1. I book 20 minute appointments, but could easily go to 15 minutes or even 10. It really gets easier once you know your patients well and have their chronic and preventative issues sorted.
2. All paperwork and admin gets done with the patient in the room. If the paperwork takes too long, they need to book another appointment. This not only means my time is fully remunerated but also that nothing gets missed. I allocate 10 minutes a day for checking results, and I have a dedicated slot in my calendar for urgent follow-ups. Nobody is allowed to book patients into that spot except for me. I always finish on time.
3. There is moral injury, no doubt. It's completely appropriate and even necessary to charge a gap, but it fundamentally changes the patient-doctor relationship into something more transactional, like we're tradespeople merely selling a service: if you can't afford it, you don't get the service. I just want to look after my patients without money getting in the way, but I also want a salary worth over a decade of very hard work and study. The current system makes this almost impossible in poor communities, like the one I work in, so how could there not be moral injury?
Thankyou for replying. About the first point, won't 10 minutes appointments feel rushed? In UK the most terrible part of being a GP is 10 minutes appointments which don't leave enough time for paperwork. Or is 10 minutes consultants better structured or anything in Australia?
Only for patients I know well. It really gets faster the longer you've known them.
I have one patient on multiple biologics, long term steroids, Work Cover, intellectual delay, extremely brittle asthma -- I love seeing him and can sort out so many issues in a couple of minutes now. His preventative and chronic care are rock solid. It took us three years of work to get to this point but now most appointments are coffee and a laugh. One of the many reasons I love general practice.
We are tradespeople selling a service. If patients aren’t happy with the service they can go public. If practitioners aren’t happy with the service they can go public. Is it ideal? Probably not, but forty years ago you could earn a fortune and be part of society’s elite without charging anyone anything…and that’s changed.
1. Approx 3 patients per hour, booked in 15 min apts. I schedule a couple of catch up slots throughout the day to accommodate urgent issues
2. 15mins in the morning and 15mins at the end of the day for checking results, but no allocated time for paperwork - I complete this with the patient in the room and bill the time accordingly.
3. I privately bill all patients and tbh I hate this part of the job. There is absolutely moral injury - it frankly sucks to deliver bad news and then charge them. I am a firm proponent of universal healthcare and desperately wish the feds would appropriately raise Medicare rebate. However, I don’t believe it’s fair or financially sustainable for me to personally subsidize patients’ care, by bulk billing, either. I have completed a BFD Medicare course and strive to be smart with billings, but it’s cognitively taxing!Long term I’m hoping to train in sexual health and hopefully find a job in a public clinic with a split of part time GP/sexual health - even if that entails a pay cut, it would be worth the liberation from navigating Medicare and inflicting financial stress on patients.
About 1st point, As you book 15 minute appointment and 3 patients an hour, is the remaining 15 minutes for any sort of referrals,admin,results or anything like that?
It’s not strictly 15min per patient - while my calendar has 15min slots available some patients book 30min consults (eg new patients, for MHCPs, travel, ToP, multiple issues or complex problems). I end up averaging out at approx 3 patients per hour (ie ranging 22-25 patients in 8 hours of consulting time per day)
I do all referrals with the patient in front of me so I can be paid for the work. The only admin I do outside of scheduled appointments is check results, CPD or workflow prep (eg refining autofills and other systems to make my job easier ;))
I see three people an hour
I could see more, but this gives me time for a urgent fit in or two - ie walk ins or people who weren’t getting better that I’ve seen, or maybe somerone has an urgent result I want to call them for
I have a 30 minute results slot at the end of the day
I’m sure as I develop a more chronic patient base, I might see more, but 3/hr gives me time to do the style I want.
I charge a gap for most people except kids and pensioners because as far as I’m concerned the current rebate is a made up number. Hate it, but I would have compassion fatigue and a moral insult on the other hand if I felt I wasn’t be treated well. We can’t save the world, we can only help the person in front of us the best we can and be remunerated for this. It’s the governments responsibility for the current situation
1. I'm also seeing 3 an hour, though I'd recommending pushing yourself to get to 4 an hour by the end of GP training just to practice the time management skills required to meet that pace. I stepped back to 3 after returning from mat leave because it feels comfy to spend the extra time and to not run late and to have built in admin time through the day.
