‘Shadow wait lists’ leaving GPs’ patients lingering in limbo

GPs are speaking out on behalf of patients stuck on ‘shadow wait lists’, saying a growing number of Australians are being left to choose between years-long waits on the public health system or huge out-of-pocket private fees.
 
And with a new investigation from Avant revealing two thirds of GPs are dissatisfied with the functioning of the public referral pathway, grassroots GPs say the time for change is now.
 
It is an issue Newcastle GP and practice owner Dr Max Mollenkopf says will ring true for GPs across Australia, and one he sees firsthand in his practice.
 
He highlighted one of his own patients, Bob*, as a case study for a system that is significantly delaying care: a blue-collar worker in his late 60s who is in chronic pain from hip arthritis.
 
He says the man has been waiting in limbo with no initial appointment after being referred for non-GP care four years ago.
 
Having been Bob’s GP for many years, Dr Mollenkopf told newsGP he has watched him slowly deteriorate and feels ‘completely powerless’.
 
‘As GPs, one of our roles is to help patients to navigate health services and help them find out what options they have for the problem they have,’ he said.
 
‘One of the first questions I, and I’m sure all my colleagues ask, when we find out someone has particularly a surgical problem, is “Do you have private health insurance?” because the private health insurance path is typically one of much less resistance in which you know your patient can get the care they actually need.’
 
Dr Mollenkopf said this often leads to a conversation about what the patient needs done versus what they can realistically do in a timely fashion.
 
He is clear the issue does not lie with individual non-GP specialists, but with the system itself.
 
‘For the clinicians who see Bob every day for his pain, we have to tell him there’s not much we can do – we still have to wait,’ he said.
 
Dr Mollenkopf’s situation is echoed in the new Avant report, which delved into whether the current GP referrals system is working and what influences referral decisions.
 
After surveying 357 practising GPs, it found that while cost is important, it ‘generally acts as a secondary consideration after clinical suitability and access’ when choosing between public and private pathways.
 
However, almost half of GPs report ‘often’ or ‘very often’ managing conditions themselves because non-GP specialist access is a barrier to referral, and 59% of patients have experienced at least one access-related challenge.
 
When deciding whether to refer a patient to public or private pathway, 79% of GPs answered financial factors, 74% said non-financial access factors, and 56% said clinical factors.
 
RACGP President Dr Michael Wright said the report shows GPs continue to do more of the ‘heavy lifting’.
 
‘It’s the availability of non-GP specialists through the public system that’s having the greater impact on reducing access, and that might be a way to prioritise and improve costs for patients,’ he told newsGP.

‘We really need more support for GPs providing that more complex care, and obviously the place to start with that is increasing the Medicare rebates for longer consultations and better support for GPs to work with multidisciplinary teams.

‘Increasingly many of us have had to talk to patients about why there might be private fees to see a GP as Medicare rebates haven’t kept pace with the cost of care, so it’s something that many of us have had to become familiar with.’
 
But being on a wait list can also mean jumping through many other hurdles, such as finding a surgeon who sees public patients in their private room, which are not always viable solutions, Dr Mollenkopf says.
 
It also means often having a financial conversation as much as a care conversation while trying to offer patients choice.  
 
‘If there’s three local surgeons who I think are all equally great at their job, and one of them charges $5000 out of pocket, one of them charges $1000 out of pocket, one of them no gaps, that’s actually an important conversation for me to have with the patient at the point of referral,’ Dr Mollenkopf said.
 
‘Because when we create that referral and send them down this path, we are dooming them to whatever one we have chosen. It’s an uncomfortable part of our role, but one that’s increasing as there’s less public services to offer them as an alternative.
 
‘I very much recognise and understand we work in a two-tiered private and public system, but the continued erosion of the public system is making these conversations harder and more nuanced than ever.’
 
The Federal Government announced a recent ‘crackdown’ on soaring non-GP specialist fees, with Federal Health and Ageing Minister Mark Butler facing pressure to cap fee increases, backed by private health insurers.
 
‘It is completely a rip-off sometimes because there is no rhyme or reason to it,’ he said last year.
 
The Government is looking into how this crackdown on doctors who are not transparent about fees would work, such as introducing a new watchdog or expanding powers for the Professional Services Review.
 
But Dr Mollenkopf says the healthcare system must stop providing ‘band-aid’ solutions.
 
‘Bob doesn’t need another urgent care clinic or Government-funded bulk billing centre down the road, he needs a public outpatient department that actually looks after him,’ he said.
 
‘He needs his local hospital to see him in a timely fashion and help him with the surgical care he needs.’
 
*Name has been changed
 
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