“Keeping a person healthy is no small charge. Keeping a nation healthy is a near Herculean task. Yet that is exactly what general practitioners (GPs) do.”
So begins the introduction by RACGP President Dr Harry Nespolon to General Practice: Health of the Nation, the latest annual report on the state of general practice in Australia.
The College, which represents 90 per cent of the general practice profession, commissioned research involving more than 1100 RACGP Fellows (of 37,000 in 6500 accredited practices in Australia) as well as drawing on information in the MABEL (Medicine in Australia: Balancing Employment and Life) Survey and a range of government publications.
Each year the release of the report generates media interest but this year’s has been something of a blockbuster, attracting widespread coverage for the statistic that 65% of patients raise psychological issues with their GP.
The likely reason is that the subject of mental health has moved increasingly onto the media radar, thanks to the efforts of interest groups and various politicians. As the report notes, “Psychological issues (e.g. depression, mood disorders, anxiety) again appear as the most common health issue managed by GPs.”
The 2017 and 2018 reports found a similar trend, although the figures were several points lower, but attracted less coverage. Now, mental health is being recognised increasingly as one of society’s major health issues and delivering appropriate care is seen as a key priority by governments and clinicians. Again, or if you prefer, still.
However, words do not always translate into actions and impediments to this happening include the inadequacies of the Medicare Benefits Schedule.
“Care for health issues such as obesity and mental health can be complex, and require more time [i.e. longer consultations] to work through,” the report notes.
“Many GPs find it difficult to provide this care viably due to the structure of Medicare. The Medicare model better supports shorter consultations for more straightforward health conditions, and essentially undervalues longer consultations that are required for complex issues.
“Medicare rebates for the treatment of mental illness are also lower than the rebates for physical illness. For example, the rebate for item 2713 for mental health consultations over 20 minutes is $72.85. A standard consultation of 20–40 minutes, by comparison, pays patients $73.95.”
Patients commonly seek out a GP from their own demographic. Interestingly, the report notes that “GPs with different characteristics are managing different conditions… When looking at the three most commonly managed health concerns – psychological, musculoskeletal and respiratory issues – female GPs are more likely than their male colleagues to manage psychological issues. Male GPs are much more likely to manage musculoskeletal and respiratory issues.”
It was found that while 45% of doctors have a diagnosed medical condition, in common with the general population, but have higher than average levels of mental distress. A large number (84%) have difficulty finding time to seek medical care. One in 10 GPs delayed seeking care because of the mandatory reporting of medical impairment to health authorities in all States except Western Australia.
Most patients make multiple visits to their GPs, with 41% of women visiting from 4 to 11 times per year and older patients being the most frequent.
Patient satisfaction with GPs was high – 76% said GPs spend enough time in consultations, 81% show respect and 74% listened carefully.
While out of pocket costs are increasing faster than the CPI, now averaging more than $38 per consult, only 4% of patients cited costs as the main reason for delaying or not seeing a GP. Some 44% of GPs reported being moderately satisfied with their remuneration, with 22% being very satisfied. More than 80% are satisfied or very satisfied with their working hours.
The challenge to both clinicians and patients of living in rural and regional areas was marked, with 34% of GPs noting difficulties of accessing specialists. Patients in areas of the greatest socio-economic disadvantage, largely rural/regional, are sicker and see their GP more frequently, yet one-in-three wait more than 24 hours for an appointment on an issue they consider urgent.
However, regional GPs are happier with their remuneration than their urban colleagues.
General Practice: Health of the Nation 2019 can be viewed on the RACGP website.