Potential rebate increase for rural general practice

Matt Woodley

10/01/2020 3:27:13 PM

A new plan could see certain Medicare rebates more than double for doctors formally recognised as ‘rural generalists’.

Aerial shot of isolated house in the country.
The number of GPs choosing to practice outside major cities is steadily declining. 

The proposed changes are aimed at alleviating the current GP shortage in rural and remote areas across Australia, which in some instances has contributed to vastly differing health outcomes.
According to The Australian, the proposed remuneration increase is linked to the successful creation of a new rural generalist specialty that already has the tacit support of the Federal Government.
A joint application submitted by the RACGP and Australian College of Rural and Remote Medicine (ACRRM) is currently being assessed by the Medical Board of Australia (MBA). If successful, it would see formal recognition for the specialised skills of rural generalist doctors trained in obstetrics, anaesthetics, mental health and emergency medicine.
Doctors recognised as rural generalists could then be able to access higher Medicare rebates for certain specialty services, such as mental health assessments, in some instances at more than double the rate of their city counterparts.
But, a Department of Health spokesperson told newsGP even if the MBA approves rural generalist medicine as a sub-specialty, it will not provide automatic access to specialist MBS items.
‘Further analysis on this matter will be undertaken by the Department of Health in 2020, including investigation of potential unintended consequences,’ the spokesperson said.
‘For example, rural generalists may prioritise specialist services over general practice if specialist services support higher rebates.

‘GPs already have the ability to claim some specialist procedural items, except in the few circumstances where a specific specialist qualification is required.’
RACGP Rural Chair Associate Professor Ayman Shenouda said increasing rebates would be a positive step, but stressed that attracting GPs to rural and regional areas will take more than money.
‘GPs are overworked, undervalued and underpaid. GP job satisfaction is falling which further impacts on recruitment and retention,’ he said.
‘We need to reform the funding model to prioritise primary care and generalism. The way we are paying registrars needs to be reviewed.
‘We know that expected future earnings influence specialty choice, with many choosing general practice following rejection of another specialty. To attract more doctors to general practice, we need to compete with the higher earning specialties.’
Aside from additional funding and better remuneration, Associate Professor Shenouda said it is ‘clear’ that general practice is losing some junior doctors in the prevocational space.
‘For this to change, postgraduate medical curricula need more focus on general practice and rural health,’ he said.
‘While there are now new programs to direct our efforts – the HubsRJDTIF and more recently through MDRAP – uncoordinated decision-making will continue to limit our success.
‘Differing state arrangements dominated by hospital need and an underlying lack of ownership mean the only consistency through the layers of complexity is the trainee. The funding needs to follow the trainee, but we also need to build in incentives to retain them on a specific pathway.’
Associate Professor Shenouda said it will likely take around 18 months for the MBA to fully assess the RACGP–ACRRM application, which was submitted in December last year, but that the Rural Generalist program would be ready to launch once given the green light.
‘Many rural-based RACGP members could benefit from formal recognition and the RACGP will have a process in place to recognise their skills to attain rural generalist Fellowship,’ he said.
‘There are also 300 positions in the current training program that would benefit from the new recognition, with this number to increase in stages over coming years to reflect community needs.’
Despite evidence that junior doctors are more likely to be happy training and living in rural areas than their city-based counterparts, the number of GPs choosing to practice outside major cities is steadily declining
But RACGP President Dr Harry Nespolon told Fairfax the college is working across every level of government to address the shortage.
‘The rural pathway and the Rural General Policy are designed to encourage GPs to work in areas of Australia that have traditionally struggled to attract and keep appropriately trained GPs,’ he said.
‘We know that GPs who train and upskill in rural or remote settings are more likely to remain there caring for their patients, so this is vital.’
*The headline of this article has been updated because it originally implied GPs were to receive a pay increase.
**The article has also been updated to include comment from a Department of Health spokesperson. 

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Dr Michael Rice   10/01/2020 8:25:28 PM

I'd like to hear my College presenting this in patient-centred fashion - after all, the rebate is the patient's to claim or assign, it's not what the doctor is "paid"

For example: "Govt backs rebate increase for rural patients"
"Patients being treated by rural generalists would then be able to access higher Medicare rebates for certain advanced services, such as mental health assessments and antenatal care, in some instances at more than double the rate of their city cousins"

"That will reduce their out-of-pocket costs and may support increased access to bulk-billed advanced care, in their own communities"

Dr Michael Charles Rice   11/01/2020 9:11:09 AM

I've re-read this piece by Matt Woodley

Linking "formal recognition for the specialised skills of rural generalist doctors trained in obstetrics, anaesthetics, mental health and emergency medicine" to "higher Medicare rebates for certain specialty services" seems speculative, based on an opinion piece in The Australian.

What's the primary source for possible increased rebates (for patients, not doctors)? Why are obstetrics, anaesthetics, mental health and emergency medicine singled out when advanced skills exist in many more fields?

If increased rebates are only for patients seeing a doctor in their advanced-skill domain, is that really going to help much? Antenatal patients' claim for item 16500 is the same whether billed by GP or consultant. Many anaesthetic and emergency consultations (in Qld at least) are salaried (non-MBS) services. Indeed, I suspect that for many RGs, rebateable advanced-skill visits are a modest part of their total work

Dr Eric John Drinkwater   14/01/2020 7:14:11 AM

Profoundly disappointed my College has made a fundamental and crucial error. Rebates are not Dr’s pay, the rebate belongs to the patient ... always has been patient rebate not doctor income.

You are propagating the myth that bulk billing rates is a measure worthy of achievement.

Dr Peter JD Spafford   14/01/2020 11:38:14 AM

Very disappointed that the College has interpreted Medicare rebates as doctors pay. I am a GP and Fellow of the College working in a small town and have done for years. Calling me a Rural GP is ridiculous and makes me "different". Makes everyone else think that if you practice in a rural area you are not a GP but something "special". That is why the number of GPs working in small towns has gone down. It is time the College supported GPs a bit more wherever they work, and not doctors whose training is to provide hospital based services and reduce the need for the Government to properly staff and fund their facilities. Already most 'Rural Generalists' here do no General Practice, only work at the hospital. This has only further de-moralised this GP who is already overworked and now further unsupported by his College.