‘I’m on my knees’: GP cries out for workforce remedies

Michelle Wisbey

7/06/2024 1:52:31 PM

As GPs share heartbreaking stories of practice struggles and recruitment impossibilities, one fed-up doctor says action is needed to ‘build the career back up’.

Dr Liz Chappel at her Apple Tree Medical practice
Dr Liz Chappel at her Apple Tree Medical clinic in Cairns.

When Dr Liz Chappel opened her first practice 20 years ago, the medical landscape was a very different place.
At one point, the Cairns GP was running four busy clinics with a total of 16 doctors, but in recent years, those numbers have been dwindling.
Today, she runs two Apple Tree Medical centres, but constant GP vacancies have led to a dramatic cut in their opening hours to just three days a week – and even then, Dr Chappel is still working around the clock.
Her situation is likely familiar to owners right across the country, many of whom are struggling with how to attract more GPs to the regions, and the profession more broadly.
‘We have just been unable to recruit GPs, and I’m trying to cover both practices because we’re short and we can’t find doctors – no one wants to do the job,’ she told newsGP.
‘We had to close one practice down just before COVID-19 in Palm Cove, and then another one … so we’re left with two practices now, and they are privately billing and very busy.
‘It’s never been an easy thing to recruit GPs, but we’ve never had issues [this bad] in the past, so I just work, and work, and work, and I don’t take sick leave – I just can’t.’
Dr Chappel says the situation is ‘dire and unsustainable’, and she is not alone.
An alarming trend across Australia is seeing hundreds of practices being forced to reduce hours or shut up shop completely.
GPs have cited a long list of reasons for the trend, but the inability to recruit doctors coupled with the skyrocketing cost of running a practice are near ever-present factors.
Last year alone, around 200 GP clinics closed across the country, and there are fears that if nothing changes, the healthcare system at large will suffer.
‘How am I feeling? I’m on my knees really,’ Dr Chappel said.
‘Primary care is going to be forced to change, there’s going to be an awful lot more attendances at the hospitals, inappropriate prescribing, and patients being poorly managed.
‘There’s going to be a decline in the health of the population generally in times to come unless things change.’
Dr Chappel says general practice has long been misunderstood, resulting in a lack of meaningful funding, as well as a shift in professional relationships.
‘Until recent times, we had a wonderful collaborative working relationship with the pharmacy teams, but it has now started to become very different,’ she said.
‘I am having numerous reports from patients about pharmacists criticising what we do, and it is so sad as we used to work together really well and now it feels like we are in direct competition with them.’
That changing sentiment comes amid much-criticised pharmacy prescribing pilots rolling out across the country, which have drawn the ire of GPs and led the RACGP to raise ‘significant concerns’.
With a recent analysis predicting a shortfall of 11,392 full-time equivalent GPs by 2032, an influx of new GPs will be desperately needed.
But according to the latest Medical Deans Australia and New Zealand data, general practice was the first preference for only around 10.5% of medical students in 2023, down from 13% the previous year. 
‘We just need to get more people wanting to love the job, and it is an amazing job, it is such a privilege, and I feel honoured to be trusted,’ Dr Chappel said.
‘We need to build the career back up, we need more people wanting to do general practice again.
‘We try and encourage the medical students, but they get a lot of encouragement from the hospitals to stay in the hospital system, it’s hard.’
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Dr Ruth Sophie Ratner   8/06/2024 7:56:09 AM

A further problem is the RACGPs ridiculous standards to maintain a general practice, most notably for me is that my 42 years of notes are not all done electronically. At this end of my career telling me that a record system that has served our practice so well will no longer satisfy the Accreditors - and is a deal breaker if I don't switch to electronic progress notes, or keep duplicate handwritten and electronic notes - will further push me to close the practice. And then my 'succession plan' - also required by the accreditors - will be put into place: I will close the door and lock it. Unable to attract any new young doctors, I had thought that the practice would just get quieter and we would be able to reduce the hours and fade away, but instead we are just busier and busier with patients daily saying, 'you're not going to retire are you?',, and the ACF begging us to take more and more residents. I'm glad that dementia doesn't run in my family so I'll keep going while I can.

