Issue 10 / 25 March 2013

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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8 thoughts on “Aniello Iannuzzi: Lies and statistics

  1. Ally Russell says:

    Who to believe – Medicare or HWA? In our area (regional SA – popn 15,000) Medicare say we’re ‘not an area of need’ as we already have 25 GP Provider numbers registered. But only 14 of those are practicing and not all are full time. Days to get in? Here it can be over 6 weeks to see your regular GP & over a week to see ‘anyone’. We have a solution for Farmeister’s employment dilemma!

  2. Brian Morton says:

    Aniello makes some interesting points but ignores the age distribution of GPs. Government looks at cost rather than quality. Younger doctors are given a distorted view of life, quality, remuneration and care in General Practice. A recent newspaper article listed DOHA stuff ups including workforce issues. The most disappointing aspect is the view that there is a conspiracy of medical organisations to distort reality. Most doctors function on tenets of evidence. Why suddenly is there a change of motives when its a professional medical membership organisation of those very same professionals ?

  3. Shrink says:

    I don’t know whether we have a shortage, or an excess, of GPs but it takes several days to get an appointment with mine. The Medicare bureaucracy can possibly see an advantage in there being an oversupply of GPs as it would enable them to favour the compliant in issuing casual contracts and control the profession as their fellow bureaucrats have with teaching and nursing.

  4. Prof Gerard Gill says:

    I think we can summarise this argument rather more elegantly. What do we need medical practitioners including GPs to do and what should society pay them to do this?
    Where do we need them to do these tasks?
    Like the military we need to provide a living for our health professionals, for when we need them.
    We have a forty year old sacred cow national health insurance scheme, Medicare, designed for funding health care for a different generation. Vested interest groups including the AMA protest when some rational reform of Medicare is proposed.
    For the past 15 years our government have severely restricted GP numbers in a belief that this will restrict flow on costs.
    Anyone who has lived in Tasmania or the bush has experienced the GP workforce crisis. It is real.
    Some medical practitioners have gamed the system and are being paid by the insurance scheme for poor quality or unnecessary services. Other perverse incentives have enable GPs and specialists to practice where they want to, not where the need is.
    Reforming the payment system is long overdue
    We need a system where patient interests, and safety are paramount and taxpayers get value for money.

    I doubt I will see that in my lifetime!

  5. don campbell says:

    great question
    arguably the college of physicians (RACP) is training too many people who could be training to enter general practice.
    Why is this so?
    if there are too few GPs in one place and too many in another then it should be possible to provide incentives that work to promote a redistribution.
    However my wife is a GP in an inner urban practice that can’t find a doctor to replace a partner who has left to go back to the country.
    So this is a complex issue whose causation and effective resolution is unlikely to be a simple matter of too few, too many or a maldistribution.

  6. Anonymous says:

    We have 3 new GP Practices in our suburb but the cost has gone up with bulk billing now being reduced in our clinic to those with VA cards only. Despite the increase in GP supply, the cost is still increasing – I think tax payers need a return of investment from the funding provided for medical training (undergraduate/entry level and post graduate). There should be a requirement for primary care services to be “free” ie. “no gap” for the elderly and children under the age of 12.

  7. Steven Boyages says:

    Real world big data will always trump modelling techniques. Modelling is just that a model or a constructed view of the world. It’s time that we used the power of big data that is available to analyse in real time the capacity (including workforce supply) and demand of our health system. It’s technically feasible and relatively simple to deploy.

  8. Farmeister says:

    Spot on. Great article.

    Recent medical graduates such as myself now face the very real possibility of unemployment or underemployment after finishing internship and residency. Already in Queensland, several hundred PGY3 doctors failed to find jobs at the beginning of 2013. Unfortunately, many of my peers persist in this belief that “we need all the doctors we can get” and insist that the solution is (as always) “more funding” rather than scaling back the explosion in medical schools and students.

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