What a pleasant little gig the Australian Medical Association has.
The AMA claims to be a caring and sharing organisation for all Australians but ultimately it is just a union, arguably Australia’s most successful.
The Coalition’s budget proposal to continue the indexation freeze on Medicare rebates until 2020 has caused renewed outrage in the profession. The freeze was introduced by Labor and implemented in July 2014.
There’s nothing wrong with a union advocating for its members, and in many instances the AMA and its executive does promote the healthcare needs of patients and communities, but in my view the current campaign by the AMA and the Royal Australian College of General Practitioners (RACGP) is akin to the CFMEU enlisting home and building owners to argue for their next pay rise.
The CFMEU must be in awe – if only they could persuade ordinary Australians that their homes and offices would fall down if their members didn’t get more money.
But that’s all the AMA’s bare-faced attempts to persuade Australians that they’ll get sick if GPs don’t get an indexed Medicare rebate, amount to.
And if the CFMEU was aware of the extra payments (the GP equivalent to tool and site allowances) that GPs receive through PIPs (practice incentives programs) and SIPs (service incentive payments), they’d be gobsmacked.
The AMA and the RACGP seem to believe that many Australians still have the same kowtowing attitude towards doctors as my late grandmother, who gave every indication that she would have happily agreed to decapitation if that’s what The Doctor ordered.
Australian taxpayers paid out $8bn in Medicare rebates to GPs in 2003-04. Ten years later, in 2014-15, they paid out more than $20bn. And, according to the budget papers, the intergenerational report nominates Medicare as the fastest growing element of health care spending in coming decades.
So we’ve got massive budget deficits into the foreseeable future, a fairly fragile economy, flatlining growth in overall wages, very low inflation, an apparent national oversupply of GPs, record bulk billing rates of 84%, and the AMA still thinks this is a good time to enlist taxpayers in their industrial relations battle with the government?
Now let’s add the other taxpayer-funded perks – the ones the AMA and the RACGP never mention – into this industrial relations environment.
The figures that the AMA and the RACGP don’t include in all their modelling of dire consequences are the many government “perks” that doctors already receive – the PIPs and SIPs, the bulk billing incentive itself (in addition to the actual rebate) and two incentives for ensuring child patients are vaccinated.
The PIPs system was developed by the federal department of health to encourage improvements in patient care quality and to overcome complaints from doctors about the administrative cost of doing so.
While there is no evidence that the PIPs and SIPs are misused, they can be very lucrative for savvy general practices, even if they do lead to better government-funded health outcomes for Australians.
According to the 2016-17 budget papers, Australis’s GPs earned more than $243m from PIPs and this is set to rise to $368m in the 2017-18 year.
Given there’s about 5,000 GP practices registered for PIP, that averages out at about $69,500 per year. Not a bad indexed perk.
Currently five out of every six GP services are bulk billed, according to the secretary of the health department, Martin Bowles. But the government pays a bulk billing incentive on top of the actual rebate for GPs who bulk bill commonwealth concession card holders and children under 16. At $6.15 per visit in cities and $9.25 per visit in rural and regional areas currently, that amounts to another $23,500 or more a year.
The current departmental PIPs list has 10 programs that cover a mixture of patient health issues and health service issues. These are too be streamlined into fewer payments in the next few years but will continue to incentivise doctors to develop treatment plans for patients with some chronic diseases such as asthma and diabetes, to urge “lapsed” patients to be screened for cervical cancer or to get their children’s vaccinations up-to-date, to encourage rural and remote doctors to do hospital procedures, to computerise their patient records, and to encourage doctors to allow medical students to sit in on consultations.
Each PIP has a sign-on payment and a SIP attached to it. For example, practices can receive $1 per patient for signing up diabetes patients to a treatment plan, $20 per patient for providing a cycle of care to 50% of eligible patients, and $40 per patient per year for keeping the patient on their books. Asthma patients with a treatment plan are each worth $100 per year.
Doctors can also receive a $6 payment for notifying child vaccinations to the Australian Childhood Immunisation Register and an extra $6 for tracking down children who are more than two months overdue for their shots.
These payments, generally made quarterly, were introduced to improve health services to patients and they’ll increase next year – by more than 50%, according to the budget papers.
But these are silent payments – almost no patient would know when a consultation puts a PIP payment in their doctor’s pocket.
And the AMA and the RACGP like it that way. Brian Owler’s two-year stint as president of the AMA has just ended. Owler opposed just about every reform to Medicare proposed by the Coalition government, including the introduction of a patient co-payment. But he offered no constructive alternative suggestions to address the ballooning cost of health.
His attitude was, in many ways, a continuation of the old-fashioned “protect our patch” attitudes of past AMA leaderships. The AMA was at the forefront of opposition to increased responsibilities for nurse practitioners and midwives, to acknowledging any role of therapists, and to any efficiencies in the Medicare Benefits Schedule, to name but a few.
And the under-representation of women in the AMA’s leadership is another indicator of their old-fashioned stance.
While women make up just on 40% of Australia’s medical professionals, this certainly isn’t reflected in their leadership.
Since 1962, only two of the AMA’s 24 presidents have been women (8.3%) and only two of the current board of 10 are women (20%).
The current AMA, under new president Michael Gannon, needs to decide what it wants to be – a union interested only in members’ pay packets or an organisation that works in consultation to improve health outcomes and members’ pay packets.
