Australian general practice has been pummelled over the past year. With its proposed co-payment plans, prolongation of the rebate freeze, defunding of Medicare Locals and shake up of Vocational Training among others, the Abbott government has delivered punch after punch.
Understandably, many of us have become disillusioned, angry and distrustful. Some are fantasising about a career change or considering early retirement. Meanwhile, there are unprecedented numbers of medical students and prevocational doctors asking, “Should I even consider a career in general practice?”
When under attack counting one’s blessings does not come naturally, but this is exactly what’s needed. I don’t want to sound like the kind of doctor who tells his patient “Cheer up, it could be worse”, but will briefly reflect on a medical system more broken than ours, despite multiple resuscitation attempts.
According to statistics from the World Health Organisation, in 2012 the US spent more than twice as much on health per capita than did Australia ($8,895 US cf. $4,058 US)(1). Much of this was private expenditure, but even so, government spending on health in the US is higher than in Australia (in 2012, 8.3% of GDP cf. 6.1% of GDP)(2). And what do they have to show for it? Lower life expectancies, higher rates of premature death, unhappy doctors and patients financially crippled by medical bills.
At times of life-threatening illness, having to worry about accumulating massive medical bills is a significant extra burden. I speak from personal experience.
Last December, while on vacation in the US, I developed pyelonephritis and became pretty ill, very quickly. To complicate matters, the infection brought on premature labour. My newborn daughter, Amalie, was rushed to the NICU, and I found myself in a high dependency unit with early sepsis. Three days later, my beloved daughter’s system was overpowered by the E. coli infection, while my body, with the help of modern medicine, was well on its way to recovering from it.
There are no words to describe the pain felt. While the medical and nursing staff did everything they could to comfort, those working in the finance department were not so empathetic. Within hours of losing Amalie, I was presented with hospital bills (not including physician fees or other charges) for over $70,000 US, and told “We expect payment at the time of service.” Salt was rubbed into my already almost unbearable wound.
I couldn’t get back to Australia fast enough.
Many of our current woes are because Australian general practice is so directly and largely dependent on government funding. We GPs are tremendously vulnerable to the whims of politicians whose motives are often self-serving rather than altruistic and whose promises are meaningless. On the flip side, when done well, there are big benefits for patients and doctors alike in government playing such an active role in healthcare funding and regulation. Keeping private health insurers, drug companies and other health-related corporates on a leash helps limit overall health expenditure, and therefore the downstream financial and emotional consequences for vulnerable patients.
I’m not for a moment suggesting that we lie down and take the ongoing beating that’s thumping our profession, or that the proposed changes are not ill thought out and unfair. Quite the opposite. Individually and collectively we need to take stock, remind ourselves of all that is good about Australian general practice, and then use this to further ignite our passion and do whatever we can to defend and strengthen our great profession. Let’s help make it something we can enthusiastically recommend as a rewarding career choice for our best and brightest, without crossing our fingers behind our backs as we do so.
First published in Good Practice magazine, March 2015