A comprehensive new report on the makeup of general practice in Australia has found that while GPs continue to play a critical role in the health sector they face “significant challenges due to funding and demographic changes in the medical workforce”.
Notable factors include falling GP job satisfaction, which could hurt GP recruitment and retention; a trend for larger practices and corporate ownership; declining real Medicare funding per GP and new funding models such as Health Care Homes due to commence in July 2017; and a continuing rise in the number of doctors choosing to specialise rather than enter general practice.
The ANZ, Melbourne Institute Health Sector Report on general practice from the University of Melbourne analyses 10 years of the latest available public data about general practice as well as a custom designed study, the Medicine in Australia: Balancing Employment and Life survey of doctors.
Noting Australia’s ageing population and growing burden of chronic disease, the report says the funding of primary care accounts for more than 35 per cent of the national $162 billion health sector.
However, the number of GPs - 32,275 in 2014-15 - continues to grow relatively slowly and is outstripped 10-to-1 by the rising number of new specialists.
Other identified trends include -
- A rising number of women are working as GPs - up from 33 per cent in 2005 to 40 per cent in 2015. But they earn 25 per cent less than male doctors after accounting for differences in hours worked. Further, female GPs’ careers are more disrupted by having children, in terms of reduced workforce participation.
- Practice sizes are increasing, with a wider range of services delivered by different types of health professionals, for example, on-site pathology, but the proportion of GPs who own their practice is declining, which signals a potential rise in corporate ownership.
- Medicare revenue per full-time-equivalent GP has declined in real terms since the Medicare fee freeze in 2013.
- Total GP personal hourly earnings have increased at double the rate of real wage growth in the economy. There are a number of potential reasons for this divergence, including practice efficiencies and increases in revenue from other sources.
- Reported GP job satisfaction and work-life balance have deteriorated since 2013. This suggests reduced morale, which, if continued, could compound existing slow growth and difficulties in recruitment and retention in the sector.
“The impact of these trends on costs, quality and access to health care is largely unknown, which is a problem in such a key sector in the health care system,” said research leader Professor Anthony Scott.
“It is imperative to understand the drivers and impacts of these trends in order to ensure that reform efforts support an efficient and healthy general practice care sector, whilst improving health outcomes and access to care for patients.”
The report adopted a wait-and-see approach to the forthcoming Health Care Homes scheme, saying it is unclear how the introduction of new incentives for quality will affect the sector in the longer term: “Moving away from a fee-for-service structure is generally welcomed, but success hinges on GPs’ morale and willingness to participate. The key issue is how the sector can generate efficiencies while maintaining access to health care and supporting population health.”
