Dr Kerryn Phelps, AMA President, Sydney
QUESTION: First of all, what do you make of the Minister's comments that obviously the Government doesn't approve of doctors charging extra to cover the indemnity?
PHELPS: The Government can't have its cake and eat it, too. It can't ignore the increased practice costs. The fact that the Medicare Benefit Schedule is grossly out of date and have doctors continue to bulk bill and not put up their fees. The two things just don't work together.
The Minister's comments are extremely disappointing and they show a great lack of awareness of the pressures facing general practitioners, particularly in rural Australia. GPs have been trying to maintain the viability of their practices. The Medicare Benefit Schedule hasn't been keeping up with the cost of running the practice and doctors are having to put their fees up.
QUESTION: How do you find the comment that you should actually avoid these doctors?
PHELPS: I think that there is great danger in these comments. It flies in the face of good clinical practice which involves continuity of care and to say, 'just go to a cheaper doctor', is really not addressing the issue. The issue is that practice costs have gone crazy, that medical indemnity is only one of the factors involved.
Bulk billing is almost completely over, I think. It's just a matter of time before bulk billing disappears and, to say that patients should just go and find another doctor, to jump around from one practice to another, while they find someone who's cheaper, is just not good clinical practice. Continuity of care is essential to medical practice.
QUESTION: How widespread is the practice of adding an extra fee to the cost in the area of GPs?
PHELPS: I think we'll see more and more doctors having to charge a fee and how much that fee is will depend on where they practice and what their practice costs are, but we will see more and more of that as bulk billing becomes increasingly irrelevant.
QUESTION: Do you have any idea how widespread it is now, though?
PHELPS: I don't think anybody knows how widespread it is because there hasn't been a survey done right around Australia but certainly anecdotally we're hearing that many doctors are abandoning bulk billing.
Doctors will increasingly be abandoning bulk billing and putting their fees up because they cannot run their practices and keep them viable, cover all their costs and still bulk bill. And medical indemnity is just one of the costs.
QUESTION: Is the Government moving fast enough for you on the indemnity solution?
PHELPS: We would have liked a solution about five years ago but certainly we would like to see more progress than we've seen to date. I think credit though where is due. The Prime Minister did step in, he did announce a guarantee for UMP until 31 December and we're very grateful for that but we do need to see action from state and federal governments. We have to see Statute of Limitations. We have to see the Commonwealth and the states getting together on a care and rehabilitation scheme for the severely injured. We need to look at alternatives to the adversarial legal system.
QUESTION: What will happen with the levy that the Government's talking about putting on doctors to cover the tail of UMP? How will that impact? Will it mean that more doctors will have to introduce this payment?
PHELPS: Doctors are not prepared to even countenance a levy until all of the pieces are in place that will bring some commonsense back into the whole medical indemnity scenario. There is no point just throwing money at a bad system. What we need to do is to see the system renovated, to see some commonsense prevail and then we will sit down and consider what, if any, doctors should be contributing to this particular situation.
QUESTION: On the increasing fee that doctors are doing to cover the indemnity, you're obviously condoning it at the AMA. Should there be a set amount that they can add to their fees?
PHELPS: It's not just about medical indemnity and each practice will be different, of course. For example, an urban practice, general practice, will be different to a procedural GP in the bush. An obstetrician will be different to a neurosurgeon or a physician and so it actually depends on the risk. It depends on the amount that the doctor is already having to pay for medical indemnity and we don't know yet how much the levy is going to be. If there is going to be a levy, who's going to have to pay it? That is all still very unknown.
QUESTION: But, I think some of the practices have been charging like a $6 per consultation fee. Is that something that you would agree with?
PHELPS: Practices simply have to charge what they need to charge in order for the doctor to be able to cover their costs and to make a reasonable living and, if that means $6 over the bulk billing rate then that's what it is. And, most people would consider that to be an extremely moderate increase in fees, given the current level of the real value of fees and where fees ought to be, given practice costs and where the bulk billing rate is. I mean, the bulk billing rate is just a joke.
QUESTION: Do you think it's unfair though to pass that $6 cost off as because of the premiums that are skyrocketing when a $6 cost for each of the patients would be far more than just the rise in their premium?
PHELPS: It really depends on what that doctor's rise is. Some procedural GPs would be paying increases in the order of about $40,000, so they have other costs as well. I mean, we have to pay public liability costs for our practice premises, we have to pay for workers' compensation, we have to pay for a whole range of different insurances. It's not just about medical indemnity insurance. We've got increased wages, we've got increased costs of drugs, dressings and supplies, costs of providing the services generally. So, if doctors are needing to increase their fees, as they indeed are, then it's something that we have always said would need to be passed onto patients.