‘A kick in the guts’: Frontline GPs respond to Medicare story

Jolyon Attwooll

21/10/2022 5:23:17 PM

How serious is the fallout from this week’s ‘rort’ headlines? GPs around the country explain why they are so upset.

Sad GP.
Many GPs have found it hard not to see the reporting as a personal affront to their professionalism and ethics.

There has been no hiding from the media’s Medicare coverage this week, particularly the ‘rorting doctors’ angle adopted by Nine Newspapers and the ABC.
Reporters behind the coverage would have known the defrauding doctor narrative would dominate.
Despite the scale of the allegations and potential reputational damage that doctors, in particular GPs, have faced as a result, it is worth noting that the RACGP was not given any chance to comment, or a right to reply, ahead of the stories emerging.
The inevitable pushback was immediate, both among GPs and beyond, and the reverberations are still playing out days later on social media, in the medical press and in newspaper opinion columns around the country.
Is it a passing storm? Or is the reporting, which has been sharply criticised by health professionals from many different quarters, likely to have a lasting impact on general practice?
To get a sense of how those ‘at the coalface’ have felt about the coverage, and their perception of the likely effects on general practice, newsGP reached out to a broad range of GPs – from high-profile faces to those simply getting on with their jobs.
The views ranged from ‘storm in a teacup’ to ‘another nail in the coffin’, although with a heavy slant towards the latter. Here are the themes that emerged, with some selected comments from those who responded.
Critical of reporting
RACGP Rural Chair Dr Michael Clements described the story as ‘storm in a teacup’ based on one person’s opinion.
‘There is certainly a large proportion of our membership offended by the statements, but … the accusations are baseless,’ he told newsGP.
‘Rural GPs will continue to get on with the job.’
Such a sanguine approach was a rarity among the GPs contacted. Many have taken the coverage much more to heart, with rural Victorian GP Dr Rebecca McGowan calling it ‘a kick in the guts’ while Tasmanian GP Dr Donald Rose said the ABC had lost a viewer.
High-profile Melbourne GP Mukesh Haikerwal lamented what he called ‘one-sided’ reporting, while his partner and fellow Altona GP Dr Karyn Alexander labelled it ‘sloppy journalism’ which followed a similar line to attacks on British general practice.
‘I myself am going to cancel my Age membership if there is no balance on this atrocious story,’ she told newsGP.
‘The articles in the media this week will likely further fuel public anger and the backlash will impact our front of house staff, our practice managers, our nurses and our GPs. They will become ill and they will leave in droves.’

Karen-Magraith-Hero.jpgDr Karen Magraith says it is far more common for GPs to under-bill than try to rort the system.
Many commentators have queried the evidence behind the $8 billion Medicare claim and called into question the diligence of the reporting in testing the claim. Toowoomba GP Dr Gabriel Roux shares the concerns.
‘We’ve all seen doctors investigated around us over the years and my concern has always been more about the impact of unnecessary harassment,’ he told newsGP.
‘For Medicare to be so active in pursuing small matters and then to overlook $8 billion of fraud per year is simply unthinkable.’
What about under-billing?
Dr Roux said the coverage has missed an area that could have formed a very different story.
‘I was once audited and it turned out that I actually under-claimed,’ he said.
‘When I pointed it out to Medicare, they ignored me and certainly did not pay out the deficit.
‘The inevitable effect of being investigated is for myself and colleagues to respond with under-billing. I concluded that this must be the ultimate target of Medicare in order to save money.’
In fact, Dr Roux said he has seen many GPs only billing item 23 for a 20-minute consultation, despite spending up to 45 minutes on a consultation.
‘If you calculate the impact on the industry of Medicare harassment resulting in under-claiming – especially by young doctors scared of everything – this might even tip the real scale the other way,’ he said.
A similar point is also made by Dr Karen Magraith, a Tasmania-based GP.
‘In my working life I have seen many more doctors who under-bill, through fear of audits, or through compassion for their patients,’ she told newsGP.
Gold Coast GP Dr Tammra Warby cited figures from the latest RACGP’s Health of the Nation report, which suggest that around 47% of GPs underbill.
‘This means we are working for free, which previous published evidence has supported,’ she told newsGP. ‘That is unsustainable for any profession, as it means relying on GP goodwill, which has rapidly waned especially during the pandemic.’
Meanwhile Adelaide GP Dr Alvin Chua pointed out the vast unpaid work many GPs do, giving examples such as fielding phone calls from patients and concerned relatives, dealing with Centrelink forms, and filling requests for patients who have forgotten repeat scripts. 
‘Do not get me started on how much money I am actually owed by Medicare,’ Dr McGowan said, simply.
Impact on patients
Many of the GPs contacted by newsGP are concerned about the unintended consequences on patients the coverage might cause.
Dr Rose said he is abandoning pro-bono work and billing gaps for all patients where possible. He also said the coverage has prompted him to begin ‘quiet quitting’.
‘I have not needed to work for many years but felt I needed to during the pandemic,’ he said. ‘This latest round of doctor bashing has changed my view.’
Dr McGowan reports a similar trend among her contemporaries.
‘So many of my female colleagues, the Generation X mob in their 50s, are retiring early [or] looking at non-clinical work,’ she said.   
‘We have had enough of the gaslighting and the coercive control of the abusive relationship that is Medicare.’

