Financial stress and lack of PPE affecting GPs’ mental health

‘As GPs we’ve been dealing with the pandemic, people’s fears and trying to manage it through telehealth as best as we can. This current research strengthens the evidence for what we’ve been experiencing.’
 
That is Dr Michael Wright, GP and Chair of the RACGP Expert Committee – Funding and Health System Reform, referring to the new Health Sector Report examining the impact of the coronavirus pandemic on GPs and other specialists in private practice.
 
Released by the University of Melbourne on 17 July, a representative sample of 2235 GPs and non-GP specialists completed the Medicine in Australia: Balancing Employment and Life (MABEL) COVID-19 Short Online Survey (SOS) between 14 –24 May 2020.
 
Responses were then compared to the MABEL Wave 11 survey conducted in 2018–19.
 
The results confirm a significant shift in workplace operation to help keep GPs, practice staff and patients safe with the rapid shift to telehealth.
 
Thirty six per cent of all consultations in April were provided by telehealth, and was more common among GPs practising in wealthier areas, urban areas, and larger practices.
 
Use of video was relatively low, with 96% of GPs telehealth consultations conducted over the phone, compared to 81% of non-GP specialists.
 
The report attributes this to either practitioner choice, patient preference or issues with access to technology, while more non-GP specialists may have video set up, given their pre-existing telehealth item numbers for patients in remote areas.
 
Dr Wright says video calls may also be a less attractive option for GPs, who often offer shorter consultations.
 
‘Telephones are very familiar to GPs and their patients, and GPs are at a disadvantage because often they have shorter consultations,’ Dr Wright said.
 
‘So if you have to spend five minutes sorting out the video call or the bandwidth, that’s a lot of your consultation time for a GP. Whereas if it’s an hour-long consult for a mental health session, losing that five minutes, you still get a good session.’
 
While Medicare data from April shows an overall increase in activity for GPs – 4.7 million new telehealth services were provided that month, exceeding the fall in face-face items (2.7 million) – that did not necessarily translate in financial health of all practices, according to the MABEL COVID-19 SOS data.
 
Sixty-five per cent of GPs and 83% of non-GP specialists reported a decrease. Surgeons and anaesthetists were the hardest hit due to the temporary suspension of non-urgent elective surgery, with almost one-third reporting a fall in income of 50% or more.
 
Professor Anthony Scott, who led the report and heads the Health and Healthcare theme at The Melbourne Institute: Applied Economic and Social Research, told newsGP this was largely attributed to the Medicare Benefits Schedule criteria, requiring that telehealth be bulk billed for vulnerable cohorts.
 
GPs bulk billed 95.8% of telehealth consultations, compared to 76% for non-GP specialists, and more than half of the GPs surveyed increased the number of face-to-face consultations that they bulk bill.
 
As a result, GPs from practices in urban or affluent areas were more likely to report a fall in income, as the Medicare rebate did not substitute higher fees charged for face-to-face consultations prior to the pandemic.
 
‘Increased activity is good, but actually, telehealth is [almost] all bulk billed, and it’s replacing privately billed consultations,’ Professor Scott said.
 
‘So that leads to a net fall in earnings, even with activities increasing.’

Professor Anthony Scott was the lead researcher of the latest Health Sector Report.
 
Due to this financial downturn, 31% of GPs and 27% of non-GP specialists reported feeling very or moderately financially stressed about their private practice, particularly among larger non-GP specialist practices.
 
Almost 6% of GPs and 8.4% of non-GP specialists thought their practice might be sold or closed in the next six months.
 
Dr Wright fears the billing restrictions have guaranteed patient access in the short-term ‘at the price of practice viability’.  
 
‘So in the long run, if practice viability is reduced, practices are likely to close or further merge,’ he said. ‘And with further mergers, people are going to have to travel further to see their GP.
 
‘There’ll actually be reduced choice in general practice, and in the long run that may increase prices.
 
‘So it’s important that telehealth continues, but in a form that supports practice viability, rather than reduces it.’
 
Lack of adequate access to personal protective equipment (PPE) emerged as another contributor to higher levels of stress for one-third of GPs, which Dr Wright says has been ‘a big concern throughout the pandemic’.
 
‘PHNs have distributed masks for GPs, but other PPE has been limited and only been available from private providers and the costs of getting that has gone up markedly,’ he said.
 
‘Many practices have said, “Okay, well we’re not going to do testing. We’ll screen to avoid people with potential COVID coming into practice”.
 
‘Moving forward, I think we need to get PPE supplies back into practices, so that if the pandemic spreads that practices are able to continue to provide safe care for their patients.’
 
Professor Scott agrees.
 
‘It’s something that does cause a lot of stress and meant that doctors haven’t really been safe at work themselves, which is a big issue,’ he said.
 
‘Often a lot of the PPE goes to hospitals first and then health professionals in the community second. But I think that needs to be swapped around.’
 
In the face of uncertainty, however, the majority of respondents reported being satisfied with the support they received, particularly from colleagues, followed by employers, professional organisations, governments and financial services providers.
 
Overall, non-GP specialists were found to be more affected than GPs in April and May, but Professor Scott says they are likely to financially recover more quickly than GPs.
 
‘At least they’ll have a backlog of surgical cases,’ he said.
 
‘It’s different for GPs, where this is probably the new normal for them. They have to adapt in different kinds of ways to kind of maintain the viability of the practices and maintain access for patients.’
 
Beyond the pandemic, 84% of respondents thought telehealth should be permanently funded by Medicare. But Professor Scott says further research is needed to understand the effects of telephone and video consultations on the quality and continuity of care.
 
For the longer-term financial health of the sector, the report concluded it would depend on a mix of bulk-billed telehealth and full-fee face-to-face consultations, and how practices adapt in the context of Medicare funding. Continued economic hardship could also have some longer-term impacts on the demand for private medical care and on the use of public hospitals.
 
‘It’s important to monitor what’s happening,’ Professor Scott said.
 
‘For doctors, these are really huge changes in activity that have happened. The way doctors and patients respond to this is really important for how the sector can go forward in a positive way and learn from this and adapt to it, to lead to new and better models of care for patients.
 
‘These are the opportunities that we have with these big changes, to make the best of them.’
 
The RACGP has run its own survey on the impact of COVID-19 on GPs. The results will be included in the next General Practice: Health of the Nation report.
 
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