Female GPs more likely to spend time on non-billable work

Anastasia Tsirtsakis

1/11/2021 2:51:31 PM

Australian research has found GPs spend more than five hours each week on work that is not remunerated – and it is likely to increase.

Busy female GP at computer
GPs who work part-time, are female and work in a rural practice are most likely to do non-billable work.

GPs spend more than 14% of their time each week on non-billable activities.
That is according to recent research published in the Australian Journal of General Practice.
Drawing from a sample of 2907 Australian GPs, who responded to the 2016 MABEL survey, the authors found respondents spent an average of 5.1 hours on work outside of patient consultations.
This was more likely to be the case if the GP is female, works part-time, or is employed in a rural practice. Other factors included having graduated from an Australian medical school, having a college fellowship, or being a practice principal or partner.
The authors note that the findings could provide a partial explanation for the gender pay gap in general practice.
‘The finding that female GPs performing more non-billable work is significant in terms of the earning gap between male and female GPs of $83,000 per annum,’ they wrote.
The findings come as little surprise, according to RACGP President Dr Karen Price, who understands the realities firsthand as part-time GP, juggling her presidency and a PhD, not to mention family and home life.   
‘It’s absolutely spot on,’ Dr Price told newsGP.
‘Female GPs do tend to see more complex patients; there’s studies suggesting we attend to more problems per visit.
‘For instance, I’m trying to get one very vulnerable person vaccinated and I’ve got to do a home visit. The logistics for me to do that are far in excess, there just simply isn’t a Medicare task descriptor that fits that kind of patient.
‘But I’m going to do it because that’s what I’m trained to do – to look after people.’
The research found that GPs who work between 7.5–19.9 hours per week perform the highest proportion of non-billable work, at 16.6%.
Since transitioning from full-time to part-time, Dr Price had noted the added challenge. She says there is often additional work behind the scenes to ensure continuity of care.
‘Now I have to make sure I get everything sorted in a consultation [and] write out for the patient what I need to do and what they need to do, and I need to make sure those things are followed through,’ she said.
‘So that checking and double-checking just takes that little bit longer.
‘Or a patient may well ring up and leave a message saying, “I’m not due to see you for another six weeks, can I have my referral because I realised I have to go and see my cardiologist” and because I’m part-time, I tend to do those quickly. But if I was full-time, the receptionists might well book them in for an appointment.’
Under the current fee-for-service model, the authors anticipate that the extent of non-billable is ‘likely to increase’ as Australia’s population ages and comorbidity rises, and while ‘the workforce works [fewer] hours overall and becomes more feminised and more likely to hold a fellowship’.
Dr Price agrees and says a significant issue is that general practice is treated as a task-focused specialty, rather than what it is, which is longitudinal care.
‘Looking at medicine, and particularly general practice, as some sort of discrete task is not at all correct – we need to understand that,’ she said.
‘It means there’s lots of following up, there’s lots of closing the loops, there’s lots of checking, underwriting and safety-netting.
‘And to do that, you often have to attend to results, follow up results, check with patients to see what’s going on, and you have to hand over to another doctor – particularly if you’re part-time.’
With the expected rise in non-billable work, the authors also note that the lack of reimbursement for much of this work ‘challenges economic viability and GP job satisfaction’.
‘Identifying how to reduce the burden of inefficient administration procedures, but fairly recognise and incentivise efficient and comprehensive primary care, will assist in maintaining the stability of the general practice workforce,’ they wrote.
Dr Price believes the impact is also clear in the number of medical graduates choosing the specialty, but is hopeful that if it is addressed that it could turn things around.
‘For all of that intellectual grunt, you get paid the least and you have a mass of undifferentiated patients, so it’s seen as a harder specialty and it’s seen as a poor-paid specialty,’ she said.
‘And these younger doctors are now older than what I was – I went straight through from high school to university – and they’ve got a HECS debt. So they’re not choosing it for obvious reasons.
‘I mean, 15.2% of new doctors wanting to be GPs is going to be a tragedy for the Australian health system. We need it to be 50%.’
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Dr Suresh Gareth Khirwadkar   2/11/2021 8:02:21 AM

There is no 'unbillable' work. There is work that is already billed that includes admin time, and there is work that GPs are choosing not to charge for. GPs need to detach themselves from Medicare funding being the sole source of income and final point on what they can and cant bill.

I do not disagree that the pay gap exists, it does, evidence demonstrates that, but one way to help fix it would be encouraging GPs (and the article suggests primarily female) to stand up for themselves, charge appropriate rates, and for all the work they do. Maybe then the government and patients realise the extent of the work we do.

Dr Keren Lee Witcombe   2/11/2021 9:36:14 AM

I was doing an hour of unbillable work per hour of billable work when I was in GP. Now in jobs that pay me for all the work I do.