A new report by the Grattan Institute argues Medicare’s fee-for-service system incentivises short consultations and calls for alternative funding models that would allow GPs to provide more comprehensive care outside standard appointment structures.

Royal Australian College of General Practitioners vice president Ramya Raman says Medicare rebates for longer consultations need to increase, arguing the current system underpays the time and complexity involved in extended appointments, with doctors effectively earning less per minute the longer a consultation lasts.

“We don’t want to be rewarding speed, instead supporting safer care. We need to fix the funding so we can fix the workforce.”

Dr Ramya Raman

Australia’s population is ageing, with 17 per cent of Australians aged over 65 in 2021, meaning the number of patients with complex problems like these will only increase.

RACGP president Dr Michael Wright says average consultation times are increasing because doctors need more time to support patients with complex conditions, including chronic illnesses and mental health issues.

Dr Wright says female general practitioners typically spend longer with their patients than male general practitioners, and provide more complex care.

Dr Ramya Raman says a gender lens should be applied to Medicare reform, arguing the current funding model is widening the pay gap for female general practitioners, who are more likely to provide longer consultations.

“Because we do the longer, more complex care, we tend to carry more unpaid work and I earn less at the end of the day,” she says

Dr Raman says some people still refuse to believe the gender pay gap is real, but “my colleagues and I are living through it.”

Australia Institute researcher Skye Predavec says the issue is not new, arguing longstanding gender biases continue to shape the healthcare system, with female general practitioners often expected to manage patients with complex women’s health and mental health concerns.

“You know, if there’s someone crying coming into the GP’s office, the receptionist might go, ‘let’s send them to a female GP’ because of the perception that they might be able to deal with that better,” she says.

“This means they’re shunted onto these longer consults which are now being undervalued in funding.”

Ms Predavec says medical misogyny should not be treated as something that’s been fixed.

“Obviously, you know, as a problem of gender inequalities in our health system, we are better than we were 50 years ago, but there is at this point still a problem.”

GP and author Dr Anita Campbell says she went into medicine to solve medical mysteries, and working conditions for doctors need to change to allow them to provide better care.

“I don’t really understand why we don’t want to improve on, you know, what we’re doing and helping people be seen,” she says.

“It was always going to get to this point, and it’s a pity that the government doesn’t appreciate that the current system is how we have. Rather it’s always the doctor’s fault.”

She says the government needs to work collaboratively with general practitioners, rather than making doctors feel they are being blamed for rising healthcare costs.

“There’s a big fear system going on at the moment, that if you bill the wrong way, you’re cheating Medicare,” Dr Campbell says.

“So it really needs to be where we work together with the government in the same way that the doctors in the hospital work together with the government, and get paid for our time, not necessarily how many patients we see.”

The federal budget will be released next Tuesday.