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‘It’s been an ongoing struggle’: Clinic closures continue


Michelle Wisbey


24/01/2025 4:10:53 PM

After making the tough decision to close her practice after years of ‘hanging on’, one GP is calling for urgent workforce and funding reforms.

Stethoscope.
‘As time went on there was obviously increasing health demand, not enough workforce, inability to get additional workforce, and I utilised all the strategies around that most GPs know about.'

‘Because I am such a small practice, delivering this news to the community has been challenging.’
 
Just hours after telling her patients, Dr Robyn Mathews has spoken out about the realities of being a GP and practice owner, and the tough decision to close her clinic on 28 February.
 
For the last six years, Dr Mathews has owned and worked at Bridge Street Surgery Richmond, a regional Tasmanian clinic servicing around 1500 patients.
 
Soon after she opened her doors, she became the only GP in the popular tourist town, surrounded by working farms and about 30 kilometres out of Hobart.
 
‘We had a small workforce, one full-time receptionist and one part-time nurse,’ she told newsGP.
 
‘Then COVID hit and there were all the challenges that went with COVID for everyone.
 
‘As time went on there was obviously increasing health demand, not enough workforce, inability to get additional workforce, and I utilised all the strategies around that most GPs know about.
 
‘All the way along, you’re hanging on.’
 
Dr Mathews’ story will ring true for many GPs and practice owners right across Australia, as they work within a healthcare system facing older and more complex patients.
 
‘I can tell you now, I have not paid myself properly in the last six months, my practice actually owes me,’ she said
 
‘I’m able to pay all my bills, I pay my staff, I’m able to keep the doors open – I don’t owe anyone anything except myself.’
 
But earlier this month, Dr Mathews made the decision to close her practice, saying ‘it’s been an ongoing struggle’.
 
‘There are increasing issues around lack of general practice across the nation, not just Tassie, but it’s particularly worse in the rural and regional areas,’ she said.
 
‘Some of the key barriers are things around registrar training and experiences for potential junior doctors to see different types of practice.
 
‘Incentivising may be a part of that, but I’m not sure that’s necessarily the golden ticket.’
 
On social media, her saddened patients shared their own views on the closure.
 
‘I can imagine the decision was a hard and heartbreaking one, that no one, especially you, enjoyed making! Thank you for sticking around Richmond for as long as you could,’ said one person.
 
‘It’s been a privilege to be able to come to your practice with any health concerns and be looked after and treated so kindly,’ commented another.
 
Dr Mathews also pointed to her difficulties within the Modified Monash Model (MMM) system, saying it had been a ‘big issue’ for her.
 
‘I’m an MMM2-rated practice under the Federal Government, but if I was five kilometres down the road, I’d be MMM3 … that is a huge barrier for me in accessing potentially another workforce that would maybe be attracted to the MMM3 region,’ she said.
 
‘There’s also really more of the complex types of care – the people are travelling an hour to see me here and they’re not going to be wanting to come back the next week for another item 23 consultation because they’ve got five things on their list of things to do.
 
‘Often people wait a little longer too, the farmer may not come in quite when they need to, and they probably sit at home for a little bit longer and trying to see if they can manage their health and needs without having to seek additional help.
 
‘By the time they come in maybe the health issues have been exacerbated a bit further, so there is a bit more complexity there.’
 
Dr Mathews’ is far from alone in her experience as across Australia, practices are being forced to shut their doors, many citing similar reasons.
 
With a Federal Election on the horizon, on Thursday, the RACGP released its election asks, aimed at addressing the systemic issues currently plaguing GPs.
 
The college is calling on all parties to support a 40% increase in patients’ rebates for longer consultations, for an extra 1500 training places to be funded over the next five years, and for an extension in eligibility for annual GP health assessments for all women.
 
In the meantime, Dr Mathews will be moving to another practice.
 
‘I don’t want to abandon my patients, that’s another thing that I’ve really been conscious about,’ she said.
 
