing number of patients are not wanting to go to hospital to avoid long waiting times, and she recently spent 45 minutes helping a patient with serious chest pain find an alternative care plan.
She said she often spends her lunch breaks checking up on patients or dealing with compliance or paperwork.
"It's very easy for others to bounce things back and it all comes back on our lap," she said.
Health Minister 'genuinely committed' to solving issues
Karen Price is the president of the Royal Australian College of GPs (RACGP) and works at a clinic in Highett, in Melbourne's south.
She said Health Minister Mark Butler was listening to GPs' concerns.
"I'm really pleased we've got a listening ear of the Minister, I think he's genuinely committed," she said.
"He knows it's a wicked problem and we're all working to try and solve that."
She said the Medicare rebate needed to be urgently lifted — and the AMA guidelines on the cost of a GP consult indicated what that rebate should be.
"They're in the order of $80 or $90 [per consult] — but I'm not holding my breath on that," she said.
She said she understood it was a difficult time for patients.
"Try and let the front desk staff know a little bit about what you're suffering from so we can help determine whether we need to make an urgent appointment," she said.
In a statement, Mr Butler said the Health Department would investigate the state of bulk billing.
"Our Strengthening Medicare Taskforce will identify the best ways to boost affordability, improve access, and deliver better support for patients with ongoing and chronic illness, backed by the $750 million Strengthening Medicare Fund," he said.