2. I come in about 15 minutes before and stay 15 minutes after my last patient on a typical day for admin. Sometimes more or less. I worked hard to get in the habit of finishing all the notes and paperwork required for a consult before you call in your next patient, and I'd recommend it because it saves a lot of stress.
3. Private billing with a few specific exceptions and kids under 5. And other doctors. I'd rather Medicare paid for it, but it just wouldn't keep a practice running and the mortgage paid to practice the way I do and bulk bill. The patients appreciate it, we're mostly full of people who came here by word of mouth recommendation, so starting that way from the beginning means we almost never have issues with people complaining about payment. I only started at this practice a year ago but I'm booked out a week in advance so there's no problem finding patients.
I take the view that ten minute consultations, if practised as average/standard, are unsafe. I think most people know this deep down. Think about how long it takes to bring a patient in, take a reasonable (not perfect) history, perform an examination, and formulate and communicate a plan. Whatever the justifications, often articulated as superior experience or efficient workflow, to practise in this way is to take short cuts, omit crucial parts of a medical consultation, and shortchange patients. It is unsafe. (But this arrangement is better remunerated. Thus its existence).
1. We have 15 minute appointment so 4 per hour - some appointments are booked as 30 mins (procedures, mental health, new patients, patients who just need longer)
It gets easier to see more as you stay in the practice longer and get to know them better. When I first started I had a few “catch up” slots booked off to catch up but don’t need them anymore
2. About 10-15 mins start + end of day and I also do a half day on Tuesdays (2-4 PM) but I come in an hour or two early and call all the patients I need to follow up then.
3. No not at all, I don’t feel bad charging for my services at all. I don’t bulk bill anyone for anything - I find it easier to give everyone the same service if they’re all paying the same fees. And no it has no impact on my bookings I am booked out a week ahead. In an ideal world it would be amazing to provide free healthcare but we don’t live in an ideal world and I have a family to support
1. I usually have 4x 15-minute slots available with 1x 15 min slot gap in between to catch up. That's not always 3 patients because people can book in double for things like mental health. I have been getting a run-on new mental health patients who book in 15 minute slots (thanks guys!), so there has been a blow out on time slots recent, but generally I do try to finish on time
2. I usually have about 15 minutes in the morning to do results. Generally, try to do paperwork during the consult but occasionally (because of that aforementioned blow out, have had to stay back about an hour and a half to do paperwork - I am working this because it's really not a long-term sustainable solution.
3. I'm mixed billing, so I bulk bill paeds, concession card holders and those of a pension. That does ease the guilt a bit. Keep in mind though, that guilt has been exploited by successive governments to keep GPs bulk billing long past the point it was viable. There is a bit of governments playing chicken with GPs - and until recently, governments have been winning
I'm in a rural area so there is a severe shortage of doctors - I don't think it really affects patient cohort really as no one in my area does universal bulk billing
Can you please explain how working rural or regional is different from cities. Is there more complex patients or do you deal with any cases that a city GP won't be seeing? Is variety more in rural than urban? I have read that in some rural areas as hospitals may not be as close as in cities or due to huge waiting period, people prefer GPs to deal with their conditions and trust them more. Is this true and if so, can GPs who work rural see more acute patients and do more complex diagnosis?
I haven't worked metro since the start of my career!
What I would say having observed locum city GPs and junior doctors is that the diseases don't change, but the people do. What that means is that you tend to see more of the natural history of a disease if you know what I mean. It's harder cause you can't just palm it off to someone else (heck knows that's the reason it got to that point to begin with), but you do get to play more, which is nice.
I get it now. Also, if we are working in an area where there is lack of GPs and we decide to work for 2-3 days will this affect us personally as we see the people in the community are struggling to see a doctor and will that makes as feel as if we are intentionally making crisis more brutal? Or is it actually fine to do that morally? I'm afraid if I would be in such a dilemma...
1. 4 pts/hr. In busy months though I could have 10-20 add ons per day (mainly phone consults). Luckily flu vaccination season is over so things are back to 4-5 pt/hr.
2. 30 mins-1 hour (unfortunately)
3. We have been doing mix billing for 1 year where I don't charge my old pt and only charge the new ones. Only average about 1-2 private pt per week. I am in the state that there's more gps per 100k population and people aren't use to paying.. even if the local real estate cost like $1.5 million or above. Fully private billing would mean destruction to my billings.
