College President to GPs: be proud, stand tall, keep punching

OUTGOING President of the Royal Australian College of General Practitioners (RACGP), Dr Karen Price, wants GPs to share her vision of the profession as one of which to be proud, one that is noble and resilient despite the “very deep pain of decades of neglect”.

Speaking in an exclusive podcast, Dr Price said her last few months of the Presidency were set to be among the busiest of her term, with her time split between speaking with young people, the Strengthening Medicare Taskforce, and continuing advocacy for GP funding reform.

“The need for reform has been coming for a long time and the Medicare rebate freeze was just the start of the decline,” Dr Price told InSight+.

“Even before that, the indexation of Medicare was the beginning of the ‘slow boiling of the frog’. Now we’re at the point where we have to do something and it’s critical.

“For at least a decade, if not more, there has been a pernicious and ridiculous denigration of our profession.

“The result of that is a lack of a workforce pipeline, which is only really starting to manifest now.”

Research published in the MJA in 2020 showed that the proportion of medical graduates from the University of Western Australia registered as GPs in December 2019 had dropped from about 40% of those who graduated in 1985–1987 to about 15% of those who graduated in 2004–2007. At the same time, the Medical Schools Outcomes Database National Data Report 2022 showed that the proportion of final-year medical students whose first preference for specialty was general practice has dropped to just 13.8%.

“We’ve supported and backfilled using the wonderful international medical graduates who make up nearly 50% of our College membership now,” said Dr Price.

“But it’s not a long term strategy to keep importing professionals when there are absolutely high quality high school students, or primary school students or even students not born yet in Australia who will make great doctors in general practice.

“Australia has failed in this regard.”

Dr Price and the College have been very vocal about the future of bulk-billing, telling GP practices to “do what they have to do” to stay financially viable.

“We certainly have anecdotal evidence that patients who are very engaged with their GP, who see them regularly, are saying ‘don’t you dare bulk bill me – I want you to keep your doors open’,” she told InSight+.

“We know [privately billing patients] is most difficult for those doctors who are committed to low income areas.

“And I know, to some extent, that might have put pressure on some doctors, but the message wasn’t about abandoning bulk-billing. It was, do what you must to keep your doors open so that you can service your patients.

“If that means you have to charge a gap to some, then do so.

“I have great compassion for those doctors who are working in low income areas, where they’re very challenged by Medicare, and it’s just not acceptable for our country, which is wealthy, to have a system where people are not able to access health care on the basis of cost.

“That’s not acceptable, and I think most Australians would agree.”

Dr Price continues to advocate for multisource funding for general practice.

“There’s no one answer,” she said.

“If you’re in Rose Bay, you’re going to need a very different funding stream to whether you’re in Broken Hill or in Arnhem Land.

“It doesn’t matter which system you use, if it is underfunded, it will not deliver outcomes. All of the systems applied as a top-down approach will have unintended consequences.

“What we’re trying to advocate is that GPs will be able to choose which funding model they design their clinic around, and that allows for professional autonomy, it allows us to address the inverse care law [the principle that the availability of good medical or social care tends to vary inversely with the need of the population served].

“At the [Strengthening Medicare] Taskforce, I keep putting on a table that there is no health system in the world yet which has truly addressed the inverse care law in terms of funding – multisystem funding comes the closest.

“When you go one way as the UK or you go one way as America, you have these terrible gaps and terrible clogging of the system and poor functioning. We really want to avoid those very salient lessons.

“We can’t keep separating out bits of the system, and only funding bits of the system. That is how you break the system.

“This is absolutely not about GPs’ incomes. It is about the resourcing of primary care. It’s about GPs working to full scope. It’s about us delivering health care for all Australians.

“To ignore this problem is to go down the path of disaster, in my opinion.”

Despite all the problems Dr Price remains optimistic about the future of general practice.

“If we can get some really strong signals from this government, I think that that will help improve the morale,” she said.

“We’ve got a 10-year plan and that’s how long reform is probably going to take.

“I’m hoping that we can really start to move the dial. We need to be able to signal for the younger generation [of doctors] that there’s a lot of reason for optimism.

“If we’re going to approach this intelligently, we’ve got to look at the whole thing, we’ve got to look at rational use of resources, and we’ve got to look at the whole system.

“And the evidence tells me so if you invest in primary care, you’re going to get a much higher functioning health system with much less use of the overall dollars.”

As the clock runs down on her term, Dr Price reflected on her time as a “wartime” President, coming in to the office at the height of the COVID-19 pandemic.

“People have said, ‘oh, you drew the unlucky straw’,” she said.

“You could look at it like that, and that first year in Melbourne on Zoom constantly, that was pretty tough.

“But on reflection, I’m also lucky because I got to showcase what general practice could do. I got to speak about the obvious evidence of what my colleagues were doing. To lead a college and the community through a pandemic is an amazing experience. So I think I’ll look back on it with all of that kind of awe and wonder.”

And what is she proudest of?

“I’m proudest of, hopefully, reflecting a vision of general practice that the GPs themselves can be proud of, GPs have a sense that they are being heard, that they’ve got a voice, that they’re actually doing a bloody amazing job, and to have pride in their professionalism.

“Look, the system’s really hard. Don’t let it change how you practice, try and keep practising in a professional way.

“I’m just proud of the fact that GPs can say, we are a noble profession. They have acted as that through COVID-19 and they’re doing that, through articulating the very deep pain of what has been decades of neglect.”

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