Bulk-billing GPs risk running medical practices “like fast food restaurants” that dish out prescriptions, with doctors warning they are under pressure to rush patients through in as little as six minutes.
They say one of the largest cohorts of victims of a so-called “turnstile consultation” model is Australians who are taking prescription opioids for pain relief.
Dr Ramu Nachiappan, a private practice GP in NSW, said Medicare had become a “poisoned chalice” as GP rebates failed to keep up with inflation and the Consumer Price Index.
To run a “successful business”, Dr Nachiappan said, GPs are having to resort to short consultations because rebates drop in value every minute after the six-minute mark.
When it comes to decisions about pain management, he said it is “implausible” that an adequate assessment can be undertaken in an appointment of less than 15 minutes.
Dr Nachiappan said the bulk-billing model was “fraught with danger”.
“My colleagues, fellow GPs, are likely to face poor patient outcomes, be subjected to complaints, self-doubt their skills and competence, and become disillusioned with patient care in general practice,” he said.
Lack of incentives for GPs to have longer consultations with patients is “compromising quality general practice” and “resulting in a fast-food general practice scenario”, he said.
Consulting at several Melbourne hospitals, neurosurgeon and spinal surgeon Dr Michael Wong said he sees patients every day who are dependent on opioid medications to relieve back pain.
It’s only when they arrive at his office they realise there are more effective treatments to deal with the root of their problem.
But many have already spent years taking opioids and need additional help tapering off the drug once the underlying source of their pain is removed, Dr Wong said.
Prescribing pain medications can be a “very quick” process, whereas “sitting down to listen to the patient’s problem, doing the proper test, looking at the test results, thinking what else can be done is a much more lengthy process”, he said.
But “our health system is not designed for that to happen”, Dr Wong said as GPs are under “enormous cost and time pressures”, meaning “a lot of patients” are prescribed opioids to simply mask their pain, leaving the real source of their problem unaddressed.
“Many patients say to me that they hardly even get to sit down in the chair when they go to see the GP.”
Doctors prescribed 15.4 million opioid scripts to 3.1 million Australians in 2016-17, the most recent data shows.
Dr Paul Grinzi, a private practice GP in Melbourne specialising in addiction medicine, said shorter consultations generate a higher rebate per minute compared to longer, more comprehensive consultations.
“If I’m looking at purely a financial model, then I’ve either got to see more patients or charge greater fees to offset the decreasing Medicare rebate as the time complexity goes on,” Dr Grinzi said.
GPs solely reliant on the rebate amount can find it “very difficult without seeing a lot of patients very quickly to make that work”.
Developing a suitable remedy for chronic pain requires GPs to spend more time with patients, but Dr Grinzi said the “financial incentives disincentivise” doctors from doing so.
“Even if I spend 20 minutes or 30 minutes with a patient, appropriate treatment of chronic pain is not just in medication … It really more importantly requires physical therapy, a psychological therapy, a social therapy around that. That’s complex to put together,” he said.
Even more concerning is the little training GPs have around addiction and pain, Dr Grinzi said.
“It’s only really been a focus over the last five to 10 years … so there’s a whole lot of generations of GPs who never had access to this training,” he said.
“If we’re looking at a medical student’s university course syllabus, there would be a very small amount of time dedicated to chronic pain management and even a smaller amount – we’re talking maybe an hour or two possibly over the whole curriculum – of looking at addiction as a specific area.”
- See The New Daily on Tuesday for Part Two of a look into Australia’s opioid problems