Doctors fleeing private practice?

johnboy 17 February 2009 15

The ABC has a story on moves by doctors from O’Connor, Macquarie and Kaleen are all shutting up shop and moving to a single facility in Belconnen.

Apparently a private health care company is making them an offer they can’t refuse and lifting the burden of administration off their backs.

Katy Gallagher is mumbling about attracting more doctors to the ACT, which isn’t much use if they can’t afford to practice.

Here’s a question, why do doctors need to be in the same building as the administrators?

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charliemack charliemack 11:11 pm 23 Jan 12

The gov’t could help with the GP shortage by limiting the number of medicare numbers issued for places that do not have a shortage… big cities and tourist areas, mostly. They could link medicare numbers to geographical areas to even out the doctor numbers a bit.

There’s been a big increase in intakes into doctor training in the last few years, so in a few years, there’ll be a lot of new doctors coming out. Hopefully numbers being trained in specialties (like GP!) also increase.

Medicare has indeed proposed a “district of workforce shortage” whereby the applicants from other countries such as the UK etc may apply – Canberra is currently a district of workforce shortage area.

Indeed there has been an increase in doctor training, unfortunately however, there will not be an over supply as the majority of the workforce will be attempting to scale back and thus the cycle continues, this time however with a chronic lack of experienced GP’s/specialists for training purposes…

sepi sepi 10:51 am 18 Feb 09

The govt already has a scheme whereby doctors in areas of GP shortage can get extra payments.

Unfortunately Canberra doesn’t get this extra allowance, depite having the least GPs per capita in the nation. The Federal govt is just petrified of doing anything that looks like it is benefitting Canberra.

I would also introduce a special payment for doctors who sign up to treat a particular patient for 5 years. Or even 2 years. Or even the course of a particular health issue (like pregnancy).

ant ant 9:42 am 18 Feb 09

Interesting ideas from Dr Lee. Worth a try. What people don’t realise is that many/most of our country hospitals are kept open by importing foreign doctors. Some of these hospitals have 100% foreign medical personnel.

The gov’t could help with the GP shortage by limiting the number of medicare numbers issued for places that do not have a shortage… big cities and tourist areas, mostly. They could link medicare numbers to geographical areas to even out the doctor numbers a bit.

There’s been a big increase in intakes into doctor training in the last few years, so in a few years, there’ll be a lot of new doctors coming out. Hopefully numbers being trained in specialties (like GP!) also increase.

goose goose 7:34 am 18 Feb 09

Interesting article by Dr Lee from Erindale Medical Practice

Proposed policy for bringing GPs to the suburbs/bush

http://www.drdouglee.com/index.php?option=com_content&view=article&id=16&Itemid=31

What is a “family doctor”?

A family doctor is a caring doctor who is familiar with the health needs of your family, like your favorite hairdresser who knows what hairstyle best compliment your face, or your favorite mechanic who knows all the peculiarities of your car. Medical doctors with whom you have this kind of relationships provide the backbone of primary medical care. No doubt, Superclinics and afterhours GP clinics are valuable in providing episodic care and convenience, but is that what you need? Just imagine the government subsidises “supersalons” where you can go and have your manicure, perms and facials done under the same roof, any time of day, without appointment. Isn’t it great? The catch is: there are lots of other women with the same idea and they all want their perms at 10 pm at night. None of the hairdressers is aware of the nuances of your hair or your complexion. Worse still, your favourite hairdresser is now working there because her business cannot compete with the supersalon, but you can’t make appointment to see her! Is that what you want?

Why is there a doctor shortage in Canberra?

Many rural communities in Australia do not have a GP service. Some town folks (such as those in Temora) have taken the desperate step of offering a $500,000 incentive for a GP to set up practice in their town. This situation is caused by insufficient financial incentives as well as lack of government encouragement for GPs to set up practices in places where they are needed. It is not a matter of insufficient numbers, it is simply a matter of mal-distribution and lack of government guidance.

The Government pledges support for “super clinics”. “Super clinics” are businesses which need to operate for profit. They must be situated in population centres to be profitable. Due to their substantial financial backing, (with shareholders’ money) they can offer sign-on incentives to attract doctors.

If one is a newly qualified doctor with a young family, a mortgage, and a HECS debt, faced with the choice between being given $100,000 upfront to work in a superclinic for 5 years, or to borrow yet another $100,000 to set up a practice in a suburb, what will one do?

