The Federal Government claims GPs who offer universal bulk billing will earn more than $400,000 a year under proposed changes to Medicare bulk billing rebates.
While that figure may be about four times the average Australian wage, the AMA(WA) and the founder of a network of Perth GP clinics say it’s not as simple as that.
At the moment, a bulk billing GP earns less than their mixed billing or privately billing colleagues for providing the same number of services.
Labor has promised $8.5b in Medicare funding if it is re-elected, which it claims would deliver an addition 18 million bulk billed GP appointments each year.
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According to new campaign material released by Health Minister Mark Butler, a GP who currently bulk bills one in four patients could earn $371,390 a year, while their counterpart who bulk bills all of their patients would be earning about $45,000 less than that.
The Labor Party claims that from 1 November, their measures would close that earnings gap. The Liberals have promised to match these Medicare investments dollar for dollar.
Analysis from Mr Butler’s office suggests a city GP who bulk bills all of their patients under the proposed system, could earn up to $403,805 and a GP who bulk billed one in four of their patients could earn up to $398,448 a year.
But AMA(WA) President Dr Michael Page and Dr Kiran Puttappa, founder of GP West, agree that while some Perth GPs may make up to $400,000 a year, the situation is being highlighted for political gain.
“I think the health ministry is trying to play a little bit of class warfare there and say ‘Look at the greedy GPs, $400,000 isn’t enough for them”, but the fact is that we don’t think GPs are going to be making that off of this,” Dr Page said.
“For most GPs, in the city in particular, it’s more likely to reduce their take home income if they actually go ahead and bulk bill all patients. The average fee for each patient will decrease rather than increasing, so there’s no way, with a decreasing fee paid per patient, you can increase your income.
“That doesn’t make any mathematical sense.”
The decreasing fee Dr Page refers to is the rate at which the government is proposing to pay for a standard consult under the bulk billing arrangements.
While the AMA’s suggested fee for such a consult is $102, the government is proposing to provide a little less than $70 for a standard consult when it is bulk billed.
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“Clearly you’re going to be behind and that’s not just about doctor’s incomes per se, it’s about practice costs – there are some practices that just can’t make it work on less than that,” Dr Page said.
Under Labor’s proposals rebates for bulk billing practices for a standard consultation would be increased by up to 62% for a metro clinic, up to 98% for a small rural town clinic and 103% for a remote clinic.
For fully bulk billing practices, there would be an additional 12.5% loading payment on their Medicare rebates on top of the new bulk billing incentive.
Dr Puttappa, who oversees 20 GP clinics across Perth, said many factors came into individual GP wages but he estimated the average take home salary of full time GP in Australia was between about $200,000 and $320,000.
He said such proposals made as part of election campaigns often came without extensive consultation, meaning they have the potential for unintended consequences that may not have been factored in.
Currently, it is standard for about 30% of a GP’s earnings to be paid as a practice fee to cover clinic operating costs.
“It becomes so much more of a headache running the practices, if they keep changing all these things,” Dr Puttappa said.
He explained some GPs may want to negotiate a reduced management fee if bulk billing rates increase.
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Labor confirmed to Medical Forum the estimated incomes were potential full time GP earnings before tax after a standard 30% practice fee was taken out.
Dr Puttappa also said the proposed 12.5% incentive being promised as an additional payment for practices that fully bulk bill all patients created additional variables for GPs and those operating clinics.
‘It’s not very clear who gets it, because they also said that there will be a split between the practice and the practitioner,” Dr Puttappa said.
Labor has said the payment split would be determined in consultation with the sector prior to the program’s launch.
“Let’s say the government comes back and says the incentive should be shared 50/50. The GPs say ‘as I’m working more, 60%’, so you’re opening all sorts of unnecessary headaches in running the business by doing these things,” Dr Puttappa said.
The Labor Party’s numbers wee based on the GP earnings calculator provided by General Practice Registrars Australia and modelled on standards set by the Royal Australian College of General Practitioners (RACGP).
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