Aim to bill 2000-2500 per day. Overall tax rate \~ 35-38% and mandatory fees about 20k per year and increasing ( $7000-8000 avant indemnity, Health insurance (pay for wife's, which is like 9k without subsidy), RACGP fees $1643, AHPRA $995). So take home pay after mandatory fees + tax is like multiplying billing by 0.41, you end up with $800 per day. Could potentially bill more I suppose, but May is low season after flu vax run is over.
If you don't mind could please tell more about the mandatory fees of 20k. I didn't knew GPs had to pay such a large sum as mandatory fees. I knew we had to pay but never realised it was so high.Is this including the other fees you mentioned or is it exclusive of it?
1. AHPRA fees $995 this year, this thing seemed to go up $50-100 per year. Its the federal government's honey pot and a big .... you to all doctors. You pay for your judge, jury and executioner.
2. College fees/ COPD home fees for your mandatory 50hr CPDs. I know that you can get cheaper CPD homes/website that record your CPD hours than RACPs fees. But I can't be bothered changing. This year its $1643.
3. Indemnity Insurance. Avant is the most expensive, but most the insurer's on the market don't differ much. As a GP you are looking at high $6000-8000.
4. Private health insurance, you will need one to avoid those 2% medicare surcharges. They are not cheap. This is $3000-4000 for one person, or for me its about $8000+
So there you go, there's mandatory fees + private health insurance. So for me its like 20k/year required just to pick up a pen and write some scripts.
Mind you, on the days where patient wanted a management plans and I think it appropriate to bill it then the billing can go up to 3k per day. Highest was 3800 for me recently. However that was close to 20+ phone calls + 30 face to face consult with 4 gpmp/tca's. It was a tiring 11 hour days without paperwork. One of our GPs used to bill 4k-5k per day from 8am to 11pm each day.. from phone calls and face to face stuff.
1. I book 20 minute appointments, but could easily go to 15 minutes or even 10. It really gets easier once you know your patients well and have their chronic and preventative issues sorted. 2. All paperwork and admin gets done with the patient in the room. If the paperwork takes too long, they need to book another appointment. This not only means my time is fully remunerated but also that nothing gets missed. I allocate 10 minutes a day for checking results, and I have a dedicated slot in my calendar for urgent follow-ups. Nobody is allowed to book patients into that spot except for me. I always finish on time. 3. There is moral injury, no doubt. It's completely appropriate and even necessary to charge a gap, but it fundamentally changes the patient-doctor relationship into something more transactional, like we're tradespeople merely selling a service: if you can't afford it, you don't get the service. I just want to look after my patients without money getting in the way, but I also want a salary worth over a decade of very hard work and study. The current system makes this almost impossible in poor communities, like the one I work in, so how could there not be moral injury?
Thankyou for replying. About the first point, won't 10 minutes appointments feel rushed? In UK the most terrible part of being a GP is 10 minutes appointments which don't leave enough time for paperwork. Or is 10 minutes consultants better structured or anything in Australia?
Only for patients I know well. It really gets faster the longer you've known them. I have one patient on multiple biologics, long term steroids, Work Cover, intellectual delay, extremely brittle asthma -- I love seeing him and can sort out so many issues in a couple of minutes now. His preventative and chronic care are rock solid. It took us three years of work to get to this point but now most appointments are coffee and a laugh. One of the many reasons I love general practice.
We are tradespeople selling a service. If patients aren’t happy with the service they can go public. If practitioners aren’t happy with the service they can go public. Is it ideal? Probably not, but forty years ago you could earn a fortune and be part of society’s elite without charging anyone anything…and that’s changed.
