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‘A cultural issue’: Minister calls for attitude shift to general practice


Jolyon Attwooll


16/02/2023 3:14:44 PM

‘We’ve got to get away from this idea that general practice is somehow a B grade,’ the Federal Health and Aged Care Minister has said.

Minister for Health and Aged Care Mark Butler
The Minister for Health and Aged Care Mark Butler has said existing attitudes are a barrier to making general practice more attractive for medical graduates. (Image: AAP Images/ Mick Tsikas)

‘There’s frankly a cultural issue within medicine.’
 
That is the view of Federal Health and Aged Care Minister Mark Butler, who has conveyed his concern about medical educators deterring would-be GPs in a podcast for The Guardian.
 
In an interview considering the implications of the Strengthening Medicare Taskforce report, he told The Guardian’s Political Editor Katharine Murphy he wants attitudes to change.
 
‘I speak to GPs and medical graduates all the time about their experience of being in a hospital and expressing to a consultant who might be supervising them, expressing an ambition to be a GP, and being told, “Why would you want to do that? You could be an anaesthetist, you’re smart enough to be a cardiac surgeon, why do you want to be a GP?” he said. 
 
‘We’ve got to get away from this idea that general practice, the backbone of our healthcare system, is somehow a B grade.’
 
Minister Butler made the remarks as he addressed the prospect of GP shortages.
 
‘We think it’s hard to see a GP now, [but] when you look at the pipeline of new GPs 5–10 years down the track, if we don’t turn that around our primary care system will be in enormous strife,’ he said.
 
‘And that will place even more pressure on the hospital system that some of those structural challenges – an older population, more complex chronic disease – are already placing on them.’
 
During a discussion that ranged from the COVID-19 response in aged care to the prospect of voluntary patient enrolment, the Minister challenged the view of general practice as an easy option.
 
‘Managing overwhelming demand for good mental health support, complex chronic disease, lots of comorbidities – that’s hard work,’ he said, as well as acknowledging the ‘additional pressure’ of managing a general practice.
 
Introducing a longer consultation rebate – one of the tangible recommendations of the Strengthening Medicare Taskforce report – is one possible solution to help address an outdated system, he stated.

‘The system really is set up for procedures,’ Minister Butler said. ‘In the old days, you’d do yourself an injury, get an infection, you’d go to a doctor, there’d be a procedure, and they’d get a rebate for it.
 
‘And that’s really the emphasis of the system rather than on the consultations that underpin really good chronic care. So how do we shift the balance to that sort of care?’
 
Minister  Butler also acknowledged the pay gap between general practice and other specialists – again neither committing to increasing Medicare rebates, nor entirely ruling it out.
 
GPs have consistently raised Medicare rebates as one of the most pressing factors affecting the viability of general practice. In the RACGP’s most recent Health of the Nation survey, only 3% of respondents said they believe the current MBS rebate is sufficient.
 
‘There’s no question, there’s their salary difference and … we need to think about some of those issues,’ Minister Butler said.
 
‘There are other conditions of employment that particularly public hospital employees enjoy that you don’t get, particularly while you’re training [to be a GP].’
 
He pointed towards the recent program announced in conjunction with the Tasmanian State Government to make rural GP training more attractive, and repeated a commitment from politicians at different levels of government to prioritise healthcare reform.
 
‘It’s really complex,’ he said. ‘The premiers and chief ministers have raised in cabinet the need for there to be a focused strategy on building the general practice workforce, making it more attractive for medical graduates to go into.’
 
RACGP President Dr Nicole Higgins agrees that the negative attitudes referred to by Minister Butler need to stop – and that the appeal of what she describes as ‘an incredibly satisfying career’ be allowed to shine through during medical studies.
 
‘The experience for doctors when they go through medical school and hospital training is often one where general practice is seen as a second-rate choice,’ Dr Higgins told newsGP.
 
‘I love general practice, it is intensely rewarding professionally.
 
‘I love the relationships that I have with patients and their families, the continuity of care.’
 
It was an aspect of healthcare also referenced by the Minister during the podcast.
 
‘I speak to lots of GPs, lots of medical students, they want to be general practitioners because there’s huge reward in it – [I’m not] not talking about money particularly, but huge reward from the connection to community,’ he said.
 
‘They get the idea that you have this … sometimes lifelong relationship with a family, from when they have a little baby to the baby growing, right through childhood and adolescence and dealing with the health challenges that you see moving from young adulthood into middle age.
 
‘This is something that GPs talk to me all the time about.
 
‘There is a little bit more control over your work–life balance. You work long hours but being a hospital doctor means you work shift work.’
 
Dr Higgins said she is fortunate that her studies brought her into contact with strong general practice advocates who emphasised the rewards of the specialty.
 
