Is the GP gender pay gap getting worse?

The GP gender pay gap is once again in the spotlight, with both the Department of Health, Disability and Ageing (DoHDA) and the Minister of the same portfolio increasingly facing questions.
 
Last week at the National Press Club, the issue was raised by a journalist who suggested policies such as the expanded triple bulk-billing incentive, urgent care clinics and the removal of mental health items may have exacerbated the gender pay gap in general practice.
 
Asked directly whether longer consultations, which are disproportionately carried out by female GPs, should receive a higher rate to address that disparity, Federal Health and Ageing Minister Mark Butler said he had not seen hard data on the topic.
 
However, he accepted female GPs tend to do longer consults.
 
‘I’ve just seen enough anecdotal evidence about that to accept that as a general proposition without necessarily seeing the hard data,’ Minister Butler said.  
 
‘They do a lot more mental health work, they do a lot more multiple condition work, particularly with female patients.’
 
He pointed towards the introduction of the Level E consult of more than an hour in 2023 in response to concerns about access to longer consultations.
 
‘And we were very careful not to nickel and dime that consult,’ Minister Butler said.
 
‘It is a relatively generous consult level which, with bulk-billing incentives on top of it, is working very well as I understand it.’
 
When newsGP followed up with the Minister’s office to ask if steps are being taken to assess data on the impact of recent policies on the gender pay gap, the questions were referred to DoHDA.
 
Subsequently, newsGP asked for the Minister’s view on two studies which include data suggesting a significant disparity.
 
These include research commissioned by Ochre Health which found a pay difference of more than $24 per consulting hour between female and male GPs in a survey of 511 GPs; and the most recent RACGP Health of the Nation report, where a sample of 2416 GPs found female GPs spend on average three minutes more with patients than male GPs.
 
The response from the Minister’s office did not address the studies, but instead referred newsGP back to a transcript of the National Press Club Q&A.
 
‘Now, we’ll continue to work with the AMA and with the College of GPs about the way in which the rebates are both tiered and recompensed, I recognise that is ongoing work we have to do,’ Minister Butler said at that event.
 
He said the Government’s first priority had been to address an affordability crisis and a rapid decline in bulk-billing rates.
 
‘I do accept though, that the broader reform work, the deeper reform work that I wish I’d been able to spend more time on in our first term instead of just dealing with that affordability crisis is still work to do,’ he said.
 
But RACGP Vice President and WA Chair Dr Ramya Raman said ‘the pay gap is real’.
 
‘This is not about the effort, but it’s more about where the value is actually placed,’ she told newsGP.
 
‘If we look back to the Ochre analysis, and the key interpretation out of that is the hourly gap was modest but persistent, it was largely driven by the consult volume per hour.
 
‘Over a year, the gap widens as women GPs often deliver fewer consults overall, because we, and I, deliver longer consultations.
 
‘We know the way the system is set up with Medicare rewards fast throughput in terms of financial benefits, and women GPs disproportionately do the work that the system actually relies on: mental health, family care, pregnancy, complex chronic disease.’
 
Dr Raman says one in two of her consultations includes mental health.
 
‘This is where it really has affected women and women GPs, because the mental health consult numbers were removed from the MBS in November,’ she said.
 
‘We know that as the consultation becomes longer, we actually get paid less so it’s counterproductive.
 
‘And the truth is, this is what our community needs – the care that prevents hospital admissions, but it’s also the hardest to fit into a short consultation.
 
‘The other component of this is greater than 50% of our workforce in general practice are women, so if we underfund time, we’re underfunding women, because women are disproportionately delivering time-intensive care.
 
‘The reality is we need to see an increase in the Medicare rebate for longer consultations and apply a gender lens to Medicare reform.
 
‘Fix the funding and you’ll fix the workforce – and if we ignore it, you’ll widen the gap and drive people out of the profession.’
 
RACGP President Dr Michael Wright notes the issue is a long-standing one.
 
‘We’ve known that the gender pay gap has been a built-in problem with Medicare for a long time and become more prominent as the care GPs have been providing gets more complex and our patients need more time at their GP,’ he told newsGP.
 
‘We’ve seen evidence for that in the data and it’s also one of the reasons why the college has continued to push for measures to reduce the gender pay gap, the most obvious of which is by increasing the Medicare rebates for longer consultations.
 
‘This remains a really important issue for our GPs, that we are properly remunerated for the complex care that we’re providing and not discouraged from providing it because of barriers within Medicare.’
 
Time-tiered items review
The Minister’s office also referenced the work of the MBS Review Advisory Committee (MRAC), which is looking into time-tiered MBS items, the most commonly used items in general practice.
 
Its review is looking at MBS consultation item consistency, whether the number of items could be streamlined, and if current time-tiers ‘appropriately support contemporary clinical practice’, including when they are bulk billed.
 
The Minister’s office also said the fact that women are more likely to require longer primary care consultations, which are more likely to be provided by female practitioners, is ‘an important consideration’ of the review.
 
Recommendations from the MRAC review are due to go out for public consultation this year.
 
DoHDA did not respond to a query on whether it is analysing data to monitor the impact of the expanded bulk-billing incentive on the gender pay gap.
 
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