Outgoing President of the Royal Australian College of General Practitioners (RACGP), Dr Karen Price, wants GPs to share her vision of the profession as one to be proud of, noble and resilient despite the “very deep pain of decades negligence”.
speaking in an exclusive podcastDr. Price said his final months as president were expected to be among the busiest of his term, with his time split between speaking with young people, the task force on strengthening Medicare and continuing to advocate in in favor of the reform of the financing of general practitioners.
“The need for reform is long overdue, and the Medicare reimbursement freeze was just the beginning of the decline,” Dr. Price said. Preview+.
“Even before that, indexing Medicare was the beginning of the ‘slow frog’. We are now at the point where we have to do something and it is essential.
“For at least a decade, if not more, there has been a pernicious and ridiculous denigration of our profession.
“The result of this is a lack of labor reserve, which is only beginning to show up now.”
Research published in the MJA in 2020 showed that the proportion of University of Western Australia medical graduates registered as general practitioners in December 2019 had fallen from around 40% of those who graduated in 1985-1987 to around 15% of those who graduated in 2004-2007. Meanwhile, the 2022 National Data Report from the Medical School Outcomes Database showed that the proportion of final-year medical students whose first preference for specialty was general practice fell. only 13.8%.
“We have supported and replaced the wonderful international medical graduates who now make up nearly 50% of our College membership,” said Dr. Price.
“But it’s not a long-term strategy to keep importing professionals when there are very high quality high school or primary school students or even students who haven’t yet been born in Australia who will make great physicians in general medicine.
“Australia has failed in this respect.”
Dr Price and the College have been very vocal about the future of wholesale billing, telling GPs to “do what they have to do” to stay financially viable.
“We certainly have anecdotal evidence that patients who are very engaged with their GP, who see them regularly, are saying ‘don’t you dare bill me en masse – I want you to keep your doors open,'” he said. she stated. Preview+.
“We know [privately billing patients] is more difficult for physicians who have committed to low-income areas.
“And I know to some extent that may have put some pressure on some physicians, but the message was not to give up on bulk billing. It was, do what you must to keep your doors open so you can serve your patients.
“If that means you have to charge some spread, then do it.
“I have great compassion for doctors who work in low-income areas, where they are very challenged by Medicare, and it is simply not acceptable for our country, which is rich, to have a system where people cannot access health. cost-based care.
“That’s not acceptable, and I think most Australians would agree.”
Dr. Price continues to advocate for multi-source funding for general practice.
“There is no single answer,” she says.
“If you’re in Rose Bay, you’ll need a very different funding stream than you’re in Broken Hill or Arnhem Land.
“Whatever system you use, if it’s underfunded it won’t deliver results. All systems applied top-down will have unintended consequences.
“What we’re trying to advocate is that GPs will be able to choose the funding model around which they design their clinic, and that allows for professional autonomy, that allows us to address the inverse law of care [the principle that the availability of good medical or social care tends to vary inversely with the need of the population served].
“At [Strengthening Medicare] Task Force, I continue to put on the table that there is not yet a health system in the world that has really addressed the law of reverse care in terms of funding – multi-system funding is the closest.
“When you go one way like the UK or you go one way like America, you have these terrible gaps and terrible system bottlenecks and malfunction. We really want to avoid these very salient lessons.
“We cannot continue to separate parts of the system and fund only parts of the system. This is how you break the system.
“It is absolutely not about the income of general practitioners. This is primary care funding. These are generalists working at full range. It is about providing health care to all Australians.
“To ignore this problem is to go down the road to disaster, in my opinion.”
Despite all the problems, Dr. Price remains optimistic about the future of general practice.
“If we can get really strong signals from this government, I think that will help improve morale,” she said.
“We have a 10-year plan and that’s how long reform is likely to take.
“Hopefully we can really start to move the dial. We need to be able to signal to the younger generation [of doctors] that there are many reasons to be optimistic.
“If we want to approach this intelligently, we have to look at the whole, we have to look at the rational use of resources and we have to look at the whole system.
“And the evidence tells me that if you invest in primary care, you’ll get a much better health care system with a much lower use of money overall.”
As time is running out for her term, Dr. Price reflected on her time as “wartime” president, coming to office at the height of the COVID-19 pandemic.
“People said, ‘oh, you pulled the unlucky straw,'” she said.
“You can see it like that, and that first year in Melbourne on Zoom all the time, it was quite difficult.
“But on reflection, I’m also lucky because I was able to show what general medicine could do. I have to talk about the clear evidence of what my colleagues were doing. Leading a college and the community during a pandemic is an incredible experience. So I think I’m going to come back to it with all that kind of awe and wonder.
And what is she most proud of?
“I am most proud to hopefully reflect a vision of GP that GPs themselves can be proud of, GPs feel they are heard, have a voice, they actually do amazing fucking work and pride themselves on their professionalism.
“Look, the system is really difficult. Don’t let this change the way you practice, try to keep practicing professionally.
“I’m just proud of the fact that GPs can say we’re a noble profession. They have acted like this through COVID-19 and they do, articulating the very deep pain of what has been decades of neglect.
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