One does not need to be a genius to recognize that neither of these policies will alleviate the situation of doctor shortage where they are needed most.

Proposed policy to attract doctors to areas of need.

The problem with GP workforce shortage is that fewer and fewer doctors are willing to take the financial risk and responsibilities of opening up and running medical clinics in the suburbs, the type of clinics that provide personal care like your favourite hairdresser or mechanic does. Current government policies , rather than addressing this problem, are exacerbating it.

If a swimmer is struggling, rather than pledging funds to build a super doper swimming school, the obvious and sensible thing to do is to throw him a line or a floatation device.

Metamorphically, this is what my proposed policy does.

My proposal is for the government to offer an interest free loan of $100,000, repayable over 4 years, to any doctor wishing to set up a medical practice in an “area of need”.
An “Area of need” is defined as a location with a population of 1500 within 5 km of the proposed surgery. If a doctor, or a local community, can identify a site which will be suitable to set up a medical surgery, he/she/they can bring it to the attention of the “Doctor Workforce Taskforce” and the exact location is pegged for a potential $100,000 grant.

This “loan” is not granted to line the doctor’s pocket. It is only available to pay for the rent for the first two months, the fit out, and initial purchase of equipment, in the setting up of the surgery.
This loan is interest free and must be repaid in full if the doctor leaves the area. However, for every year that the doctor remains in the location, the loan will be reduced by $25,000. If the doctor stays for 4 years, there is nothing to repay, (but by then the doctor will have been firmly established in the area). If the doctor leaves before the 4 years, he will have to repay the remaining loan on a pro-rata basis. However, if he manages to find a doctor to succeed himself, then the term of the loan continues as long as there is a doctor at the location.

To qualify for the loan, the doctor (or local residents) must prove that there is a population of over 1500 in a 5 km radius of the location and that there is no other medical services available. (This is easily done with figures from the Bureau of Statistics)
He will forward detailed invoice for the fit out, equipment purchase, and copy of the lease agreement to the Task Force, which will scrutinize, and then pay, these invoices directly, up to a limit of $100,000. If the doctor has purchased the land or building, the equivalent of two month’s rent calculated on a commercial basis by a valuer, will be paid). The properties paid for by the task force remain the properties of the Task Force until four years are up.

If another doctor joins the practice, and the original doctor can prove that there is now a population of 3000 or more within 5km of the practice, another $100,000 will be available, again paid directly to the architect, builder, tradesmen who carry out the building extension and renovation. Two months’ rent will be payable to the landlord or to the owner of the building.

This policy will give doctors enough incentive to go into the suburbs and country areas and open up medical practices in areas where they are needed most.

It removes the initial risk for the doctor to set up the service, offers significant incentive for doctors to venture out into the suburbs or country areas, and the facilities remain in the community. Even if the doctor decides to leave, there is now a ready to go surgery waiting for another doctor to step in.

This policy will truly address the problem of medical service shortages in the suburbs and country areas. The grant will also hopefully address the problem of sub-standard corner shop type surgeries of the bad old days, and the country will be served by well distributed, well fit out and well equipped medical surgeries to serve the population where they need it most.

VYBerlinaV8_the_one_they_all_copy VYBerlinaV8_the_one_they_all_copy 9:06 pm 17 Feb 09

The only reason doctors and medical services cost us so much is because sick people are very easy to negotiate with.

That’s a pretty negative view.

My poor attempt at smartassery…

sepi sepi 8:31 pm 17 Feb 09

People in other cities in Australia still have the local GP model of medicine and care.

Seeing one GP and having your health records in one place is the recommended medical model.

It is a worry that this model is becoming unavailable in Canberra.

Large medical centres are fine if all you need are occasional prescriptions, antibiotics and medical certificates. If you actually have an ongoing condition, a pregnancy, depression, a mental health issue, or a disease, then seeing one doctor continuously is far better.

These medical centres end up only seeing the quick and easy patients, creaming the easy and quick work away from suburban GPs, who struggle more and more, and eventually give in and join a medical centre.

As I understand it, the administrators of these centres are adept at garnering the maximum subsidies, such as those for ‘long visits’ and other non-standard GP visits. Whereas small local GPs just claim basic medicare appointments for every patient, and it all evens out in the wash, between complicated appointments for breaking the news to someone that they have cancer, and writing up a quick medical cert for someone with a cold.

