AUSTRALIAN Medical Association fees are expensive, and many GPs and specialists charge higher than the recommended rate for their services.
Medicare rebates are relatively low until a patient meets the safety net thresholds. It is not viable for most clinicians to bulk bill everyone, and many reserve this for concession card holders. Bulk billing is on the decline as well (here and here).
In my experience, many of my colleagues, especially psychologists and psychiatrists, believe that people don’t value their services unless they pay for them.
I argue that this is patently wrong. While it’s possible some patients may feel paying for a service is contributing to the therapeutic relationship, public patients and bulk-billed patients can be extremely grateful for care they receive for free. Being bulk-billed saved my life, and it has saved others too.
I am a psychiatry registrar and support my family on a single income. Like many who began medicine in Australia as an international student, I have an unfathomable amount of debt related to being a student in a capital city and paying full fees.
Although the salary of a registrar in my state is nothing to scoff at, I often struggle financially. I have rescheduled medical appointments and investigations to be able to buy everyday essentials or pay other bills on more than a few occasions over the years.
In late 2021 and well into 2022, I experienced a severe major depressive episode and at one stage had a quite lethal suicide plan. I finally recognised this as depression and sought help from psychiatrists and psychotherapists.
It has taken many months to find a psychotherapist, but I got lucky to find my psychiatrist relatively soon. When my psychiatrist learned I was having financial difficulties, they bulk-billed me for several months until I was really getting back on my feet.
The act of bulk billing took an immense weight off my shoulders. I did not have to choose between bills piling up and getting treatment. This enabled me to focus on my recovery and to not be afraid to reach out because I might have another bill to pay. I don’t know where I would be without this gesture. My psychiatrist bulk billing me saved my life, and I can’t think of another medical service I’ve received that I have valued more.
Imagine finding out someone stopped seeing you because it cost too much, only to not have that cancer screening and subsequently not be diagnosed until it was too late. Imagine finding out a patient has died by suicide because they couldn’t pay for psychiatric care.
While some may say that these patients could have accessed public services, that’s not always the case.
Public services may not be able to provide ongoing treatment outside of emergencies and crises or could deem someone low risk compared with others who have imminent risks. This can especially be the case in regional settings, which often face under-resourcing and staff shortages while covering large catchment areas.
I urge my colleagues to consider their bulk-billing policies and to actively ask patients about their financial situation. We often don’t ask this outside of a psychosocial assessment, but patients may not spontaneously disclose their financial worries. It can be embarrassing, or they may view themselves as somehow failing.
I have been there, and bulk billing saved my life.
Dr Israel Berger is a Child and Adolescent Psychiatry Advanced Trainee at Goulburn Valley Health and is involved in medical and public health education at the University of Sydney and Monash University.
If this article has raised issues for you please reach out to any of the following resources:
DRS4DRS: 1300 374 377
Hand-n-Hand Peer Support ... www.handnhand.org.au
If you or someone you know is having suicidal thoughts, there are people here to help. Please seek out help from one of the below contacts:
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Medicare rebates are relatively low until a patient meets the safety net thresholds. It is not viable for most clinicians to bulk bill everyone, and many reserve this for concession card holders. Bulk billing is on the decline as well (here and here).
In my experience, many of my colleagues, especially psychologists and psychiatrists, believe that people don’t value their services unless they pay for them.
I argue that this is patently wrong. While it’s possible some patients may feel paying for a service is contributing to the therapeutic relationship, public patients and bulk-billed patients can be extremely grateful for care they receive for free. Being bulk-billed saved my life, and it has saved others too.
I am a psychiatry registrar and support my family on a single income. Like many who began medicine in Australia as an international student, I have an unfathomable amount of debt related to being a student in a capital city and paying full fees.
Although the salary of a registrar in my state is nothing to scoff at, I often struggle financially. I have rescheduled medical appointments and investigations to be able to buy everyday essentials or pay other bills on more than a few occasions over the years.
In late 2021 and well into 2022, I experienced a severe major depressive episode and at one stage had a quite lethal suicide plan. I finally recognised this as depression and sought help from psychiatrists and psychotherapists.
It has taken many months to find a psychotherapist, but I got lucky to find my psychiatrist relatively soon. When my psychiatrist learned I was having financial difficulties, they bulk-billed me for several months until I was really getting back on my feet.
The act of bulk billing took an immense weight off my shoulders. I did not have to choose between bills piling up and getting treatment. This enabled me to focus on my recovery and to not be afraid to reach out because I might have another bill to pay. I don’t know where I would be without this gesture. My psychiatrist bulk billing me saved my life, and I can’t think of another medical service I’ve received that I have valued more.
Imagine finding out someone stopped seeing you because it cost too much, only to not have that cancer screening and subsequently not be diagnosed until it was too late. Imagine finding out a patient has died by suicide because they couldn’t pay for psychiatric care.
While some may say that these patients could have accessed public services, that’s not always the case.
Public services may not be able to provide ongoing treatment outside of emergencies and crises or could deem someone low risk compared with others who have imminent risks. This can especially be the case in regional settings, which often face under-resourcing and staff shortages while covering large catchment areas.
I urge my colleagues to consider their bulk-billing policies and to actively ask patients about their financial situation. We often don’t ask this outside of a psychosocial assessment, but patients may not spontaneously disclose their financial worries. It can be embarrassing, or they may view themselves as somehow failing.
I have been there, and bulk billing saved my life.
Dr Israel Berger is a Child and Adolescent Psychiatry Advanced Trainee at Goulburn Valley Health and is involved in medical and public health education at the University of Sydney and Monash University.
If this article has raised issues for you please reach out to any of the following resources:
DRS4DRS: 1300 374 377
- NSW and ACT ... 02 9437 6552
- Victoria ... 03 9280 8712
- Tasmania ... 1800 991 997
- Queensland ... 07 3833 4352
- WA ... 08 9321 3098
- SA and NT ... 08 8366 0250
- NSW ... https://www.mbansw.org.au/
- Queensland ... https://mbaq.org.au/
- Victoria ... https://www.vmba.org.au/
- South Australia ... http://doctorshealthsa.com.au/resources/medical-benevolent-association-of-sa
Hand-n-Hand Peer Support ... www.handnhand.org.au
If you or someone you know is having suicidal thoughts, there are people here to help. Please seek out help from one of the below contacts:
- Lifeline | 13 11 14 -- 24-hour Australian crisis counselling service
- Suicide Call Back Service | 1300 659 467 -- 24-hour Australian counselling service
- beyondblue | 1300 22 4636 -- 24-hour phone support and online chat service and links to resources and apps
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
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