Aniello Iannuzzi: Lies and statistics

HOW does a paediatric umbilical hernia relate to the supply of GPs in Australia?

Professor Bob Birrell, a demographer from Monash University who is no stranger to controversy, recently released a report titled “Too many GPs” outlining evidence on an oversupply of GPs and remedies for this.

Health Workforce Australia (HWA), the AMA and the Royal Australian College of General Practitioners (RACGP) were quick to criticise Birrell, with exchanges between the parties attracting considerable attention in both medical and mainstream media. The HWA was particularly critical of Birrell’s methodology.

Birrell’s report is based on Medicare, population and immigration data and an analysis of rules and regulations that govern the supply of doctors in Australia and how we practise.

His conclusions include:

• Apart from in rural and remote areas, there is an oversupply of GPs

• Australia should stop “the large scale importation” of overseas-trained doctors

• High bulk-billing rates are evidence that the supply of doctors is adequate

• The oversupply of doctors results in more visits to GPs and greater cost to Australian taxpayers

• Agencies that propagate the view that there is a GP shortage have a commercial interest in promoting such a view

• Politicians remain quiet on the matter because local shortages of GPs (eg, in some rural towns) are more politically sensitive than the overall waste of money from Australia’s addiction to bulk-billing

The character and strength of the response from the HWA, AMA and RACGP made me uneasy. Birrell has clearly struck a nerve and in many ways foretold how they would react.

If there is no GP shortage then there is no need for workforce agencies and immigration programs. No GP shortage means a slowing of the growth in membership and influence of organisations representing GPs.

And what about the tsunami of medical students? Silence from them on Birrell. I am sure most students and graduates agree that there is an oversupply, otherwise they would not be so worried about job security.

Both methodologies presented by Birrell and HWA are persuasive — Birrell uses Medicare data while HWA used modelling based on data from voluntary surveys compiled by the Australian Institute of Health and Welfare.

Having been subjected to so many of the latter, I do question the validity and reliability of the surveys. At least Medicare data reflects activity that has definitely occurred.

Birrell’s critics also build a case against him based on growing patient demand for GP services and government incentives to promote bulk-billing. However, from my experience much of this “demand” and “incentive” is for perverse reasons.

From what I see in my day-to-day practice, a lot of this demand comes from patients wanting GPs to complete forms so they can access government programs and satisfy government departments, eg, drivers’ licences, electricity subsidies, transport subsidies, Centrelink payments, care plans, parking permits, public housing applications — the list goes on.

Do these really represent increased demand or do they indicate government “medicalising” of social problems?

And why did some of Birrell’s critics react so harshly to rumours that the government may soon wind back the funding of care plans?

If there is a shortage of GPs and care plan funding is scrapped, then it should be quite easy for GPs to respond how the market normally responds to such matters — raising the price of consultations.

Which brings me to the umbilical hernia. Last week a GP told me that she was approached by a parent wanting a care plan for her toddler with an umbilical hernia, putting the GP in a difficult predicament. It is an example of the point we have reached in the stupidity stakes.

Demographic data does not lie. I think Birrell may be onto something.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 25 March 2013

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