‘I’m not retiring, I’m not sick, I still want to practise and give something back.’
 
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Dr Salah Amedi   24/01/2025 7:37:35 PM

So true ,urgent refunding needed before all small practices will succumb to the pressure of not beeing able to afford the costs of maintaining optimal care and sandards .It is more urgent than politicians and community think


Anonymous   25/01/2025 9:01:36 AM

Remember when 60 day dispensing came in and the pharmacy guild said there’d be over 600 pharmacy closures (which didn’t even end up happening) and the government gave them billions in funding? When clinics close and rebates have been stagnant for years what does the RACGP do?


Dr Tsoake Azer Faso   25/01/2025 10:22:40 AM

I feel for Dr Matthews and wish her all the best with the transition and her new journey.

It is truly disheartening to keep hearing one GP clinic closure after another for the same reasons. It is one thing to have authorities express their sympathy and acknowledgement of the difficulties faced by GP owners, but urgent reform and action is what is needed.
1. Disparity in GP training accreditation needs to be attended to urgently as it unfairly puts smaller practices at even worse disadvantage against their larger counterparts. ( after 7 yrs of freezing of Expression of interests, it is frustrating that only limited openings in Tasmania, QLD and Victoria are just been rolled out.) How many closures will it take to recognise this as an emergency?
2. Restitution for the long term freezing of rebates has not been on the table, worse in the light of excessive running cost blow outs since covid.
3. The GP governing bodies need to urgently address these matters ! Really disheartening !


Dr Dhara Prathmesh Contractor   25/01/2025 10:45:41 AM

Nicely written Michelle. Practice owner struggles!
Although, increase in rebates for certain consults will not help the non-cooperate practices. But certainly help the running of new handshakes of running new urgent care clinics. Medicare items currently funded items consultation only - is it not sufficient to keep those doors open! Even the political backed and funded clinics are struggling to see it work! “ Medicare rebate increase for certain complex presentations “ will only benefit to closures of all family owned private practices. Unfortunately, classifications of RMMA & MMM are population ratio driven. Struggles all along! Example, we have fast growing 10 practices within 2-3 kms circumference. Competition.And now will have add on surrounding urgent care clinics 100% bulk billing. Running on our tax paid money, to compete with us! Each day, only one prayer to start with : God bless us to provide the best clinical care to our patients. Keep our communities healthy and saf


Dr J.   25/01/2025 12:55:57 PM

Same happened to me. Slightly larger practice, ~ 4000 patients load. Couldn’t generate enough income to attract/keep doctors. We were MMM3. If there are less than 5000 patients in a district, it is unlikely your community can sustain a GP practice. The small town doctor is a thing of the past now. My colleagues and registrars were well aware that to have an equivalent income to other professional occupations, you needed to be working in a practice that could afford 2 nurses (one for wounds and vaccination, one for care plans and health assessments). Best of luck for the future and I hope the decrease in stress makes up for the loss of having your own practice.


Dr Richard Mark Smith   26/01/2025 2:03:29 PM

Try this exercise..
Patient pays $132 for level B Item 23 lasting (exactly) 20 minutes including documentation
Patient contributes $89 (68%) Govt contributes $43 ($32%)
Doctor has 1 hour of unpaid lunch break
Doctor works 38 hours per week for 48 weeks per annum (43 hours onsite/week )
Doctor has 4 weeks funded leave
132 * 3 * 38 = 15048 / week > 722304/48 weeks
Practice overheads 299921
Net 433382 per annum
Conclusion ?
Comments ?


Anonymous   28/01/2025 8:29:06 PM

That’s an interesting thought exercise Richard, I also wished I lived in fairy tale land too. Are you suggesting that every patient is going to pay an $89 gap in a population of 1500 (or anywhere for that matter) ? Are you also a gp? Are you one of the reasons the rebate has been stagnant for so long because “you’ve got yours” and don’t put the pressure on the government to properly provide universal health care to everyone?