Aniello Iannuzzi: What are we worth?

ALL the argy-bargy from this month’s federal Budget about budget surpluses and deficits has made me wonder about the budget woes we doctors face.

It seems some doctors might also be struggling to achieve a budget surplus as Medicare rebates — frozen in the 2013 Budget until July 2014 — fall further behind inflation. Now the AMA schedule of fees — which is indexed fairly — is about double the Medicare Benefits Schedule.

Then there’s the Practice Incentives Program (PIP), which has not been indexed for years, and the immunisation incentives for GPs which have been axed.

Meanwhile, the costs of doing business continue to burgeon, with accreditation and insurance demands growing yearly, and energy bills, rents and wages rising at or above inflation.

The Rural Doctors Association of Australia (RDAA) has for some time expressed concern about the viability of practices in rural and remote areas and I am sure many urban colleagues share the worry.

In a bid to help rural practices, the RDAA wants a review of PIP funding and how GP registrars are employed. One suggestion is for the Regional Training Providers (RTPs) to employ the registrars.

While I can see why the RDAA wants a change of paradigm, I fear its proposal is naive. In hospitals, practice accreditation and assessment of education and training, we have already seen third party organisations burdening us with more forms and more demands for our time, but with little or no remuneration and a shift in responsibility from them to us.

If we let outside organisations into our private practices, we will soon see another layer of conditions and imposts. There is the danger that paying registrars will become contentious, as will workplace safety, rostering, liability for time off and fringe benefits.

Just as we are beginning to see with Medicare Locals and Local Health Networks, the RTPs will say “it’s our way or no way”. All we will achieve is an acceleration of supervisors no longer prepared to take on registrars.

So just what is a doctor worth?

Supervisors and medical educators are paid $100–$140 an hour to attend to the education of registrars. The same hourly rate applies for doctors coopted to most government committees. For supervising medical students, GP practices are paid $25 an hour ($100 per session).

In modern private practices, it is reasonable for each doctor to have a nurse and receptionist as a support.

A good practice nurse costs $30–$40 an hour, plus superannuation, leave entitlements and some education. The real cost to practices is therefore closer to $55 an hour. A good receptionist costs $25–$30 an hour plus benefits, so the real cost is closer to $35 an hour.

So paying a doctor $100–$140 an hour to supervise a registrar can leave $20–$40 an hour to the doctor after wage expenses alone, ignoring all the other expenses. Given that most of these organisations do not pay for reading time and travel time, the doctor is actually losing money.

As more and more registrars enter training, rather than being more centralised, we need to be more flexible, and to shift funding to the practices and registrars and away from the bureaucrats.

General Practice Education and Training (GPET) controls a large budget for the education and training of GPs. GPET could reallocate a percentage of its budget towards helping to pay the salaries of registrars, as well as allowing registrars to tailor their own college-approved education. We keep insisting that doctors are intelligent and responsible, so why not be treated in this way?

Why do we sell ourselves so cheaply? If current funding anomalies are not addressed and money continues to be poured into bureaucracies rather than where it is needed, salaried doctors and academics will be the only ones left who can afford to provide training, education and health policy.

Or we could just start charging patients, educational institutions and government what we’re really worth.
 

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