Dr Greg   8/06/2024 9:14:45 AM

Dr Chappel’s situation is heart breaking, but becoming more common. This problem has lots of causes. Failure to predict doctor demand way back in the 1980’s and 1990’s. The huge disparity between GP and specialists salaries. The erosion of the GP skill set. The constant devaluing of the profession by successive governments. Practice creep by voracious pharmacists (who BTW just received a lovely $2b payment to compensate them for 60 day prescribing). Lastly, the failure by GP practice owners to pay the younger GP’s a salary rather than a % of billing’s (nearly 60% of young GP want this). Urgent care clinics are paying a healthy hourly rate, sick leave, annual leave, parental leave, superannuation and salary packaging. Why would a junior GP leave this for just 60% of billings? Is it any wonder why only 15% of medical students want to become GP’s.

Dr Kpokpogiri zOkpororoko   8/06/2024 9:33:09 AM

Rural Gp must be on salary basis. When d IMGs influx they'll find out quickly about rent, low density population and that being remote won't get you any help if your appointment not full. If we can fund ...abroad we should be able to subsidise at least rural Gps to be on fixed salaries. The current model is not sustainable cos practices strive to get as many Gps when they can and this means they may not each have enough patients, then they leave for other places or even back home and the shortage-surplus-shortage cycle continues. MANY WOULD BE GPs NOW going to be pharmacists too.

Prof Max Kamien, AM. CitWA   8/06/2024 9:52:14 AM

Rigid, uncompromising and ageist bureaucracies are failing patients and their long time GPs. One size rarely fits all. Is it really beyond the capacity and intelligence of the 'regulators' to show some flexibility to keep the patient oriented and dedicated Dr Ratners of Australia working unharassed for as long as they are able? If the regulators treated their aging patients in the way they are treating Dr Ratner, they would be deregistered.

Dr Siva Kumar Raju Muppala   8/06/2024 10:02:54 AM

Similar situation. Unable to recruit one doctor and stressing myself to run a clinic and can’t see any hope in near future.

Dr Aletia Vivienne Johnson   8/06/2024 11:16:35 AM

I’m at the opposite but somehow same end of this. I practice ‘slow medicine’ in a low SES letter. I take the complex, chronic multisystem disease, complex mental health patients. I bulk bill a lot of them. I do a good job. Too good a job, in fact, because the patients all want to only see me and it’s causing problems. I’m being sacked as a result. And noone is going to want to hire me. Why? I always run late. I’m booked out up to a month in advance and there’s no redundancy for emergencies and walk ins. I don’t earn enough to pay my fair share of the practice running costs. Patients complain that the other doctors aren’t as thorough as me, which is upsetting for everyone. Yes, my patients thrive and live longer and get better and stay out of hospital, but that doesn’t matter to anyone except the patients. And frankly, medicine isn’t about patients anymore. It’s about kpi’s and compliance and admin and documentation. It’s not about doctors either. I’m exhausted. I’m broke. I’m broken.

Dr Aletia Vivienne Johnson   8/06/2024 11:27:09 AM

Part 2…
I’m actually glad I’m being let go. Being an old school GP has been slowly killing me. Everyone loves my work but not enough to pay me for it. Only about a third of what I do is actual medicine. The rest is bloody paperwork. I’m glad I’m being forced into retirement… at the age of 44. General practice is dead, proper General Practice anyway. I’m the doctor you’d want to look after your elderly mum. But that’s not economically viable and not sustainable. You can’t have that unless you’re very rich apparently. Most of my patients are poor. (Or DVA, which amounts to the same thing because you have to bulk bill them even when they’re loaded.) Don’t they deserve to live too? Apparently not. I guess the hospitals will just have to deal with them, because hospitals are so good at dealing with high risk, high maintenance patients!

Dr Alexander Ulysses Apfel   8/06/2024 1:29:42 PM

If the government, AHPRA and RACGP really want to increase numbers of GPs they need to streamline the process for IMGs to come and work in Australia. As a UK gp it took 14 months to get a provisional AHPRA registration and many 000s. Then a further $8000 and 12 months to complete RACGP’s PEP programme for specialist recognition. The high cost and time puts a lot of my uk colleagues off. FYI It takes <3 months to work in New Zealand as a GP from the uk.

