GP Burnout

GP Burnout

Financial pressure, staffing shortages and public scrutiny is impacting on the mental health and wellbeing of general practitioners. Isabella Angeli asks three different GPs about the unique stressors impacting their specialty.

DR SOPHIE BERNARD

General practitioner Dr Sophie Bernard has been the practice principal of a clinic in Five Dock since 1987.

In addition to being a Fellow of the Royal Australian College of General Practitioners, she has a Masters of Paediatrics. Her areas of interest include child health, chronic disease and mental health.

In the three decades since Dr Bernard became a GP, general practice ownership has changed significantly.

“Running the practice was less stressful,” she said. “I bought into a small two-room practice in partnership whilst caring for two young babies. It was difficult but doable.”

Having grown her practice into a larger entity, Dr Bernard feels a greater responsibility to her long-term staff, colleagues, and patients. And when the practice was in trouble due to poor indexation of the Medicare rebate, Dr Bernard was forced to dig into her personal funds to keep it afloat.

Her practice’s financial hardships mirror the chronic underfunding of the Medicare rebate. According to AMA’s 2022 report, “The general practitioner workforce: why the neglect must end” from 1995 to 2022, Medicare rebates have only seen an average annual indexation rate of 1.1%, well below average changes to the Consumer Price Index and Average Weekly Earnings of 2.4% and 3.5% respectively. There was a slight boost in indexation of 2.5% in 2006, but this was followed by six separate years of no indexation and the other remaining years with an average indexation rate of 1.3%.

Dr Bernard said that in addition to financial instability, the accreditation and audit process has become “a nightmare” placing a lot of unpaid, unrecognised administration burden to jump through the increasing hoops of government bureaucracy. Added to this strain has been the challenge of staffing shortages.

“We lost two doctors to burnout and one to retirement just before our accreditation. We only just kept our heads above water – it was truly horrific,” she said.

The AMA estimates there will be a shortage of 10,600 GPs by 2031, with the supply of GPs not keeping pace with growing community demand.

Several factors are contributing to this shortfall, including a decline in the number of doctors-in-training choosing general practice as a specialty, as well as an increase in the number of GPs who have indicated they intend to retire in the next five years.

A 2022 AusDoc survey found 28% of respondents said they had already quit the profession or had plans to find a new career or planned to retire within 12 months, citing poor remuneration and burnout as the main reasons.

Now on the verge of retirement herself, Dr Bernard said: “‘I feel for my younger colleagues in terms of the stresses of income and trying to start out in the housing market and raise a family in a very different world.”

DR PRIYANKA ANAND

Dr Priyanka Anand grew up in Hong Kong and Singapore but completed her medical degree when she settled in Sydney.

She is a GP at a clinic in Sydney’s Inner West, although is currently on maternity leave. Dr Anand is also a GP supervisor at the University of Notre Dame and holds a Diploma in Child Health and a Professional Certificate in Dermoscopy. Her areas of interest are women’s health, contraception, paediatrics, mental health and comprehensive skin checks and dermoscopy.

According to Dr Anand, recent reports of Medicare rorting have contributed to a public perception that doctors are greedy.

“The assumption that doctors are rich is breaking us,” she said, adding that the bulk billing under the current rebate is not feasible.

“We can’t make ends meet with this current situation,” Dr Anand said.

According to the Cleanbill’s Health of the Nation report, released in April, only 35.1% of GPs across Australia now bulkbill. The survey of 6,363 GP clinics also found that average out-of-pocket costs at the 65% of clinics that do not bulk bill are $40.42 for a standard, 15-minute consultation.

Dr Anand also commented that negative perceptions of general practitioners being “the back-up option” has made general practice less attractive as a specialty.

What makes this particularly frustrating for Dr Anand is that the opposite is true.

“If we crumble it will directly affect the emergency department and other specialities … we are the main anchor of our health system.”

Dr Anand suggested international medical graduates should be given greater support to address language and financial barriers, which in turn would assist with workforce shortages. Increasing workforce numbers would also improve the health and wellbeing of GPs, Dr Anand said.

“There is a lot of burnout and fatigue, especially after COVID, we need to encourage and incentivise GPs to seek treatment from professionals if or when they need it.”

Dr Anand added GPs need to prioritise their own health.

“We need to break down the stigma that holds doctors’ health and well-being differently to those we treat – we all face our own problems,” Dr Anand said, adding that she has her own GP and undergoes regular health checks to avoid self-diagnosing.

DR LUCINDA LUCKETT

Dr Lucinda Luckett has been working as a general practitioner for seven years, currently working at a practice in Balmain.

She is an accredited prescriber of opioid pharmacotherapies and oral medical termination of pregnancy.

Dr Luckett’s areas of interest include women’s health (termination of pregnancy and HRT), drug and alcohol, mental health, sexual health and paediatrics.

According to Dr Luckett, the fear of receiving a ‘nudge letter’ is a big stressor, making underbilling a common practice to avoid being audited.

She echoed concerns about the financial sustainability of general practice and said the Commonwealth must increase the Medicare rebate to ensure practices remained viable and patients didn’t seek “free health care” from hospitals, which are already overburdened.

According to Dr Luckett, exempting general practice from payroll tax is one of the most critical policy-level improvements that needs to be actioned by our State government.

“If they introduce payroll tax it will absolutely directly impact my income and also my practices towards billing patients,” Dr Luckett states. “Furthermore, if I see someone with angina and stop them from having a heart attack, I’ve saved the hospital thousands of dollars. So if you look at the expenses that payroll tax will cause, it’s poor fiscal policy.”

In terms of her own mental health, Dr Luckett emphasised the importance of outsourcing.

“As a mother of two you don’t have to try and do it all, have your priorities and what works for you. I place importance on sitting down with my family and eating together. That’s why I don’t feel ashamed about saying I outsource our dinners during the week and use my trusty robot vacuum. They allow me to gain time with my family and that’s what’s important for my health and wellbeing,” Dr Luckett said.