Longer consultations, lower per-minute rebates
Australian GPs are increasingly dedicating more time to each patient, particularly for mental health issues, while the financial incentives of time-based care push the system toward what practitioners call “six-minute medicine.” A recent Royal Australian College of General Practitioners (RACGP) survey highlights the tension between the demand for thorough, empathetic care and the current Medicare rebate structure, which generally shrinks per minute the longer a consultation lasts.
Dr Owen Harris, a Melbourne GP who runs a private practice, illustrates the dilemma. He bulk-bills a small portion of patients—often those with complex needs such as mental health, substance use issues, or gender-affirming care—out of principle, despite a cost to his practice. “It’s not in line with my values to force them to pay or ask them to come back or go somewhere else … but it does mean I lose out.”
How time-based care affects practice and burnout
The survey reveals a shift toward longer appointments, with many GPs treating conditions typically managed by specialists within primary care. Yet the time-based rebate structure means longer visits yield less return per minute, prompting concerns about burnout and the quality of care. Dr Harris warns that sustaining empathy and focused attention for numerous patients each day is increasingly challenging, increasing the risk of burnout and superficial care.
RACGP reports that, as a result of wage pressures and higher private costs, roughly half of practising GPs now charge $90 or more for a 6-to-20-minute consultation, leaving patients with out-of-pocket gaps even after Medicare rebates. The data shows only a small portion of GPs can bulk-bill all patients, underscoring access challenges for many Australians seeking timely care.
GPs taking on specialist roles in mental health
The survey notes a growing trend of GPs managing more complex cases typically handled by psychologists or psychiatrists. Even in urban Melbourne, Dr Harris says finding a private psychiatrist for referral can be nearly impossible, forcing him to treat patients with a higher degree of mental health involvement himself. This reality reflects a broader pattern where primary care doctors shoulder more of the mental health burden, often without proportionate funding support.
Funding for GP care has stagnated for about a decade. In 2023–24, government expenditure per person on GP care was $452, compared with $3,649 for public hospital care per person. The discrepancy underscores calls from the RACGP for increased Medicare rebates to align incentives with the needs of longer, more intensive consultations.
Upcoming bulk-billing changes and what they mean for patients
New bulk-billing changes are set to take effect on November 1. The government will allow GPs to bulk-bill any patient, removing the previous eligibility restrictions that limited bulk-billing to children and concession card holders. An additional incentive of 12.5% will be paid when all GPs at a clinic bulk-bill every patient, split between the GP and the practice. Health Minister Mark Butler argues these changes could push nine out of ten GP visits to be bulk-billed by 2030, a claim aligned with prior successes for pensioners and families with children.
However, mental health provisions are shifting. From November 1, mental health consultation and treatment plan items will be replaced by standard time-based item numbers for mental health concerns. Dr Harris cautions that this could raise costs for patients who rely on co-billing to address multiple needs in one visit, forcing longer appointments that may be unaffordable for some families or individuals.
What this means for patients and the future of primary care
The RACGP’s findings reveal a healthcare system at a crossroads: caring, time-intensive medicine versus economically sustainable practice models. The government argues that longer consults can deliver comprehensive care with similar or even better rebates in the long run, but clinicians warn that affordability and access will be the true test for patients, particularly those with chronic or complex conditions.
Despite the administrative and financial strains, optimism remains among many GPs. The survey found 71% of doctors are satisfied with their job, though concerns about hours, pay, and administrative load are rising. For patients, the central question is whether the changes will mean more compassionate care without compromising access or increasing out-of-pocket costs as rebates realign under new rules.