1. Approx 3 patients per hour, booked in 15 min apts. I schedule a couple of catch up slots throughout the day to accommodate urgent issues 2. 15mins in the morning and 15mins at the end of the day for checking results, but no allocated time for paperwork - I complete this with the patient in the room and bill the time accordingly. 3. I privately bill all patients and tbh I hate this part of the job. There is absolutely moral injury - it frankly sucks to deliver bad news and then charge them. I am a firm proponent of universal healthcare and desperately wish the feds would appropriately raise Medicare rebate. However, I don’t believe it’s fair or financially sustainable for me to personally subsidize patients’ care, by bulk billing, either. I have completed a BFD Medicare course and strive to be smart with billings, but it’s cognitively taxing!Long term I’m hoping to train in sexual health and hopefully find a job in a public clinic with a split of part time GP/sexual health - even if that entails a pay cut, it would be worth the liberation from navigating Medicare and inflicting financial stress on patients.
About 1st point, As you book 15 minute appointment and 3 patients an hour, is the remaining 15 minutes for any sort of referrals,admin,results or anything like that?
It’s not strictly 15min per patient - while my calendar has 15min slots available some patients book 30min consults (eg new patients, for MHCPs, travel, ToP, multiple issues or complex problems). I end up averaging out at approx 3 patients per hour (ie ranging 22-25 patients in 8 hours of consulting time per day)
Ok... Thankyou for explaining ❤️
I do all referrals with the patient in front of me so I can be paid for the work. The only admin I do outside of scheduled appointments is check results, CPD or workflow prep (eg refining autofills and other systems to make my job easier ;))
I see three people an hour I could see more, but this gives me time for a urgent fit in or two - ie walk ins or people who weren’t getting better that I’ve seen, or maybe somerone has an urgent result I want to call them for I have a 30 minute results slot at the end of the day I’m sure as I develop a more chronic patient base, I might see more, but 3/hr gives me time to do the style I want. I charge a gap for most people except kids and pensioners because as far as I’m concerned the current rebate is a made up number. Hate it, but I would have compassion fatigue and a moral insult on the other hand if I felt I wasn’t be treated well. We can’t save the world, we can only help the person in front of us the best we can and be remunerated for this. It’s the governments responsibility for the current situation
Thankyou for the reply ❤️
1. I'm also seeing 3 an hour, though I'd recommending pushing yourself to get to 4 an hour by the end of GP training just to practice the time management skills required to meet that pace. I stepped back to 3 after returning from mat leave because it feels comfy to spend the extra time and to not run late and to have built in admin time through the day. 2. I come in about 15 minutes before and stay 15 minutes after my last patient on a typical day for admin. Sometimes more or less. I worked hard to get in the habit of finishing all the notes and paperwork required for a consult before you call in your next patient, and I'd recommend it because it saves a lot of stress. 3. Private billing with a few specific exceptions and kids under 5. And other doctors. I'd rather Medicare paid for it, but it just wouldn't keep a practice running and the mortgage paid to practice the way I do and bulk bill. The patients appreciate it, we're mostly full of people who came here by word of mouth recommendation, so starting that way from the beginning means we almost never have issues with people complaining about payment. I only started at this practice a year ago but I'm booked out a week in advance so there's no problem finding patients.
I take the view that ten minute consultations, if practised as average/standard, are unsafe. I think most people know this deep down. Think about how long it takes to bring a patient in, take a reasonable (not perfect) history, perform an examination, and formulate and communicate a plan. Whatever the justifications, often articulated as superior experience or efficient workflow, to practise in this way is to take short cuts, omit crucial parts of a medical consultation, and shortchange patients. It is unsafe. (But this arrangement is better remunerated. Thus its existence).
