Longer consultations, lower rebates: the pricing trap for Australian GPs
Australia’s general practitioners are spending more time with patients, especially for mental health and complex care, while the financial rewards for longer visits remain stubbornly low. A recent Royal Australian College of GPs (RACGP) survey highlights a tension at the heart of primary care: clinicians aim to deliver empathetic, comprehensive care, but funding structures lag behind patient needs.
Around the country: what the survey reveals
Dr. Owen Harris, a Melbourne GP who specialises in complex mental health care, drug and alcohol issues, and gender-affirming care, describes the dilemma vividly. Even as his workload grows more time-intensive, the current Medicare rebates do not scale with appointment length. “There is simply no way to sustain empathy, compassion and concentration seeing that many patients in a day,” he says, warning of burnout and shallower care if the system forces speed over quality.
The RACGP survey confirms a national trend: a growing number of GPs are spending longer with patients, particularly for mental health concerns. Yet the financial incentive structure disincentivises extended visits. A typical six-to-20 minute consultation can leave patients out of pocket after rebates, with about half of practising GPs reporting charging $90 or more for such visits in recent times.
Many doctors now find themselves performing roles traditionally filled by specialists. They manage chronic mental health conditions and coordinate care that would otherwise involve psychologists, psychiatrists, or hospital services. In Melbourne and other cities alike, finding private mental health referrals can be challenging, intensifying the pressure on GPs to provide more comprehensive care themselves.
The policy lever: upcoming bulk-billing changes
In the lead-up to changes rolled out on November 1, the federal government announced a plan to broaden bulk-billing incentives. The idea is to encourage more visits to be bulk-billed, by extending incentives to any patient and introducing a second incentive when all GPs at a clinic bulk-bill all patients. Health Minister Mark Butler framed the measure as a way to keep care affordable, citing previous success with pensioners, concession cardholders, and families with children.
Critically, the reform will also shift mental health items. From November 1, mental health consultation and treatment plan items will be replaced by standard time-based item numbers for mental health concerns. For clinicians like Dr. Harris, this raises a key concern: co-billing could become impossible. For instance, a patient presenting with both depression and diabetes might currently receive a mixed bill—one mental health item and another for diabetes management. Under time-based charging, both issues might be bundled into a longer appointment, potentially increasing the patient’s out-of-pocket costs.
What it means for patients and clinicians
The reform promises to push nine out of ten GP visits toward bulk-billing by 2030, a goal greeted with cautious optimism by stakeholders focused on access. Yet many GPs warn the changes could leave vulnerable patients paying more for longer appointments that address multiple needs. Dr. Harris notes the real-world impact: “If patients can’t afford it, they’ll go elsewhere or we’ll have to cram everything into a short appointment.”
The government argues that the per-minute rebates justify longer visits, pointing to higher totals for longer appointments (for example, a 60-minute consultation receiving a larger rebate). The tension remains: can funding catch up with the clinical reality of complex, ongoing mental health care?
Outlook for doctors’ job satisfaction and the system as a whole
Despite these tensions, the RACGP survey found that 71% of GPs reported overall job satisfaction. However, dissatisfaction has grown around hours, pay, and administrative burdens. The report also sheds light on a troubling aspect of practice: racism. More than 10% of GPs witnessed racism toward a patient by staff or fellow patients in their own practice, and nearly 20% have faced racism from patients in the past year. These findings underscore broader pressures that accompany modern primary care in Australia.
Bottom line
As Australia recalibrates bulk-billing incentives and refines mental health support within primary care, the sector faces a delicate balance: deliver compassionate, long-form care without destabilising patients’ finances or clinicians’ livelihoods. GPs like Dr. Harris embody the frontline challenge—to sustain both patient-centred care and a viable practice in a funding landscape that still struggles to reward the value of time.
