‘We can’t keep going this way’: GPs’ petition to save bulk billing

Everyone has a tipping point – and for Dr Sudeer Mahadeo, who works as the GP Principal at Goodna Family Medical Centre in southern Queensland, the silence from federal representatives about the financial pressures facing general practice has proven too much.
 
‘I have sent them emails, and I haven’t had any response from them – so I thought I’d start the petition,’ Dr Mahadeo told newsGP.
 
His plea through online petition platform Change.org, which has gathered just over 450 signatures at the time of writing, calls for higher rebates and funding for longer consultations, among other measures.
 
Dr Mahadeo is now seeking to amplify a message he wants to send to Federal Minister for Health and Aged Care Mark Butler, as well as Prime Minister Anthony Albanese.
 
‘Our practice here has been a bulk billing practice for the past 16 years and it is only now that we have changed to mixed billing,’ he said.
 
‘We have found that in past years, we’ve managed to absorb the freezes that they put in and just persist.
 
‘However, after COVID hit and inflation had gone up 6–7% each year, it’s made it extremely financially difficult for GPs, and that’s what tipped everything.
 
‘The amount that we get to manage and run a practice is clearly insufficient.’
 
The Goodna clinic is one of five operated by the Your Family Medical Centre, with Dr Mahadeo saying the group recently needed to shut down a practice in nearby Ipswich as it became unsustainable.
 
The RACGP has called for increased rebates as central to any Medicare reform, with most GPs ranking that as the action that would make the single biggest difference to general practice.
 
Since mixed billing was introduced at the Goodna clinic to attempt to retain doctors, Dr Mahadeo has noticed a significant impact on patients.
 
‘A lot of our patients are having difficulty even paying the out-of-pocket fee,’ he said.
 
‘As you are aware, Medicare requires patients to pay an upfront fee, and then get a rebate. A lot of our patients don’t have that amount of money to pay the upfront fee. For example, take a patient with two or three kids coming in for the same type of illness to the doctor. They have to have a couple of hundred dollars up front.
 
‘Yes, they get the Medicare rebate back, but they have to have that money up front before they can get the rebate.’
 
As a result, the petition is also calling for patients to be able to pay only gap fees, without having to pay everything up front.
 
‘They don’t seem to understand that not everybody has credit cards and not everyone has enough to pay up front immediately,’ the petition states.
 
Dr Mahadeo also describes the local emergency department as ‘creaking at the seams’, a situation he believes is exacerbated by patients attending with minor issues due to affordability concerns.
 
‘Twenty dollars out-of-pocket is what we charge, which is not very much if you look at it, but a lot of people are doing it tough at the moment,’ he said.
 
But even with the new model of mixed billing, Dr Mahadeo says the change has had a limited impact due to the area’s demographics – and believes time could be limited for the Goodna clinic without change.
 
‘If it persists, then I don’t think our clinic will be able to remain open in this area past another 12 months,’ he said.
 
It is smaller clinics, with two or three doctors, that Dr Mahadeo believes will feel the pressure most acutely.
 
‘Bigger clinics may be able to weather the storm for a while … but we can’t keep going this way,’ he said.
 
‘The Government needs to come to the party and increase the rebates. There is no job in the world where you can say “Okay, we will not give you an increase for 10 years, and that will remain sustainable”.
 
‘That’s exactly what they’ve done; they haven’t given GPs an increase for 10 years.’
 
While the Goodna clinic has moved to mixed billing, Dr Mahadeo is clear that he would rather bulk bill in an area where many of the patients come from lower socio-economic backgrounds.
 
‘We have one of the best health systems in the world because patients can get access to doctors whenever they need to and they don’t need to be concerned about money involved,’ he said.
 
‘The other thing is, as a GP, when you’re dealing [with] patients, the last thing you want to be concerned about is the finances.
 
‘There’s a conflict of interest there when you bring money into the equation.
 
‘If you start making it mixed billing, GPs eventually will start doing well, because we can charge whatever we want to.
 
‘The problem would be the people who cannot afford to pay for that and end up in the emergency departments. And, ultimately, we end up with a two-tier healthcare system.
 
‘Basically what will happen is the same thing that’s happening in the United States – if you have got money, you will get healthcare. If you don’t, you won’t.
‘My ethos has always been to make sure that I get job satisfaction from the people that I treat, and I can treat them just as well as anybody in some higher socio-economic areas would get treated.’
 
‘I believe in a social democracy, and I believe that, like food, shelter and clothing, you need health care the same way. It’s all essential.
 
‘Most of the doctors who work with me and in our practices have the same kind of ethos.’
 
In recent months, the decrease in bulk billing rates has become clearer with the most recent government statistics showing overall levels have reached their lowest in more than a decade.
 
Patients are also raising the decline in bulk billing rates as an increasingly important concern.
 
Minister Butler has not committed to rebate rises, but has said they are ‘not off the table’.
 
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