Dr Leeann Carr-Brown is a GP and owner of Tamborine Mountain Medical Practice and Tamborine Mountain Medical Practice Eagle Heights. She trained at the University of NSW in Sydney and has practiced medicine in Sydney, Canberra, Melbourne, Bungendore and Tamworth in rural NSW prior to moving to Tamborine Mountain. While practicing the full breadth of family medicine, she has special interests in complex care, older persons health, women’s health and fertility regulation including the insertion of IUDs, and minor skin surgery. Dr Carr-Brown is on the board of directors of General Practice Gold Coast.
WHERE HAVE ALL THE GPs GONE?
A few weeks ago, I was at my university medical school reunion. I won’t mention how many years, but it was not just the skin and hair that had changed. There were both GPs and non-GP specialists present. The shock for me was the general air of despondency about the state of the health system and the future care of patients, with one Emergency specialist feeling that life expectancy will start to go into reverse and many doctors present stating that in the last few years they were seeing more advanced disease of the type they had previously only seen in developing nations where heath care is neglected. Why is this happening? There were patients who avoided seeking health care for their symptoms during the height the pandemic lock downs, but there is more to it than that.
One of the big factors is lack of access to timely care. Many locals on the Mountain will have noticed that one medical practice has closed, one has restricted hours and our practice, TMMP, has longer waiting times for appointments than in the past to see fewer doctors. All of this is due to the nationwide shortage of GPs that has been looming for some time but has now reached crunch point. Current trends point to a national shortage of more than 10,000 GPs by 2030. If you are over 50, this should worry you a lot, as you have reached the age beyond which more and more health problems emerge, and your health outcomes will depend on your being able to see your doctor when you need to, and to have continuity of care with a doctor who understands you.
On average, each Australian sees their GP 6.1 times per year, with 87% of the population seeing their GP at least once per year. 85-90% of all health problems are dealt with entirely within general practice without referral to a specialist, for less than 8% of the health budget. That seems like excellent value to me. If a patient presents with an asthma attack or a wound that needs suturing for example, the exact same treatment will cost the health system over ten times more in the emergency department than a GPs rooms. Health statistics also link longevity to the number of GPs a community has, and the numbers are declining rapidly.
All our major health system problems, from swamped emergency departments to ambulance ramping, long surgical waiting lists and increased hospital admissions for stabilisation of chronic disease, all link back to a shortage of GPs. The viability of our whole health system is threatened if this issue is not corrected. But why is it happening? The drop in the number of overseas trained doctors entering the country during the pandemic lockdowns was just the straw that broke the camel’s back. The real problem has been two decades in the making.
For our health system to function, Australia needs 40-50% of medical graduates to choose to complete specialised training in general practice. It is now down to just 13% of medical graduates choosing to go into general practice. With many GPs being older and due to retire in the coming years, things are only going to get worse. A big problem is the financial viability of general practice. In the last decades, governments of both persuasions have frozen the Medicare rebates for seven years and for the rest of the last two decades has indexed rebates at half of CPI, while the cost of running a practice has soared. Earlier this year the Tristar Group of 29 general practices in regional Victoria and NSW collapsed and went into administration, leaving some communities without adequate medical services. If your GP is bulk billing you, there will be some services where it costs the practice more to deliver the service than they get from Medicare, effectively the equivalent of them opening their wallets and handing you money for them to provide a health service
Medical students and junior doctors have looked on as general practice has been treated as the poor relation with the government not providing protective equipment during the pandemic, ( as the price of one box of surgical gloves soared from $17 to $70), categorised general practice as “not front line medical” for early access to covid19 vaccines as GPs risked themselves seeing covid-19 patients face-to-face while hospital staff who did not have patient contact were classified as front line. The NSW government recently made violence against health workers-except GPs – a specific crime. The Western Australian premier blamed GPs for hospital ramping as did the Queensland
Health minister. Medical students and junior doctors look on, see what’s is happening and say, “well I am not going there,” particularly as many have large student loans to pay off.
In September 2022 Tamborine Mountain Medical Practice carried out 2,000 fewer medical consultations than the same time the year before, all due to the GP shortage, even though demand has increased. Two years ago, the government redrew rural boundaries and reclassified Tamborine Mountain as metropolitan (MMM1- the same as the centre of Brisbane). The result is that it is even harder to find GPs as we are prohibited from recruiting GPs overseas. We have had GPs in the UK wanting to come and work on the Mountain, but government regulation is the barrier. If this issue is important to you, if you want to be able to see a GP as you get older, contact your local member of parliament, and let them know.
Dr Leeann Carr-Brown MBBS(Hons) FRACGP
Tamborine Mountain Medical Practice
Ph 0412644145 www.tmmp.com.au