Dr-Tammra-Warby-Hero.jpgDr Tammra Warby has questioned the timing of the coverage, which has come just as recognition was growing that Medicare is underfunded.
Dr Magraith said she has observed a similar mood among GP colleagues, with many choosing locum work or jobs with fixed salaries that do not rely on MBS rebates, reducing hours or leaving the profession altogether.
‘All of these things unfortunately reduce the availability of ‘full spectrum’ GPs able to offer continuity of care,’ Dr Magraith said.
‘It’s patients who will really miss out, especially in areas of disadvantage.’
Distracting from reform
For Dr Mariam Tokhi, a Melbourne-based GP specialising in refugee health, the coverage has been an unwelcome diversion away from healthcare’s most pressing issues.
‘The health system needs reform to support GPs to work with the most vulnerable: those with chronic illness, multimorbidity, and social disadvantage,’ she told newsGP.
‘How do we create systems of genuine care? How do we create systems that are easy for clinicians and patients to navigate? How do we ensure that those who need it most, can get care when they need it?
‘We need policymakers to consider deeply how to support this work.
‘I’m concerned that if governments get distracted by the narrative of “rorting and fraud”, that we will sleepwalk through a primary care crisis.’
Dr Warby noted the unfortunate timing of the coverage.
‘This accusation came just as there was progress and recognition that Medicare is underfunded, and not fit for purpose, particularly for care of chronic complex and vulnerable patients,’ she said.
‘There needs to be a reset to look at that again, which is the actual story.’
‘We were already struggling’
Most of the GPs contacted by newsGP said they were concerned about the damage to the profession’s morale.
‘We’ve got to a position where we are supporting improvements to the system for better patient outcomes,’ Dr Haikerwal said. ‘In the face of significant effort, this was nothing short of hurtful, demeaning and injured the already low morale.’
Dr Chua agrees.
‘I loved my work as well as well as enjoyed the interactions with my patients over the years,’ Dr Chua said.
‘But I’m tired. I’m burnt out. I’m fatigued. And mostly I no longer have the physical and mental capacity to conduct my job in my chosen vocation.’
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, said many GPs viewed the story as a personal affront, and stressed the importance of self-care for those affected.
‘This ideally is dealt with a mindful “time out” and self-compassionate care for our own wounds within,’ she told newsGP.
‘This too shall pass. When you bring your calmer prefrontal lobe back online you know you’re “good enough” and you don’t have to carry the world’s worries on your shoulders.’
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Dr Benjamin Weiss   22/10/2022 7:16:41 AM

Sick and tired of doctor bashing and will definitely retire at end of this year.Surely Medicare has their protocols in weeding out doctors oveservicing and frequently using the wrong item numbers.They have been auditing rogue doctors for years.With GPs leaving in droves and only 13% of graduates wishing to go into General Practice,good luck in trying to see a GP in 10years time.As to the current rebate system it is pathetic and doctors should stop bulk billing and charge the AMA recommended fees for all patients and the patients should claim the medicare rebate.Go to a physiotherapist and the initial consultation is over $100 whether you are a pensioner or not.Podiatrists are now charging $30 above their EPC medicare rebate for pensioners.GPs are cheap compared to other allied health services and we are dealing with peoples lives every day.Good luck to the health system in the future as it at present a total mess.

A.Prof Christopher David Hogan   22/10/2022 10:01:18 AM

GPs have proven that Medicare rebates are grossly inadequate.
Many doctors are leaving General Practice & others are choosing not to enter it.
(This proves by the way that entering General Practice is a choice & GPs can shift to other disciplines if they wish. So much for #JustaGP)
Instead of doing something positive, government supports a narrative of "greedy rorting doctors".
In this instance, not condemning it is supporting it by the way.
A claim of greedy doctors was highly predictable- after all it has been used in every dispute with GPs & other doctors since at least the 1970s.
Even though some government sources agree the claim of 6-8 billion dollars is bizarre this “greedy rorting doctors” narrative will accelerate the crisis in General Practice.
Good one, minister!
Strangely, this false narrative actually blames the government. Taken to a logical conclusion it says that the only way to survive on Medicare rebates is to cheat or privately bill.

