Opinion
Medicare has a gender problem – now we have a chance to fix it
A passionate GP’s decision to leave the profession struck a nerve with colleagues nationwide. RACGP President Dr Michael Wright says her story exposes a system failing to value complex care.
‘Governments should be careful not to judge the health of general practice by the bulk-billing rate alone.’
When an experienced GP who loves her job decides she can no longer afford to keep doing it, we should pay attention.
Melbourne GP Dr Elly Goodsall recently described reaching that point. She explained how the longer, more complex consultations she provided left her earning less, despite spending more time caring for patients.
The response from GPs was immediate. Members said they saw their own experience in hers. They described unpaid hours, the growing mental health workload, the emotional load of complex care, and fears that comprehensive care is becoming financially unsustainable.
Her experience exposes a flaw at the heart of Medicare: the system increasingly rewards quick medicine at a time when Australians need more complex care.
And because female GPs are more likely to provide longer consultations, that flaw has a distinctly gendered impact.
Female GPs spend an average of 21 minutes with each patient, compared with 18 minutes for male GPs. They are also more likely to provide longer consultations and care involving complex mental health and women’s health.
Yet Medicare pays relatively less for the time spent on longer consultations.
Some have called this ‘Medicare misogyny’. I have described it as a built-in bias. Now, the draft report from the MBS Review Advisory Committee’s (MRAC) time-tiered review has independently identified the same gender equity problem.
That matters because this is not just about what GPs earn. It is about whether Medicare supports the kind of care patients increasingly need.
People are living longer and more of us have several chronic conditions at once. Mental health concerns are now a routine part of general practice. GPs also help patients manage disability, frailty and complex social circumstances.
Think about the man in his 80s who arrives with his partner after showing the first signs of dementia. His family does not know what happens next.
Or the new mother struggling to breastfeed while showing signs of postnatal depression.
Or the woman living with coercive control who needs help working out how to leave safely.
These are not problems a GP can comprehensively address while watching the clock.
That is modern general practice.
GPs consistently tell us that rising patient complexity is one of the greatest challenges they face. Members responding to Dr Goodsall’s story also described a familiar pattern: as patients receive care from more places, their regular GP is often the person who must bring the pieces together. That takes time, continuity and a clinician who knows their story.
Patients do not walk into a consulting room as a single Medicare item. A good GP needs time to listen, understand how problems connect and plan what happens next.
The Federal Government is rightly proud of its additional investment in general practice. That investment is welcome, and bulk-billing rates have risen.
But we also need to look at how that investment supports different kinds of care.
In metropolitan Australia, the tripled bulk-billing incentive adds the same $22.40 to a Level B, C or D consultation. Looking at that incentive alone, it increases the payment for a Level B consultation by around 50%, compared with around 26% for a Level C and 17% for a Level D.
The longer the consultation, the smaller the relative boost.
The new MRAC draft report recognises that problem. Its clinician-led working group found the current difference in per-minute funding between shorter and longer consultations is too great, disadvantaging patients who need more time and the clinicians who provide it. It also found the current bulk-billing incentive structure makes that imbalance worse.
Importantly, it identifies increasing fees for Levels C–E as the quickest option for addressing the wider funding gap.
This is a draft recommendation, not Government policy, and there are no proposed rebate amounts yet. The detail matters. But this is a significant step forward because the review has recognised what GPs have been telling us for years: Medicare needs to better value time, complexity and continuity.
Governments should be careful not to judge the health of general practice by the bulk-billing rate alone.
Affordable care matters enormously and GPs want patients to see us without cost becoming a barrier. But a national bulk-billing percentage cannot tell us whether a patient can find a GP with 30 or 40 minutes available to work through dementia, depression, family violence or several chronic illnesses.
Nor can it tell us whether the doctors providing that care can afford to keep doing it.
If pressure to bulk bill makes complex care financially unsustainable, we risk pushing away some of the GPs our health system needs most and putting more pressure on already crowded and expensive hospital emergency departments.
Female GPs, who provide a disproportionate share of longer consultations, feel that pressure particularly strongly.
The comments are not a workforce survey, but they should concern all of us. GPs described cutting back, thinking about leaving, or having already left traditional general practice.
Every time an experienced GP leaves clinical care, patients lose expertise and trusted relationships. Australia also loses the benefit of more than a decade of medical training and thousands of hours spent learning how to recognise illness, manage uncertainty and care for people through difficult moments.
We cannot afford to keep losing that expertise.
The RACGP has called for Medicare rebates for consultations longer than 20 minutes to increase by 40%. The MRAC draft does not nominate a figure, but it gives us an important opportunity to move reform in the right direction.
The consultation is open until 15 October. The RACGP will make the case strongly for funding that reflects the time and complexity of modern general practice, and I encourage GPs to make their voices heard too.
Sometimes a patient needs 10 minutes.
Sometimes they need 40.
Good healthcare should give GPs the freedom to make that decision based on the person sitting in front of them – not on which appointment length Medicare happens to reward most.
If we want experienced female GPs to stay in general practice, we need to value the care they provide.
And if we want every Australian to have access to high-quality care as their health needs become more complex, Medicare needs to value their time.
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