The findings, in a paper to be released today by Monash University demographer Bob Birrell, point to a major “over-servicing” problem and explode the theory that much of Australia has a doctor shortage.
Dr Birrell has used recently released 2011-12 Medicare billing data to show that the number of full-time equivalent GPs grew from 18,091 in 2006-07 to 21,119 in 2011-12 – an increase of 17 per cent at the same time that the population grew by 7.8 per cent and commonwealth payments to GPs increased by 8 per cent.
Dr Birrell argues that – with a few exceptions, mainly in remote areas – the notion of a shortage of GPs is “wrong”.
“This over-servicing is showing up in high bulk-billing rates. By 2011-12 these were more than 80 per cent in both metropolitan and non-metropolitan areas.”
Dr Birrell says another indicator of the change is the number of GP services billed per person per year in Australia. This increased from 4.9 in 2004-05 to 5.7 in 2011-12.
He warns that the over-servicing is about to get worse.
The number of domestic medical graduates has almost doubled from 1287 in 2004 to 2507 in 2011. About a third are going into general practice, he says.
The number of fully registered Australian-trained GPs who will enter the workforce will double to about 1000 a year over the next few years.
“Most will locate in metropolitan areas because they can practise wherever they choose,” Dr Birrell said. “In so doing, they will add to the over-servicing problem. They can do so because patients who are bulk-billed face no financial constraint on their consumption of GP services and GPs make the judgements about what services are needed.”
Dr Birrell said the federal government needed to rethink its policies around GP registration.
In 2011-12, the commonwealth government paid out $6.7 billion to GPs billing on Medicare and for GP incentive programs, up from $6.2bn in 2006-07.
The 2011-12 payment amounted to an average of $317,000 for each of the 21,119 full-time-equivalent GPs billing on Medicare in 2011-12.
“The emphasis of government medical manpower policy should switch to ensuring that the GPs serve where they are needed,” he argues.
He suggests the government limit the places where GPs are permitted to practise through its controls over the issuance of Medicare provider numbers.
“All that would be required to limit over-servicing in metropolitan or any other locations would be to not issue additional provider numbers in such areas until the oversupply situation ends.”
He argues against the practice of bringing overseas doctors into Australia to service areas where shortages were being experienced.
“Surveys indicate that regional communities require more medical service per person than do metropolitan communities.
“The demands on GPs’ skills are also greater in these communities because GPs are often required to provide procedural services in local hospitals as well as GP clinical services. Regional GPs also do not have the same access to specialist back-up as do GPs in metropolitan areas. It would be far preferable if the impending surge of highly trained and accredited local GP registrars served in shortage areas when they complete their training.”
He reveals the numbers being sponsored on 457 visas is surging, reaching 2663 in 2011-12.
“This reliance is now built into the business model of some corporate employers,” he says.
“One of these, Tristar, had established 40 clinics in regional Australia by 2012, all heavily reliant on the employment of IMGs on 457 visas.”Source: The Australian – “Over-serviced: national doctor shortage ‘a myth'”
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