Dr Ting Kwok Wong   22/10/2022 11:42:18 AM

Let us get the facts straight.
Last year the medicare payout to ALL medical professionals 28.8 b, with just 9.1 b to GPs.
The public's perception of doctors is GPs. So we are all cheaters !? Ha Ha !!

Dr Anne Helen Money   22/10/2022 11:53:36 AM

The Age and ABC coverage makes me want to quit

Dr Peter James Strickland   22/10/2022 12:04:08 PM

The solution is to ignore Medicare rebates for anything, i.e. asking the patient to pay upfront , and to claim via their insurance company called Medicare. That will substantially elevate the cost of Medicare for the Federal Govt in paying out claims, and they will have to institute a new system of claiming by patients that will cost a fortune, and open the system up to hacking (if Medicare are not very very careful here). Item 23 and 36 rebates are a joke compared to what governments pay for legal advice, or to have any plumbing, electrical, building etc etc advice. If the Federal Minister for Health does not solve this problem of allowing academic opinion on rorting to continue there is going to be a big loss of a lot of experienced and burnt -out GPs who retire . I retired due to all this bureaucracy by public servants after 45 years dealing with Medibank Mk1, and then Medicare. Free yourselves --get the patients to claim for your services --it will work! No freebies though!

Dr Susan Margaret McDonald   22/10/2022 12:39:17 PM

I am retiring in 10 weeks! I am sick of doing 10 hours work a week unpaid and being underpaid for the last 10 years of my working life. It is not my job to prop up the nations health anymore. I am burn't out and disillusioned and very sad at the neglect of GP's.
This last attack is a blow below the belt. Getting in to bed with Medicare was always going to end in tears!

Dr Graham William S Cato   22/10/2022 3:06:22 PM

It is extraordinary that journalists and others are allowed to get away with lies and unsubstantiated claims.There are plenty of examples where these people have been successfully sued for defamation, and I strongly urge the RACGP to take this action against these people .All the above, with which I agree 100%,will never see the light of day to the public except through the court system.We all know that no matter what the RACGP sends to media etc it will never be published-they are not remotely interested in good news stories!
I am finally retiring next month, aged 74,after 43 years in a practice I started.My goodness, what a change in GP life in that time in so many ways.It was so enjoyable and any other happy adjective you could choose, but we all know the "creeping"reasons for the steady but consistent deterioration in our lifestyle.
Obviously I could go on and on but you all know!!

Dr Raed Masoud   22/10/2022 3:19:41 PM

Patients can also be a huge burden to limited health care resources. Every day of the week I come across unnecessary medical consultations which can save medicare millions of dollars . Morally and ethically eveyone should be accountable for limited health care resouces including patients .e.g sore throat for one hour should not justify a visit to GP or a minor ailment should not require a medical certificate from a medical practitioner.e.t.c its a huge endless list of unnecessary medical consultations which are bulk billed .
Its time for reflection.

Dr Helen B   22/10/2022 4:57:08 PM

There is nothing more to be said about this gross misrepresentation of doctors.
Medicare has not kept up with CPI for 30+ years.

The only true solution is twofold-
1 ) for doctors in this country to finally go on strike like our nursing colleagues have not hesitated to do recently

2) for doctors esp in GP to stop using Medicare as part of consulting fee.
Give patients written fees based on length of time of consult and deduct the medicare rebate from what you are currently charging then tell patient fee and that there is no longer any medicare rebate for their consult. It is clear that persecution of doctors will continue to be an increasing part of medicare and so it is well overdue that we divorce ourselves from it.
It only came in in the 1970s- prior to that doctors privately billed like every other profession- time to return to that system.
If everyone does this then phDs in Medicare will no longer be of any interest!!

Dr Alan Mark Tucker   22/10/2022 5:47:22 PM

The timing of the release of this vicious attack on alleged Medicare abuse by General Practice , coincides with a budget full of blame on previous administrations, Colleges et al but is also cleverly directed with arrow precision toward each and every GP.