Dr Stewart James Jackson   8/06/2024 1:57:05 PM

Even though we are worked to death more and more demands are placed on us including escalating accreditation standards and an infantilised training program not producing the doctors we need. There are solutions.
The most important is to challenge the RACGP whose policies are damaging and making things worse.

Dr Graham James Lovell   8/06/2024 4:29:12 PM

I know that it’s amoral for a wealthy country like Australia to be depriving poorer countries around the world of their needed GPs . However ,if I was smart and in charge of the Health portfolio in Canberra or the States I would be financially incentivising the
2500 UNEMPLOYED GPs in the “crazy” English NHS to contract to our areas of need .
Our consecutive Federal Governments’ incompetence at planning for adequate numbers of Australian GPs can’t be fixed here in Australia.The new preference low of 10.5% of graduates selecting GP says it all, that no one here has implemented a successful policy to reverse the plummeting popularity, versus better paid,higher status , and markedly less bureaucratised Specialist jobs.
All I hear from GP Registrars are that all my patients being
retirement age and beyond are too hard, with all their multiple comorbidities. And that is perhaps the other load we’ve increasingly taken on for our communities, as these patients tripled in recent years.

Dr Andra Dabson   8/06/2024 4:40:24 PM

It doesn't matter how many practices we have, or what incentives are offered or even how desperate the need, if we don't have GPs. The numbers trained have been dropping for decades and show zero sign of increasing. The government's response has been to import as many overseas GPs as possible. These GPs are working under immense burdens, and still we are falling further and further behind. We are at least most of a generation short of GPs. Even if 90 percent of medical graduates took up general practice (and why would they in the current climate?) from today, we still have no sustainable plan for general practice (that I've heard of) that will avoid or even ameliorate this crisis for the next 15 years. Sadly this is where the ever increasing disrespect for GPs in particular, and generalists in general, in the health system and profession has brought us and I can't see that anyone has the answers - unless it's the robots I keep hearing about. So much for a patient-centred system.

Dr Vito Gaetano Spina   8/06/2024 6:05:15 PM

I agree. Easy to get more GP’s. Give doctors that do GP concessions on their Hecs and fast track it to just 2 years. The numbers will jump from 10% to 35% overnight. The RACGP is failing GP’s and are directly responsible for the current situation. I understand why AHPRA are bypassing the RACGP to get more doctors working.

Dr Sina Malaei   8/06/2024 6:07:34 PM

God bless you Dr liz.
What you are doing is sacred as to not deny people of different socioeconomic backgrounds their right to access cheap healthcare is a very favored practice in all religions. Our lord jesus christ was a healer.
I wish people especially doctors would let go of earthly desires & attend to the people who are in need of help. I am currently have limited registration in NSW but if I had general registration I'd definitely come to help in Cairns. I think that spirituality is also very important for doctors to come to areas that require health professionals.
If you don't attend to spiritual aspects of this subject, doctors who are attending to earthly riches and desires will be stuck in big cities.

Dr Gudrun Inge Muller-Grotjan   8/06/2024 8:10:25 PM

My heart goes out to you, Liz. Your hurt is being shared by so many GPs across the country. We have an amazing job, amazing loyal grateful patients, and yet, it is so hard to keep going sometimes. I hope things will change. In the meantime my thoughts are with you

Dr Brendan Sean Chaston   8/06/2024 8:36:50 PM

The inaction has to be deliberate. I suspect the department of health doesn’t see general practice as the centre of primary care in the future - hence the current scope of practice review. Gps for those who can pay for it - nurse practitioners/ pharmacists for those who can’t.

