GP Dr Aniello Iannuzzi writes a guest blog on an array of media red tape.
Just as the nausea from the “Mediscare” election propaganda appeared in abeyance, we have once again seen doctor-bashing come to the fore.
Despite bulk-billing rates being at record highs, according to the narrative of the chattering classes, the greedy doctors are to blame for the unaffordable health care, poor access and the cost blow-outs of Medicare.
In truth, the two greatest threats to our economy – the Nanny State and compliance industries – are to blame.
The bulk billing paradox
Paradoxically the bulk billing rate appears to rise despite the Medicare freeze.
The corporatisation of general practice remains one of the chief drivers of the bulk billing rate. Corporates enjoy the advantages of investor capital, economies of scale and vertical integration, where they pick up profits on imaging, pathology, pharmacy and allied health.
However, the government remains the biggest driver of bulk-billing.
Government-run clinics in many guises, such as ambulatory care clinics, community health centres, and super clinics now represent a big slice of general practice. Being a government service, bulk billing is the rule. However, many of these services are robbing Peter to pay Paul; they amount to cost-shifting between Federal and State….but I dare anyone to dob in government to the government. Good luck!
Government’s nanny state role is also responsible for visits that are the bane of GPs – the red tape visits. Just to list a few forms: Centrelink; driver licence; electricity rebates; disability parking; transport subsidies. Whenever patients come bearing such forms, there is pressure that bulk billing is expected, as they are not medical but rather governmental. Such visits are unproductive and block consultation time that should be for doing real Medicine. Like so much red tape in the Australian economy, this is simply the government shifting its paperwork burden onto doctors. The irony is that because it is bulk billed, it is a false economy, for doctors are very expensive clerks.
Moreover, we note government’s bulk billing incentives for concession card holders. Concession cards are as much to do with clever accountants as they are with need. Sit in any GP waiting room, and you’ll see patients arriving in luxury cars, dripping in bling, waving health care cards to remind the receptionists of their “entitlement”.
The AHPRA monster
We have Rudd and Roxon to thank for the Australian Health Practitioner Regulation Agency (AHPRA). Accounting to COAG, AHPRA floats in an amorphous world of unaccountability, for no jurisdiction really has control of it. When it suits, AHPRA can act as a Federal agency but at other times can look like a state body.
AHPRA already has major powers to assess the performance of individual doctors to ensure public safety. Its powers rival those of the police and the Australian Tax Office.
Now we are being told it’s not enough. So it is wants to introduce revalidation, a system whereby doctors have to periodically “re-qualify” to practice. Judging by the vehement comments on the AHPRA website, revalidation has upset many doctors.
Why are doctors so upset?
1. Doctors are already drowning in red tape and don’t want more;
2. Doctors already do copious continuing education;
3. This smells of a done deal with consultation that is only window dressing. AHPRA wants to tick a box to say it has “consulted the profession” but will get its cheer squad to write a few glowing comments to justify revalidation.
4. No need has been established. AHPRA has presented no evidence. It’s a solution in search of a problem.
5. Australian doctors do not want to blindly follow bureaucratic process from the UK, one of which is revalidation. The NHS is an inferior system to ours.
6. To justify its program, AHPRA has unfairly created bogeymen, which is plainly discriminatory. If you are male, or over 35, or in solo practice, or from ‘some’ overseas countries you will be targeted for being ‘at-risk.’ Think of this: a large proportion of doctors don’t even finish their training before the age of 35 nowadays.
7. AHPRA seeks to re-validate when it has never validated in the first place. Given Australia has over 20 medical schools, it would appear logical to consider validation before re-validation.
8. AHPRA is relying on a spin campaign of “protecting the public”. It knows politicians turn to water whenever this card is thrown and they know the media will exaggerate the message.
9. Realistically, revalidation will add 40 hours of work p.a. per doctor. There are about 100000 doctors in Australia. Assume a rate of $200/hr to cover time out of work and the education. That’s an $800M hit to the Australian economy. Once AHPRA adds nurses, dentists, physiotherapists, etc, to the revalidation list, we’re talking billions.
In proposing revalidation, AHPRA is, in fact, admitting it has failed. Despite being in existence for years, having extraordinary powers and the ability to rely on continuing professional education, it still feel doctors are not regulated enough.
If the Australian public ever needed evidence for the dismantling of AHPRA, it now has it.
Sick Certificates and repeat scripts
The government now has the bright idea that Medicare money is being wasted in menial tasks like repeat scripts and medical certificates.
Once again, it can only blame itself.
The repeat intervals of the prescriptions are set by government to reflect what its own health department deems to be a safe and suitable interval for the patient to be reviewed. Doctors, pharmacists, and the public do not set these rules.
Doctors take a calculated gamble when writing scripts for patients without a visit; any mishap goes brutally punished by AHPRA or in the courts.
The same applies to medical certificates; these are to satisfy the compliance industries.
I have never made a patient better by writing a medical certificate or by filling in a form…..and I probably never will.