With Dr. Teah Mogae
“Doc, are you able to bulk bill me today?” she said holding onto the doorknob at the end of our 40-minute appointment. She was my last patient of the day. She knew we were a private billing clinic. She’d booked a 15-minute appointment which she excitedly started by saying she had a list of things we needed to get through. I’d already missed my lunch trying to get on top of the never-ending unpaid paperwork but I ushered her back to the chair so we could have a chat about bulk billing in General Practice.
During the consultation, she disclosed that the reason she’d had a list of issues to address at this consultation was that she had been ‘unfaithful to me’. She’d been seeing another GP, a bulk billing one, for simple things such as medical certificates and repeat prescriptions of her medications. She felt she needed to save the more important medical issues and concerns for me such as addressing her menopause symptoms, her workplace bullying, her marriage breakdown and how to explain this to her teenage son who was already struggling with his year 11 studies.
To add to this her mother’s health had also recently deteriorated and she was struggling to navigate the process of organising permanent nursing care, all whilst dealing with her own family issues. To try and get her mind off things she’d booked a 16-night all inclusive cruise with some girlfriends around Australia and New Zealand.
After wading through these issues with her I chose to believe that she didn’t know what bulk billing meant and was simply asking for a discount on her medical care. I don’t blame her for bargain hunting especially in the current economic climate, but I also hoped that by informing her how Medicare worked, she could understand why it was near impossible to run a General Practice solely reliant on bulk billing.
I went on to explain that Medicare is a tax-payer funded health scheme for all Australians managed by the Federal Government. It means that Medicare pays the fee for your doctor’s appointment. A GP who chooses to accept the fee as the only cost is described as a bulk-billing GP. Unfortunately the fee hasn’t kept up with inflation, let alone costs of providing adequate care. This results in some clinics reducing consultation times to increase the number of patients being seen per hour to offset the reduction in patient fee contributions.
We also discussed how GP clinics are typically private clinics with general practitioners being contractors and not public servants. So, in addition to other fees like annual insurances and registration fees, which can amount to tens of thousands of dollars, GPs rely on seeing fee-paying patients. They usually have no salary, sick leave, annual leave or any other employee benefits and their income is used to fund nursing and administration costs, dressings and other equipment, state of the art computers to protect patient records to name but a few.
Nodding quietly as I put my points across, she began to understand the meaning of bulk billing and the challenges keeping GP clinics open. She described it as like going to an expensive restaurant, picking food from the menu, and when asked to pay the bill saying, ‘food is a human right, and the Australian government is happy to pay 2014 prices on my behalf for the food I have just consumed!’ Laughing at the absurdity of it all, we ended the consultation with her acknowledging that there are people in the community who need the helping hand of bulk-billed consultations. She conceded she was not one of them and was happy to pay for the excellent care she had just received.
As I closed the door after her and quickly finished my day at work I realised I hadn’t even managed a toilet break all day. My son was to be the last one at childcare pickup again. Another day in General Practice.
