The Australian Government has just proposed an overhaul of the Medicare rebate system to address the “troublesome issue of six-minute medicine”. This will create contentious debate, which can only be a good thing as the Medicare system has serious flaws. Did you know female GPs in Australia earn on average 25% less than male GPs, even after adjusting for hours worked? I believe the solution lies in the problem – we need to pay GPs in 6 minute blocks. Let’s examine the current system, and explore why female GPs lose out.
The Medicare gender income gap certainly doesn’t surprise me, or any other GP I know. According to Professor Tony Scott, the Principal Investigator of the national MABEL survey:
“This is something of a mystery… While such differences persist in other occupations, this is particularly difficult to understand in an occupation where men and women have the same high level of education. Our results have adjusted for differences in hours worked, years of experience, and a host of other factors. It could be that female doctors see a different mix of patients than male doctors. We are puzzled and are continuing to look into this.”
Anecdotally, these are the reasons female GPs see less patients in a day:
- Female patients often self-select female doctors when they wish to discuss complex problems.
- Many patients report using a male doctor for ‘quick problems’ and a female doctor for ‘slow problems’
- Female GPs see more;
- Mental health presentations, disclosure of domestic violence and sexual abuse/assault
- Family dynamic problems and child behavioural issues
- Patients presenting with long lists of multiple problems they wish to discuss
- Patients with vague non-specific symptoms and the worried well
- Some GPs laterally refer patients to their female colleagues when the problems are complex. “You should see Dr X, she’s great with hormonal problems and bloating”.
Rather than simply label Medicare as inherently sexist, I thought it was worth examining WHY the system fails female GPs. The issue at the heart of this is not gender based – it’s a symptom that female GPs are paid 25% less, but the diagnosis is a flawed payment system that favours rapid turnover ‘6 Minute Medicine’, instead of good quality thorough care.
The Medicare fee system means a GP is paid the same standard “Level B” consultation fee for a 6 minute consultation, as a 19 minute consultation. This means a GP who sees ‘quick problems’ every 6 minutes can churn through 10 patients per hour, earning $370.50 in Medicare fees. A GP who sees ‘slow problems’ every 19 minutes might see 3 patients per hour, earning $111.15. Of course, these earning figures are significantly reduced by income tax and clinic overheads. But you can see the incentive for practicing 6 minute medicine, and who will be taking home more at the end of the day! This is why female GPs overall earn less – they simply see more ‘slow problems’ than male GPs – because of the type of patients who choose to see them, and some differences in how they practice a consultation.
Of course, there are many times when 6 minutes is all that is needed – for an ankle injury, treating school sores, or tonsillitis. But at the end of the day, the Medicare system is failing patients and favouring poor quality care when it disproportionately rewards ‘6 Minute Medicine’. Counselling, education and preventative health discussions cannot be achieved in 6 minutes. Complex medical problems and care coordination suffer. The quality GP practice as the ‘central medical home’ that keeps patients healthy and out of hospital ceases to exist, and it becomes a service centre for acute drop-in presentations, saving the national health budget nothing in the long run.
Female GPs aren’t the only losers in this system – any GP, male or female, who practices ‘Slow Medicine’, is penalised. GPs who take thorough histories, who are willing to dissect complex problems, who perform full examinations, who spend time listening and counselling and educating their patients about their conditions, will end up taking a pay cut at the end of the day.
What’s my proposed solution? 6 Minute Medicine. Let’s call it for what it is, and pay accordingly for time spent. Most other professions, like lawyers and accountants, break their day into 6 minute allocations. If you spend more time with a patient, you are paid more for that time. There is no incentive to seeing either ‘quick medicine’ consults or ‘slow medicine’ consults – rather, the GP is paid appropriately for the length of time they spend with their patient. Compare our current system to my proposed ‘6 Minute Medicine’ breakdown:
CURRENT MEDICARE REBATES:
Level A 0-5 mins = $16.95 / Level B 5-20 mins = $37.05 / Level C 20-40 mins = $71.70 etc
MY PROPOSED REBATES:
Each 6 minute block is paid at the flat rate of $ 16.95
Level A – 0 to 6 minutes. $16.95 / Level B – 6 to 12 minutes. $33.90 / Level C – 12 to 18 minutes. $50.85 / Level D – 18 to 24 minutes. $67.80 / Level E – 24 to 32 minutes. $84.75
I’d love this system – I’d take home similar pay to my male colleagues. I also feel in the long run it would also raise standards in GP care by removing the financial incentive that favours ‘quick medicine’. Hopefully, it would encourage everyone to take just as much time as the patient and doctor needs, knowing they will be fairly recompensed. (Of course, the payments MUST fairly recompense the GPs for their time, expertise and overheads, which is an argument for another article!)
You may be reading this thinking, “But this would make my General Practice financially unsustainable!” Spare a thought, then, for female GPs who’ve been 25% less sustainable than you for years. Let’s keep the Medicare discussion open until we find a financially equitable and patient-centric system – after all, good primary health care must put quality of care first.