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From Luke’s Journal February 2024 | Vol.29 No.1 | Missions and Sacrificial Service

For patients, it’s getting much harder to find a general practitioner (GP) in Australia, particularly for those seeking a GP who provides continuity of care.

The situation is getting rapidly worse for a number of reasons:

• First there is a supply problem. In early career, only about 15% of recently graduated young doctors are becoming GPs.  However, to keep GP numbers in a status quo that percentage needs to be 50%. At the career conclusion stage, this results in GPs being disproportionately represented amongst retiring doctors. In other words, 15% entering whilst 50% leaving.
• Secondly, Australia’s ageing population suffers from more chronic disease, degenerative disorders, social isolation and reliance on the health system.
• Thirdly, many Australian GPs who persevere in this work are abandoning bulk-billing due to rising costs and red tape. Patients subject to rising GP fees and cost-of-living pressures therefore increasingly resort to public hospital emergency departments to deal with straightforward medical problems.

Whilst there are other contributing factors, these are the main drivers of the crisis.

One of the overarching themes is that politicians and the public do not understand generalism. It may be fair to surmise that we as doctors have also forgotten the essence of general practice.  Dr Peter McInerney, a true rural GP who does GP surgery, GP obstetrics and GP anaesthetics, expressed his concerns that as GPs we have lost our sense of vocation. I think his observation is valid.

So what is our mission as GPs?! Whilst St Paul was referring to preaching the Word, in my mind 2 Timothy 4:2 defines our mission quite well:

“Proclaim the message and, welcome or unwelcome, insist on it. Refute falsehood, correct error, give encouragement – but do all with patience and with care to instruct.” (NJB)

The Royal Australian College of General Practitioners tried to grasp this vision with its marketing campaign: I’m not just a GP. I’m your specialist in life.

As GPs we are there for the good and the bad.  We need to make difficult decisions whilst remaining compassionate, knowledgeable and patient. However, just like the disciples in the early church, we need to have the broader community to support us in our work. The more the general public can see how the bigger picture is affecting their personal healthcare, the more likely changes will be made to support GPs and general practice.  Modern Australian society has also demanded that the government have a seat at the health table. This concept is of concern to the Australian Doctors Federation as it gets in the way of the sacred doctor-patient relationship.  Nevertheless, government involvement is inescapable and one that we must work with. So in addition to community support, GPs also require governmental support.

Since the Medicare’s outset in the 1980s, Australian GPs have been the specialty group that bulk-bills the most and earns the least. Some may argue that this is the ‘natural order’ of things, seeing general practice as a default job for doctors. However the complexity and breadth of general practice easily rebuts that view.

A more reasonable analysis for the pay gap and higher rate of bulk-billing is that GPs act as the gate-keepers to the rest of the health system, being the first port of call for the most vulnerable, least fortunate and most needy of society. Accordingly, general practice is more likely to attract doctors with personalities and outlooks that are more willing to sacrifice income in order to engage in such work. Throughout history, Christians have often been the ones to heed this call.  However, even mission and sacrifice have their limits! It is increasingly difficult to keep practices afloat with the numerous demands on GPs and requirements of accreditation and registration.  The failure to properly index Medicare rebates, sidelining GPs from hospitals and many procedures, and burgeoning red tape has produced the crisis in which we are now mired.

To exacerbate the above mentioned supply issues, many GPs are now prematurely retiring mid-career, especially with the increasing requirements of continuing professional development (CPD) which are difficult to fulfil outside a regular practice.  This impacts on GPs taking time out (for family, health or other reasons) or locuming – those who would willingly work intermittently to cover others for short periods of time.  We now also see a phenomenon we hitherto thought impossible, namely general practices going bust.

“In order to resolve our GP crisis we will need much more than just money. A full cultural overhaul of Australian General Practice is required.”

In order to resolve our GP crisis we will need much more than just money. A full cultural overhaul of Australian General Practice is required. Even if this was to occur, I opine it will take 10-15 years to restore it to where it ought to be.  The public, the politicians, and sadly even our medical colleagues in other specialties, have often made lepers of GPs. General practice may be viewed as a time-consuming necessary evil for referrals and filling out forms. This cultural problem is even identified by the icon of Australian General Practice, Professor John Murtagh³, who I interviewed before the GP Crisis Podcasts. The main exception to this remains in small rural towns, where GPs still do many procedures and keep the hospitals running.

To restore respect and restore the role of the Australian GP in its fullness, it is necessary for GPs to once again play meaningful parts in the hospitals and the universities. Christians speaking on behalf of the vulnerable and needy reflect God’s heart in these areas.  Increasing financial support for general practice will encourage excellent primary care for those who need it most.  This will be assisted by the government and insurance industry removing the price discrimination that exists with respect to GP consultations and procedures, e.g. spending 60 minutes with a suicidal patient in a GP practice should not be seen as any less than 60 minutes talking about prostatism in a urology clinic.

If the opportunity is afforded, it is then incumbent on Australian GPs to seize the opportunity to restore our place within the body of the Australian medical profession for the good of those who most need it.

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