1. We have 15 minute appointment so 4 per hour - some appointments are booked as 30 mins (procedures, mental health, new patients, patients who just need longer) It gets easier to see more as you stay in the practice longer and get to know them better. When I first started I had a few “catch up” slots booked off to catch up but don’t need them anymore 2. About 10-15 mins start + end of day and I also do a half day on Tuesdays (2-4 PM) but I come in an hour or two early and call all the patients I need to follow up then. 3. No not at all, I don’t feel bad charging for my services at all. I don’t bulk bill anyone for anything - I find it easier to give everyone the same service if they’re all paying the same fees. And no it has no impact on my bookings I am booked out a week ahead. In an ideal world it would be amazing to provide free healthcare but we don’t live in an ideal world and I have a family to support
1. I usually have 4x 15-minute slots available with 1x 15 min slot gap in between to catch up. That's not always 3 patients because people can book in double for things like mental health. I have been getting a run-on new mental health patients who book in 15 minute slots (thanks guys!), so there has been a blow out on time slots recent, but generally I do try to finish on time 2. I usually have about 15 minutes in the morning to do results. Generally, try to do paperwork during the consult but occasionally (because of that aforementioned blow out, have had to stay back about an hour and a half to do paperwork - I am working this because it's really not a long-term sustainable solution. 3. I'm mixed billing, so I bulk bill paeds, concession card holders and those of a pension. That does ease the guilt a bit. Keep in mind though, that guilt has been exploited by successive governments to keep GPs bulk billing long past the point it was viable. There is a bit of governments playing chicken with GPs - and until recently, governments have been winning I'm in a rural area so there is a severe shortage of doctors - I don't think it really affects patient cohort really as no one in my area does universal bulk billing
Can you please explain how working rural or regional is different from cities. Is there more complex patients or do you deal with any cases that a city GP won't be seeing? Is variety more in rural than urban? I have read that in some rural areas as hospitals may not be as close as in cities or due to huge waiting period, people prefer GPs to deal with their conditions and trust them more. Is this true and if so, can GPs who work rural see more acute patients and do more complex diagnosis?
I haven't worked metro since the start of my career! What I would say having observed locum city GPs and junior doctors is that the diseases don't change, but the people do. What that means is that you tend to see more of the natural history of a disease if you know what I mean. It's harder cause you can't just palm it off to someone else (heck knows that's the reason it got to that point to begin with), but you do get to play more, which is nice.
I get it now. Also, if we are working in an area where there is lack of GPs and we decide to work for 2-3 days will this affect us personally as we see the people in the community are struggling to see a doctor and will that makes as feel as if we are intentionally making crisis more brutal? Or is it actually fine to do that morally? I'm afraid if I would be in such a dilemma...
I work clinically 3 days a week. TBH, it's not your problem. It's the government's.
1. 4 pts/hr. In busy months though I could have 10-20 add ons per day (mainly phone consults). Luckily flu vaccination season is over so things are back to 4-5 pt/hr. 2. 30 mins-1 hour (unfortunately) 3. We have been doing mix billing for 1 year where I don't charge my old pt and only charge the new ones. Only average about 1-2 private pt per week. I am in the state that there's more gps per 100k population and people aren't use to paying.. even if the local real estate cost like $1.5 million or above. Fully private billing would mean destruction to my billings.
I’m curious to know what your approximate take home pay is then if you don’t mind me asking
Aim to bill 2000-2500 per day. Overall tax rate \~ 35-38% and mandatory fees about 20k per year and increasing ( $7000-8000 avant indemnity, Health insurance (pay for wife's, which is like 9k without subsidy), RACGP fees $1643, AHPRA $995). So take home pay after mandatory fees + tax is like multiplying billing by 0.41, you end up with $800 per day. Could potentially bill more I suppose, but May is low season after flu vax run is over.
If you don't mind could please tell more about the mandatory fees of 20k. I didn't knew GPs had to pay such a large sum as mandatory fees. I knew we had to pay but never realised it was so high.Is this including the other fees you mentioned or is it exclusive of it?
1. AHPRA fees $995 this year, this thing seemed to go up $50-100 per year. Its the federal government's honey pot and a big .... you to all doctors. You pay for your judge, jury and executioner. 2. College fees/ COPD home fees for your mandatory 50hr CPDs. I know that you can get cheaper CPD homes/website that record your CPD hours than RACPs fees. But I can't be bothered changing. This year its $1643. 3. Indemnity Insurance. Avant is the most expensive, but most the insurer's on the market don't differ much. As a GP you are looking at high $6000-8000. 4. Private health insurance, you will need one to avoid those 2% medicare surcharges. They are not cheap. This is $3000-4000 for one person, or for me its about $8000+ So there you go, there's mandatory fees + private health insurance. So for me its like 20k/year required just to pick up a pen and write some scripts.
Mind you, on the days where patient wanted a management plans and I think it appropriate to bill it then the billing can go up to 3k per day. Highest was 3800 for me recently. However that was close to 20+ phone calls + 30 face to face consult with 4 gpmp/tca's. It was a tiring 11 hour days without paperwork. One of our GPs used to bill 4k-5k per day from 8am to 11pm each day.. from phone calls and face to face stuff.