Battling a ‘turnstile’ system?

Guild leaders highlight doctor article, saying it confirms what they’ve been saying about ‘five-minute medicine’

A Sydney general practitioner has written an article for The Australian pointing out the difficulties that come with trying to perform longer consultations for more complex patients.

“Medicare is a fee-for-service system: every visit attracts a fee, which incentivises high-volume, low-time consultations,” writes Dr Hobbs in an article entitled ‘Doctoring the system is so easy’.

“Each fee bracket is 20 minutes wide — so a five-minute-consulting GP earns three times as much as a 15-minute GP. As a result, much of general practice is quick and expensive.”

He continues: “I (appropriately) write fewer prescriptions, order fewer investigations and fix problems rather than refer them. Research demonstrates that longer consultations provide these highly economical benefits.

“I’m not better or cleverer than other GPs; all I offer is more time with each patient. In return Medicare pays me less and has audited me,” says Dr Hobbs.

“Mostly, the public is unaware of this poorly performing system, while politicians have been quick to justify their inaction with misleading distractions about high bulk-billing rates.

“The truth is consultations are shorter and practices poorly maintained. As a result, the quality of patient care is declining and taxpayers are paying far more for health funding than they need to.”

Many commenters agreed with him.

“An excellent accurate article regarding the state of general practice in Australia. Medicare has created a situation where churning numbers of patients is rewarded and GPs who spend time with patients often who have complex issues that poorly treated will end up costing the health system a huge amount are not financially rewarded,” said one GP.

“Bravo for this courageous article. My heart aches for young GPs. And especially for the public who have to negotiate a degraded system … 70% of GPs now work in the corporate environment  and this goes a long way to explain the problems alluded to in the article,” wrote another commenter.

The Pharmacy Guild says Dr Hobbs’ article confirms previous arguments from NSW Guild president David Heffernan about “corporate GP practices”.

“Walk-ins are becoming rarer. You will find in the corporate GP practices, business models that appear to encourage five-minute medicine – turnstile operations which encourage patients to come in for short visits and often,” said Mr Heffernan in February this year.

“More and more, healthier patients with low morbidity conditions fill GP time slots.

“Healthier and wealthier patients are financially more attractive to business models that put profits before patients (a GP practising five-minute medicine can earn over $400 an hour in a bulk billing practice).”

In a move certain to enrage doctor’s groups, Mr Heffernan suggested increased funding to GPs would be wasted, and funds could instead go towards pharmacists providing minor ailments services.

“Increased funding to GPs will only incentivise five-minute medicine and blow out an already out of control GP and hospital spend,” he said.

“It is a simple fact: if the pharmacist is not permitted to help you and the surgery is closed, there is no choice but the emergency department.

“A solution is there for our legislators where community pharmacy stands ready to ease the strain on a burgeoning health spend and free up appointment times for GPs and emergency rooms.”

The RACGP hit back with an article from president Dr Harry Nespolon entitled, “Do they teach perfume dispensing in pharmacy school?”

“The Pharmacy Guild is possibly the best health lobbyist in Canberra, so it is surprising to see it let one of its state presidents off his leash,” wrote Dr Nespolon.

“This is not the discipline for which the Guild is known, especially for what can only be described as an uninformed rant.

“Five-minute medicine? Turnstile operations? Where did they come from?” asked Dr Nespolon.

“The closest thing I see to a turnstile in healthcare is at the cash registers of the pharmacy.”

Anthony Tassone, Guild Victorian President says Dr Hobbs’ opinion piece “is a timely and highly relevant account of a ‘day in the life’ of a GP striving for high-quality care of complex patients in a system he believes perversely incentivises high volume ‘quickfire’ care of non-complex patients ‘through the turnstiles’.

“Rather than addressing issues within their own patch, it’s tiring having to hear of repeated public commentary from RACGP national president Dr Nespolon about pharmacies, whether it is timing of influenza vaccinations or the community pharmacy model itself.

“Instead of obsessing over derogatory remarks about ‘perfume’ available from some community pharmacies – he should worry himself of his own colleagues battling a system rewarding the ‘incentive for fast medicine’ and the impacts of corporatised medicine on patient care.”

AJP has reached out to the RACGP for comment.

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  1. help!

    My experience reflects this Gps experience. I worked in a Pharmacy in a corporate GP centre , when appointments were suddenly introduced. The result of this was that all the available appointments were entirely taken up by the same patients over and over and over again weeks in advance. I had to send walk ins to other medical centres or the emergency department of the nearby hospital depending on the severity of the presenting issues.


    Employee GP’s earning $400/hr. Good on them. What do employee pharmacists earn? $30/hr…Guild?
    And guess what – the more patients the GP’s see – the MORE SCRIPTS PHARMACY POTENTIALLY GETS. Goodness me. Everyone is in this together. Stop slinging mud at each other – or should I say stones as you are in a glasshouse.
    If pharmacies can support higher wages and higher staffing levels to deal with increased Rx numbers then that is the surefire way to success.

    • help!

      not necessarily….. if the doctor sees the same patient over and over instead of seeing walk ins or new patients, a prescription on each visit may not be the case.

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