Dr Abdul Ahad Khan   9/06/2024 3:37:25 AM

RACGP does not apply the UNREASONABLE RED TAPE for Non-MBBSs to function as a ' Defacto GP, ' , whereas oossessing an MBBS Degree is frought with Danger according to RACGP & these MBBSs are forced to go through Obstacles after Obstacles..
RACGP has never stood up for GPs

Dr. Ahad Khan

Dr Ian David MacLean   9/06/2024 12:55:54 PM

Continuing and continual government interference in the Profession When I started in General Practice 45 years ago It was run by Doctors Now it’s run by Accountants and Lawyers all with the connivance of AHPRA They should be given due acknowledgment of their role in this fiasco Crucifying doctors with vexatious complaints As if we didn’t already have enough stress I no longer take new patients Only they have have been loyal and supportive over the years

Dr Edward Thomas Wu   9/06/2024 9:37:15 PM

Prof Max Kamien is dead right:
Rigid, uncompromising and ageist bureaucracies are failing patients and their long time GPs. One size rarely fits all. Is it really beyond the capacity and intelligence of the 'regulators' to show some flexibility to keep the patient oriented and dedicated Dr Ratners of Australia working unharassed for as long as they are able? If the regulators treated their aging patients in the way they are treating Dr Ratner, they would be deregistered.
BUT as THEY are Killing OFF General Practice, they remain UNTOUCHABLE.

Dr Norman Richard Southern   10/06/2024 5:18:25 PM

I couldn't agree more with all of the above. I have been practising 43 years; I have been a GP supervisor for 20 years; and I have been teaching medical students for 15 years.
Sadly, not only have I witnessed a decreasing interest in general practice by students, I have seen a significant deterioration in the teaching provided to GP registrars by the College. Registrars are being discouraged from practising medicine as we knew it but, rather, they are encouraged to practise "economical" medicine. Prior to attending a course on shoulder injuries, I had to read the advice put out by the RACGP: "if someone presents with shoulder pain, acute or chronic, 60% will get better within 12 months without intervention". What does this teach our registrars? How would you feel as a patient if you receive this advice from your GP?
I was astounded a couple of years ago when one of my registrars told me that the College was advising to actively discourage breast self-examination. When I sought clarity

Dr Thusitha Lanka Welendawe   11/06/2024 1:28:02 AM

I understand some places have no GP's. but if they influx too many GP's rural practices are going to abuse them with low pay and lock down contracts. also too many will make us overservice and increase Medicare costs. its better to find the right balance.

Dr Lorenzo Susino   15/06/2024 2:34:28 PM

I find it hard to recommend General Practice as a career to future doctors. They can see the disaster that is unfolding.
How can I give my patients the necessary care they need in an Eight-minute bulk billing consultation, whatever the problem is? Simple Answer is, I can't. Anybody who tells you any different is delusional. The complexities of General Practice have become overwhelming. When are the RACGP going to see this. When General Practice is dead, we have ourselves and our college to blame. The Bureaucrats who create policies for us, who set standards, who communicate with government for us don't listen to grass root GPs and let us down.
Many policies to improve patient care have not made any difference to this and have cost Gps and their practices valuable time and money. EG My health Record -- No Hospital I know accesses this. We have no voice. We slog it out, like Dr Chappel with no reprieve in sight. We pretend its ok, we push ourselves to the brink.

A.Prof Christopher David Hogan   15/06/2024 3:08:41 PM

The College is not THEM it is US.
All college faculties have contact details & would love to hear from members - phone email or faculty Facebook groups. Only when we talk to each other can we help each other.
Accreditation was set up as an aid to provision of quality service but the Feds would not enforce standards nor pay for them to be enforced. Indeed the regulation of medicine has been erratic, draconian & inconsistent- which the college has repeated on many, many occasions.
Yes GP is misunderstood & pitifully remunerated even though it is the most cost effective of disciplines, although all disciplines play their part.
The atrocious level of community Health Literacy among citizens & politicians leads people into making poor health choices and believing that quack bloggers have the same status as health professionals.
However, we are starting to get traction with the politicians because GPs are contacting their local politicians & telling them about their local issues

A.Prof Christopher David Hogan   15/06/2024 3:26:27 PM

There are no quick fixes to a problem that has been years in the making.
Covid did not cause the weaknesses of our health woes, it merely revealed them.
Time to look at what services are worth, not only their out of pocket cost .
50% of Australian GPs are IMGs- but new IMGs are not an off the shelf solution.
They & their families need a lot of peer support, help to integrate into a very different health system & a multi-cultural country with much more variety than that of our native peoples.
"I cannot understand whether these people are praising me or insulting me- they use the same words !" They need industrial support- as illegal bullying & exploitation is not rare
There are many IMGs on RACGP faculty boards