The “constant” and “unfair” targeting of general practitioners by politicians is one of the reasons behind a decline in job satisfaction within the profession, the heads of Australia’s peak medical bodies say.
A report from the University of Melbourne’s Institute of Applied Economic and Social Research published on Wednesday found general practitioners are experiencing lower job satisfaction and a decline in work-life balance.
The findings are based on an analysis of nearly a decade of data relating to general practice, as well as data from a longitudinal study of doctors, the Medicine in Australia: Balancing Employment and Life (Mabel) survey.
While the study didn’t explore what had led to a job satisfaction decline, it found there appeared to be an association with the Medicare rebate freeze, which has seen the amount doctors receive back for a standard consultation capped since 2014.
“The fall in job satisfaction since 2013 is concentrated amongst doctors under 45 years old and, to a slightly lesser extent, doctors over 55 and approaching retirement,” the report found.
“Falls in job satisfaction suggest falling morale, which can in turn reduce the attractiveness of general practice as a career for junior doctors, therefore compounding difficulties in recruitment.”
The Royal Australian College of General Practitioners represents more than 80% of general practitioners and its president, Dr Bastian Seidel, said the findings from the report were unsurprising.
“GPs are constantly being targeted by politicians and policy makers as wasting medical funding and resources,” Seidel said. “We have been shaken, stirred and put in the freezer in a constant kerfuffle about compulsory co-payments and demoralising debates around the rebate freeze.”
While the analysis found the personal hourly earnings of general practitioners increased at double the rate of real wage growth in the economy, Seidel said they earned less than half that of the average wage of doctors from all other medical specialties.
He described “professional discrimination” against GPs by those from other specialities, who he said sometimes viewed GPs as working in an inferior and less desirable area of medicine.
“There’s not a single day where we don’t get a discharge letter from hospital where it says ‘the GP can chase the results’,” Seidel said. “We aren’t labradors. It’s just bizarre and I wonder where this attitude comes from. I’m a clinical professor with a PhD and peers still ask what I specialise in.
“I say I am a specialist, general practice is my specialty.”
He believes part of the issue is that trainee doctors only spend a short amount of time in a general practice rotation despite the high importance of GPs to the health system. General practitioners spend the same amount of time in medical school as other specialists and are also required to undergo years of specialist training, he said. But he believes it is not promoted to medical students as heavily as other specialties.
“It is more attractive to become a cardiothoracic surgeon, which I think is boring as, but we are rewarding it with hundreds of thousands in medicare rebates.”
Seidel said that when people suffered a serious and life-threatening condition, such as a heart attack, and were successfully treated in hospital, it was the surgeon or emergency physician who received the praise.
“GPs never get the limelight,” he said. “It costs thousands of dollars to treat a patient in hospital. But it costs $37.05 for a GP consult that may prevent a heart attack through a blood pressure check. Naturally, the attention falls on treatment, not prevention.”
A spokesman for the federal health minister Greg Hunt said the government was working with the college and the Australian Medical Association on a long-term national health plan.
“The minister has said that GPs are the cornerstone of our health system,” he said.
The head of the Australian Medical Association, Dr Michael Gannon, said the report was based on “high-quality” data but that the findings about job satisfaction were “galling” given the importance of GPs.
“General practice has been unfairly targeted by both sides of politics over the past 25 years,” Gannon said. “We are now coming into five years of the freeze on rebates, which compromises the ability of general practitioners to make a living.
“All of us have a role to play in the health system but general practice is the most important speciality amongst equals.
“They are also much loved, valued and respected by their patients, and are one of the most trusted. But one metric by which value is perceived is by how well someone is paid and it must upset GPs to be undervalued in terms of pay.”
The lead author of the study, Prof Anthony Scott, said GPs were experiencing significant challenges due to funding and demographic changes in the medical workforce that are influencing the structure of the sector.
Larger practices and corporate ownership coinciding with declining Medicare funding per GP and new funding models may be creating a more efficient sector, he said, but may not be having positive effects on job satisfaction.