‘I was lucky enough that I went through Monash at a time where we had [Professor] John Murtagh and [Professor] Steve Trumble, and champions of general practice leading medical training,’ she said.
 
However, the RACGP President also pointed towards research carried out in the UK which indicates denigration of general practice is an ongoing problem that needs to be addressed. 
 
A separate study using student feedback found that positive views about general practice were expressed in medical education but also noted the impact of disparaging remarks.
 
‘This will clearly have a negative influence on students’ perceptions of the specialty as a career choice,’ the authors of the Newcastle University study wrote.
 
There is no place for such attitudes in medical education, according to Dr Higgins.
 
‘What needs to happen is that universities must embrace and celebrate general practice as a career of choice,’ she said.
 
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Dr Joseph Dinesh Rodriguge Fernando   17/02/2023 6:50:51 AM

Haha.. your department didn’t send nudge letters to cardiac surgeons! You are the one who is responsible to make General practitioners B grade , paying lowest Medicare rebate .. Medicare students are smarter and they can see the truth 😕


Dr Suresh Gareth Khirwadkar   17/02/2023 7:20:44 AM

Yeah ok. But what are they actually going to do? This is all just smoke and mirrors to placate GPs. And again, how many GPs actually want a level E rebate? There’s no way you’ll get away with using it. PSR will take your house if you use it more than once a year probably.

Stop making GP the dumping ground for everything.

GPs should stop being the dumping ground for everything and push back.

Abandon bulk billing for all but the most needy and let the patients put pressure on the government for higher rebates.

Then GP will regain its status amongst medical specialities.


Dr J Hatch   17/02/2023 8:56:29 AM

If we are not considered B grade then let us practice at top of scope and refer for MRI’s that only non-GP specialists can order. MSK conditions I can treat without the patient and the system having the expense of an orthopod; but they often cop the out of pocket on a non rebated MRI


Dr Henry Arthur Berenson   17/02/2023 10:31:05 AM

Hospital specialists telling future practitioners General Practice is B grade......... Very interesting


Dr Daniel Thomas Byrne   17/02/2023 10:38:55 AM

The culture will change when bulk-billing hits 60%. We have a long way to go before any government - Labor or Liberal will really listen.
March 1st - Level B $90 ($65 HCC).


Dr Abdul Ahad Khan   17/02/2023 10:55:44 AM

QUESTIONS :
1. Why would any New MBBS Graduate WANT to become a GP ???
2. For Decades now, successive Govts have given PITTANCE to the Populace, for
their Consultations with GPs - do you also not think that the SAME ???
3. What is stopping you from taking the FULL BLAME , for
continuing to lower the Worth of GPs by giving Pittance of Medicare Rebates
for GP Consultations ???
3. What do YOU think should be the Medicare Rebates for GP
Consultations in 2023 ???
4. What is stopping you from RAISING THE IMAGE OF GPs in the Eyes of the
Populace & in the Eyes of new MBBS Graduates, by increasing the
Medicare Rebates for GP Consultations & thereby attracting these New MBBS
Graduates to pursue their Careers as GPs ???

Dr. Ahad Khan


Dr Sharmila Sambandam   17/02/2023 11:02:31 AM

When I was a student I was told if you get CRS ( credit scores) you will be GPS ( if you modify the letters it becomes GPS) by a surgeon. I never wanted to do general practice as I thought it would be boring and you would just treat cold and cough and do medical certificates. But in practice it is hardly the case. The day is filled with multitude of interesting things and you have to be switched on at all times as they are all different presentations and different age groups as we all know.
I agree the lower rebates and the degrading comments do make medical students think of general practice as B grade....


Dr Martin Neuberger   17/02/2023 11:57:56 AM

Politicians talk - let's give them a chance to walk the walk
Stop bulk billing - start using AMA fees and let them figure out how they can rebate the patients fairly.
All the talk about the Tasmanian training rebate model is a side issue. Students know they will be training under this model or another for 1-2 years and then?... the next 30-40 years is what counts.


Dr Bradley Arthur Olsen   17/02/2023 1:16:08 PM

Yes ,presently government is not improving the rebate, adding extra layers of red tape , rejecting valid referrals ,wasting our time. Then turn around and blame us for DEM wait times/GP style patients presenting to DEM as we have no appointments as we are filling in ridiculous forms. Yes Minister you ARE changing it from B grade..............we are well on our way to C grade!!!!!


Dr Edward Thomas Wu   17/02/2023 1:43:50 PM

"I speak to GPs and medical graduates all the time" but not getting the message though? As the RACGP president pointed out repeatedly the discrepancy between resources allocated to primary care services and hospital services reflect more clearly than words. People's "attitudes" are mere reflection to realities. Ask others to change their attitudes without changing your own attitudes is just more "political speaks"?


