GPs stretched thin as time-based care clashes with patient needs
Australian general practitioners are spending more time with patients, especially for mental health and complex care, while billing structures struggle to keep pace. A Royal Australian College of GPs (RACGP) survey highlights a growing gap between the hours GPs dedicate to patients and the rebates that accompany those hours. The result is a system many clinicians say encourages a form of time-based “six-minute medicine,” where shorter appointments are financially rewarded even as patients present with more complicated needs.
The reality of bulk-billing and patient access
Melbourne GP Owen Harris embodies the tension. He runs a private billing practice yet bulk-bills a small group of patients who would otherwise face unaffordable care. “It’s not in line with my values to force them to pay or ask them to come back or go somewhere else,” he explained. But the trade-off is real: remaining bulk-billed patients cost his practice, and the potential for longer-term burnout grows when empathy, concentration, and continuity of care stretch across crowded schedules.
Longer consultations, slimmer rebates
The survey reveals a shift toward longer consults, particularly for mental health care. Yet the Medicare rebate per minute tends to shrink as appointment length increases, creating a perverse incentive to cram more short visits into a day. As a result, more GPs report charging $90 or more for six-to-20-minute consultations, leaving patients with substantial out-of-pocket costs after rebates. A growing number of doctors now provide care that resembles specialist work in psychology or psychiatry, often without formal recognition or the much-needed coordination that longer visits require.
Systemic pressures and the risk of burnout
For providers like Dr Harris, the inability to match time spent with appropriate rebates undermines the sustainability of compassionate care. “There is simply no way to sustain empathy, compassion and concentration seeing that many patients in a day. Burnout or more superficial care is almost guaranteed,” he warned. The RACGP notes a decade-long stagnation in GP funding, contrasting starkly with the investment in hospital care and a system that increasingly asks primary care to shoulder complex mental health and chronic disease management.
People, not just numbers: GPs as de facto specialists
Many doctors report treating conditions that would typically fall under specialist purview, from mental health to chronic disease management. The reality in metropolitan areas is that finding a private psychiatrist or specialist can be challenging, pushing GPs to fill gaps and provide integrated care. The pressure is especially acute for junior doctors, who may feel overwhelmed by the demand for expert-level assessment and ongoing management outside traditional primary care boundaries.
Policy changes on the horizon
Policy discussions underway signal a potential shift in bulk-billing incentives. From November 1, the government plans to allow bulk-billing for any patient, broadening current eligibility beyond children and concession card holders. An additional 12.5% incentive is on the table when all GPs at a clinic bulk-bill every patient. Health Minister Mark Butler argues this could boost bulk-billing nationwide and reduce out-of-pocket costs for families, pensioners, and those with concession cards.
What it means for patients and clinicians
While proponents say bulk-billing incentives will improve access, clinicians caution that changes around mental health item numbers may affect how care is billed. The shift away from dedicated mental health consultation items toward standard time-based numbers could raise costs for some patients who need integrated care across multiple issues in a single visit. The net effect will hinge on clinic-level implementation and how rebates align with the time clinicians spend listening, diagnosing, and coordinating care.
Outlook
Even as some GPs report high job satisfaction—71% in the RACGP survey—dissatisfaction around hours, pay, and administrative load points to a broader need for reform. The coming policy changes offer a path toward broader bulk-billing and potentially better patient access, but the challenge remains: ensure longer, more complex consultations are adequately funded so clinicians can deliver empathetic, comprehensive care without burning out.