Our entire medical system is designed around accessible local GPs – if they dont’ exist anymore something will haev to change. AT the very least we should be able to keep our own medical records, and take them to each new dr at the mega medical centre. – Then they can bill medicare for a ‘long appointment’ while they read each new patient’s entire history every day.

I dont’ think this is really Katy’s fault – it is just a result of the lack of drs in Canberra. but it is a bad thing for patients.

canberra bureaucrat canberra bureaucrat 4:50 pm 17 Feb 09

There must also be a lot that would be cheaper in bulk (or only affordable on a large site), such as compliance with myriad regulations at a state and federal level, accreditation, accounting services, legal services, chip machines and chairs in the foyer, building services like cleaning, electricity and so on. An economist would say this improves productivity (more outputs [services] per unit input [staff hours]).

They have these larger ‘super clinics’ in NZ, and I found them to be excellent from a patient’s point of view (having various doctors, some specialists, a pharmacy, cafe, and other things on site). Not to mention the most excellent parking.

harvyk1 harvyk1 4:13 pm 17 Feb 09

VYBerlinaV8_the_one_they_all_copy said :

The only reason doctors and medical services cost us so much is because sick people are very easy to negotiate with.

That’s a pretty negative view.

To answer you question (although I’m not a Dr, although loads of my family work closely with them, not as patients) Dr’s like the super clinics, as they mean that the cost of admin is shared around. They have to have receptionists and people who deal with Medicare, however this is not really a full time job so to speak. So by combining loads of Dr’s into the one place it means that a couple of admin staff can look after an entire practice, rather than one admin staff per Dr. Furthermore it means that people can take days off if required (given most of their clients are sick, something is sure to go around) and other staff members can step in easily.

VYBerlinaV8_the_one_they_all_copy VYBerlinaV8_the_one_they_all_copy 3:38 pm 17 Feb 09

The only reason doctors and medical services cost us so much is because sick people are very easy to negotiate with.

jakez jakez 11:40 am 17 Feb 09

niftydog said :

My doc said he did it so he could choose his working hours instead of being tied to the practice 7 days a week. He can swap shifts with other doctors, take holidays without shutting down, he has allocated time in which he is not required to see patients, and he leaves work on time every day. Now he just turns up to work rather than running an entire practice. Ordering, admin, facilities etc is all taken care of.

My previous doctor moved from a hospital into private practice and had a nervous breakdown within two years.

Whoa, here’s to economies of scale.

niftydog niftydog 10:25 am 17 Feb 09

My doc said he did it so he could choose his working hours instead of being tied to the practice 7 days a week. He can swap shifts with other doctors, take holidays without shutting down, he has allocated time in which he is not required to see patients, and he leaves work on time every day. Now he just turns up to work rather than running an entire practice. Ordering, admin, facilities etc is all taken care of.

My previous doctor moved from a hospital into private practice and had a nervous breakdown within two years.

johnboy johnboy 10:00 am 17 Feb 09

Sure, but the need for a receptionist is hardly new or burdensome?

ramblingted ramblingted 9:59 am 17 Feb 09

I can’t see why Katy has a set against these type of medical facilities. In an ideal world, we’d all be looked after cradle to grave by our family GP, who would be on call, when and as often as we needed, and only too willing to do after hours home visits. The reality is quite different. I’ve got a good GP, but the quickest appointment I could get when I rang last Thursday was tomorrow- 6 days later. So thankfully i can hie myself to the big facility in Colbee Court and get seen, and effectively treated, in the same day (albeit with a bit of a wait).

I think Katy has been watching too much Dr Finlay’s Casebook (or is it, “All Creatures Great and Small?)

p1 p1 9:58 am 17 Feb 09

Here’s a question, why do doctors need to be in the same building as the administrators?

I would think that the majority of the administration would take place as part of the actual dealing with the customer.. errr patient… and what other admin there was could probably be done in the gaps. You would still need someone onsite to check people in, view Medicare cards etc. And I am sure that a lot of the admin does happen of site.

jakez jakez 9:57 am 17 Feb 09

I read a story a few weeks ago about a US Doctor who found that if he charged a full cash rate instead of dealing with all the Medicare/Medicaid/GMO/Health Insurance crap that they have over there, the savings he made not having to employ so many administrative personnel meant that he was actually cheaper than with the Govt subsidies anyway. The Govt shut him down.

I wonder how much the administrative burden is for Doctors in Aus, particularly if it is so viable to move into one super clinic as in the above story?

I also want to hear the answer to johnboy’s question. Any Doctor’s and health experts in the house?

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