Dr Mary-Anne Lee   17/02/2023 4:44:54 PM

I have been in General Practice for 35 yrs and I still enjoy it but I am lucky I have always worked part time 3-4 days a week. I feel with these hours I remain mentally able to take in and process what has been said and tolerate all the diagnostic and communication challenges we are faced with daily. We also need to " clean up our own backyard" if we are to remain respected as a profession. Medicine is such an inexact science that noone feels they can criticise the clinical accumen of others but you have to wonder at times albeit you are getting one side of the story. If you dont enjoy GP practice and its human connection and just wanting to make an income then think seriously about using your skills in another area of medicine. Let us all be able to provide A grade care to our patients as challenging as that may be. We need a voice to not allow the so called "dumping of duties" to us . If we are required to assist then have the courtesy to first give us the information .


Dr Abdul Ahad Khan   17/02/2023 7:30:50 PM

Sorry, I did no make it clear in my earlier Post.
The QUESTIONS are meant for Minister Mark Butler to ANSWER PLEASE :
1. Why would any New MBBS Graduate WANT to become a GP ???
2. For Decades now, successive Govts have given PITTANCE to the Populace, for
their Consultations with GPs - do you also not think that the SAME ???
3. What is stopping you from taking the FULL BLAME , for
continuing to lower the Worth of GPs by giving Pittance of Medicare Rebates
for GP Consultations ???
3. What do YOU think should be the Medicare Rebates for GP
Consultations in 2023 ???
4. What is stopping you from RAISING THE IMAGE OF GPs in the Eyes of the
Populace & in the Eyes of new MBBS Graduates, by increasing the
Medicare Rebates for GP Consultations & thereby attracting these New MBBS
Graduates to pursue their Careers as GPs ???

Dr. Ahad Khan


Dr Peter James Morero   18/02/2023 2:47:12 AM

"I speak to GPs and medical graduates all the time ... "

Translation - my advisors came up with some talking points so I can make sure expectations of action to fix the system will be so low that anything I do can be touted as progress.


Dr Michael Charles Rice   18/02/2023 9:39:42 PM

In order to "...get away from this idea that general practice, the backbone of our healthcare system, is somehow a B grade" the Minister has, by his own estimation, 5-10 years to complete a change.

The backbones Butler needs to be keeping the people healthy and out of hospital are making their training and career choices right now, and most of them are placed in hospitals. There they see who drives the fancy cars, they know who has the nicest holidays, they're aware of who lives in the big homes in the posh suburbs and who flies at the pointy-end of the plane.

Not the dollars banked (no-one talks about that) but the conspicuous trappings of the A-grade lifestyle will drive the choices. Not enough are choosing B-grade for themselves and their families.

Is the solution to deliver A-grade lifestyles for the new backbone of the healthcare system?


Dr Radwan Al-Musawy   20/02/2023 10:22:01 AM

Typical politician talk blaming someone else and appears to be the saver without any clear lines how to fix the problem.


Dr Wah W. Khaing   20/02/2023 9:50:16 PM

This is the worst time to become a GP . If the DOH and the health minister himself thinks GPS are the important skeleton structures of healthcare, why trying to ruin and make the General practice career even worse! What government doing is like endangered GP species to extinction!!!

No rebate increase in more than 10 years , now health minister planning to give green light to let pharmacists to treat patients ( ridiculous ideas) , give allied health workers ( to make clinical implications worse) .
All those plans were not to improve the primary health of people or promote the interests in GP career !!!

It is an absolute insult to the General practitioners and the doctor profession!!!

It is devaluing the medical profession, particularly GPs .

Unsafe for patients! If pharmacists can prescribe medications, it is the same as giving patients third world countries medicine!

How pathetic!!!

RACGP shouldn’t let this happen!


Dr Fiona Manning   21/02/2023 10:31:07 PM

As a GP registrar, this article was frustrating to read . The "medical culture" is not what needs changing. It has been informed by a disrespectful political culture toward general practice from our government and medicare bodies. Quite simply, why be a GP when you will work just as hard if not harder then your non -GP specialist colleagues, get just as much abuse if not more then your non-GP specialist colleagues, and earn a whole lot less than your non-GP specialist collegeues. And have no benefits (leave, maternity) once you are fellowed. In what world do you get more responsibility, less supervision AND get a REDUCTION in your earnings? Apparently here. All GP registrars have to take a pay DROP. Of course the advice would be not to be a GP because you will be treated B GRADE BY THE GOVERNMENT/Medicare/Community. Pay your GPs and their registrars for the GRADE A primary care specialists they are. The rest will follow. And I'll stop thinking about changing my specialty.


Dr Peter James Morero   22/02/2023 6:38:38 AM

"I speak to GPs and medical graduates all the time ... "

Translation - my advisors came up with some talking points so I can make sure expectations of action to fix the system will be so low that anything I do can be touted as progress.