Falling over time
A stated national policy objective is self-sufficiency of the medical workforce but the number of international medical graduates (GPs and non-GP specialists) continued to grow faster than the number of domestically trained GPs and non-GP specialists until the end of 2019.
Specialty choice remains an issue as applications for GP training places fall and the number of specialists continues to grow faster than GPs. Non-GP specialists earned almost twice as much as GPs with their earnings growing twice as fast such that the gap between GP and non-GP specialist earnings has widened over time, probably aided by the Medicare fee freeze. The earnings gap is likely to widen further as there are no specific national policies to address this.
Annual fee revenue per doctor has been falling over time. The most likely reason is the number of GPs and non-GP specialists (supply) has been growing leading to more competition while the number of patients per doctor (demand) has been falling even as the population increases. The Medicare fee freeze and fall in growth of private hospital care could have contributed to this.
While fee revenue has been falling, doctors’ self-reported annual earnings (after practice costs and before tax) have been increasing. This suggests doctors are managing to maintain their take home pay by either reducing practice costs per doctor or increasing income in other ways.
Doctors have also been slowly changing their billing patterns over time with higher rates of bulk billing, especially for non-GP specialists, as well as higher fees charged for non-bulk billed services. This is likely to reflect lower fees and more bulk billing for less affluent patients balanced out by higher fees for more affluent patients.
Telehealth continues, but slowly falling
During the height of the COVID-19 pandemic in Australia there were high hopes telehealth might become part of routine care. The rapid introduction of telehealth brought the future slightly closer as many healthcare providers and patients had a taste for how this could work. Telehealth can potentially solve not only issues arising during pandemics but improve access to healthcare for vulnerable and underserved populations. The use of telehealth would also make the system more responsive and flexible to patients’ needs.
New telehealth items were funded from March 2020 to help protect patients and providers from COVID-19 as well as help circumvent the fall in demand for healthcare that led to substantial falls in income for many providers in 2020. Since then, the use of telehealth has fallen overall as the pandemic in Australia has subsided.
Video consultations are still used much less than telephone though are more likely to be used by non-GP specialists. For GPs, the proportion of attendances using telehealth for GP Mental Health Plans and Chronic Disease Management Plans are slightly lower than for usual GP visits, suggesting no additional need for telehealth for these specific patient populations.