Failing approaches to GP shortage
Why throwing cash at bulk billing can’t fix this leaking ship.
Tasmania has a GP shortage. This isn’t news; it’s been a slow-moving crisis for years. But lately, the solutions coming out of state and federal governments sound more like patch jobs than actual plans. Take bulk billing top-ups, for example. The idea is that raising the Medicare rebate will magically fix everything. But here’s the thing: throwing money at bulk billing is like sticking chewing gum over a hole in a levee. Sure, it’s something, but it’s not going to stop the water from coming in.
The federal government’s big idea is to increase bulk billing rebates to make GP visits more affordable. Sounds good, but it doesn’t address why GPs are abandoning the profession in the first place.
The workload is crushing, the pay doesn’t keep up with the hours, and running a practice is increasingly unaffordable. No rebate hike is going to convince overworked, burnt-out GPs to stay. It certainly won’t conjure new doctors out of thin air. This week another GP surgery is closing under such pressures, leaving a community without their GP.
Even worse, it ignores the reality on the ground. Many clinics have already ditched bulk billing entirely because even with rebates, it doesn’t cover costs. Bulk billing top-ups might look good in a press release, but they’re not going to plug the gaping hole in Tasmania’s primary healthcare system.
The GP shortage isn’t just about money; it’s about a system that’s fundamentally broken.
Medical students aren’t lining up to become GPs. Why would they? The training pathway is long, expensive, and unappealing compared to hospital specialisations. And even if someone does want to become a GP, there’s no guarantee they’ll stay in Australia let alone come to Tasmania. Other countries offer better pay, better conditions, and less bureaucracy. Australia’s loss is New Zealand’s or Canada’s gain.
Tasmania’s rural communities are hit hardest. Even if GPs are trained, how do you get them to places like Queenstown or Scottsdale? No one’s signing up for longer hours, fewer resources, and a remote lifestyle without serious incentives. And the current incentives? They’re either too little or buried under so much red tape that they’re practically useless.
Let’s not forget the classic political tactic of buck-passing. Health is supposedly a state responsibility, but Medicare is federal. So, when things go wrong, both sides point fingers at each other. Meanwhile, Tasmanians are left wondering why they can’t get a GP appointment for weeks, while state and federal argue over whose job it is to fix the levee.
There are real solutions out there, but they’re either too hard or too politically inconvenient. Here are a few:
Recruit GPs from Overseas
Tasmania is a hidden gem. Sure, Sydneysiders won’t swap Bondi for Burnie, but plenty of highly skilled doctors overseas would happily relocate. The problem? Bureaucracy. Australia’s medical registration process is a nightmare for international doctors, and visa delays don’t help. It’s almost as if we don’t actually want overseas-trained doctors to fill the gaps. Actually, some are against the idea.
Start the Rural Generalist Pathway
There is an already established pathway for Rural Generalists to work in Tasmaina. These are doctors trained to do a bit of everything—primary care, emergency care, even specialised services. They’re exactly what rural Tasmania needs. But the training is long, the job is tough, and the support is minimal. Yet there is a plan for this and candidates willing to get going. Just that the plan hasn’t been scoped yet, i.e. the Tassie government doesn’t know what to make of it.
Community-Driven Healthcare
Why not expand the role of nurse practitioners and allied health professionals? In many cases, patients don’t need to see a GP for basic healthcare. Let nurse practitioners take some of the load. Of course, this idea hits a wall thanks to professional turf wars. The AMA has historically resisted efforts to expand the scope of practice for other health professionals, and governments aren’t keen to pick that fight.
Overhaul Medicare
Move away from fee-for-service to a salaried model for GPs. This could reduce the pressure to cram in as many patients as possible and make rural placements more viable.
OK, some of these ideas may be too radical and hard to consider.
But it’s worth chewing over.
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