Dr Saleh   22/10/2022 5:51:42 PM

After almost 10 years of heart aches out of fear of medicare audit/review, I chose to move overseas with a salary job with no hard feeling… actually happy to make the move eventually.
Has to admit I enjoyed it the most and the best thing about those years -as a VR GP in Victoria - was doctor-patient relationships.
But despite the fact, through those 10 years I never have a single complaint from a patient or issues at work, nonetheless was always looking over my shoulder and keeping records just in case medicare comes knocking, thankfully they didn’t. But the anxious feeling can’t be durable for long, and for some keep working with such burden is untenable.
Having no problem with medicare, I believe is largely because the huge underpaid fees on daily basis.
GPs in Australia needs more respect from main stream media and certainly from medicare.

Dr Abdul Ahad Khan   22/10/2022 6:49:17 PM

" ---it is worth noting that the RACGP was not given any chance to comment, or a right to reply, ahead of the stories emerging ."
This Statement needs to be further explored - particularly ' No Right to Reply ' ???

Dr Lisa O'Rourke   22/10/2022 7:29:04 PM

We all need to simultaneously stop bulk billing - even if we charge $1 more than the rebate - then the patient has consented to the fee and give them a receipt with time description -what they get back from Medicare is between then and the government & we can’t be audited . Set your own worth like dentists did decades ago . The government has proved themselves untrustworthy and we have accepted the slavery to Medicare and the farce of bulk billing for far too long - we need to stand together and be guided how to introduce this measure by the RACGP urgently . Ie No bulk billing Mondays expanding to all 7 days within a short period . It is perfect timing with nurse and police wage action . Otherwise they will divide and conquer until the health of GPs and the nation falls apart .

Dr Mark Jerry Schulberg   22/10/2022 10:08:44 PM

What a coincidence that this matter comes at a time to deflect the focus on Medicare funding!

Dr Bryan Sean Connor   23/10/2022 1:41:41 PM

Sounds like many of my colleagues are getting a crash course in political reality. There is no doubt that our profession is in an untenable position. But Labor has many more important ( to them) spending priorities than general practice. It is difficult to deny that Medicare rebates are way too low and so Labor M.Ps are now copping flak from their constituents just before a federal budget. All of a sudden 2 media outlets, not known for their impartiality when it comes to anyone right of Labor/Green, come up with an incredible ( as in no one in the know and even PSR believes it) $8 billion Medicare rort scare story that portrays G.Ps as greedy and untrustworthy. Not only are Medicare rebates not going up but we can all expect way more compliance audits, further sapping morale. Coincidences in politics are rarer than they are in medicine.

A.Prof George Theodore Somers   23/10/2022 2:30:06 PM

I believe that most “reaction” has been visceral rather than intellectual. Tammra Warby identifies the central issue (but is not further quoted)! The reason the RACGP was not consulted because this attack is a political one, in response to successful press the previous week outlining the crisis in General Practice.
GP is widely valued, even by “specialists”. I have recently come to understand why we then have little job satisfaction and are leaving in droves. I believe the salient term is respect. Our critics need us but find it in their interest not to show us respect. Respect raises our public value to the next level.
Governments and specialists know that an appropriately paid paid GP workforce is not affordable while the specialist and hospital slice of the pie is so great. Therefore, when public opinion swings toward saving GP, Government releases this barrage of attack to bolster their position.

Dr Sami Saed   29/10/2022 8:55:30 AM

Medicare adds more complexity into their item numbersand expect doctor to keep chasing this . Is this business or medicine from medicare point of view ?. Also get rid of the title "GP" as this title is actually includes doctors without qualification. VR GP and non VR GP is like saying VR orthopaedic surgeon vs non VR orthopaedic surgeon. Would orthpaedic surgeon allow this ? would AHPRA even allow this ? of course not. Then why we are allowing this to happen ? . Protect or change the title, improve incentive for doctors to chose this as a specialty and at the moment with whats happening with medicare it adds fears for medical student to chose this field. It is the only specialty that one has to deal directly with medicare claims as GP can not work in public hospitals with their qualifications. The interesting thing is that locum rates in hospitals as registrar is similar to "VR GP" locum rate. Would you imaging a dermatologist hourly rate same as hospital registrar ?!

Dr Shobha Balu   12/05/2023 11:13:56 AM

I am a solo GP and have been practising for 40+ years. My practice patients are like my extended family. I am available to them during practice hours and after hours. When I get a phone call after hours, I attend to these and mostly forget to charge Medicare unless I am reminded by my staff. Now when I read the above narrations, I am considering retiring soon though I do not feel like retiring. I believe the politics behind this sort of ad publicity towards us GPs will affect almost all of us over the coming days. Shall wait and see the outcome.