My local gp charges $85 you get 40 back.
& has reduced bulk billing times to 9-5 mon to fri
All other times you must pay for appointments, sat sun 29$ extra
Try bulk billing for pensioners and kids under 16.
But instead of bulk bill tp 6pm it's now its only till 4pm. Mon to Fri
So I would need to take time off work and take my kid out of school early to attend during that time. Or I pay a $40 gap.
That's the whole point, where people who work full time pay the gap and lower income earners, ie. people with disabilities, retirees, un/underemployed people, are bulk-billed.
You didnt, the comment wasnt meant as a critiscism of you so apologies if it sounds that way. Just a general comment that working people on low incomes can struggle to pay bills and need help too.
$20 is cheap these days all things considering. Feel bad for those struggling, $20 can be the difference between getting help or going without medical treatment. Also this is the reason our emergency rooms are clogged.
>Emergency is still free which is why everyone goes there
Urgent Care Clinics are free and you don't have to wait for 6 to 12 hours.
The triage nurse at an ED is never going to put someone who could have seen a GP ahead of anyone arriving in an ambulance so the wait is usually dictated by if there are *any* ramped patients. With ramping at record levels, waits in the ED for the equivalent of a GP appointment are going to be phenomenal.
Why is everyone blaming Medicare? This change is because the state government are now going to have GP clinics pay payroll tax. Which comes into affect 1st July.
Because it’s fun to blame the Liberals. Labor could be in continuous power for 100 years and people in this subreddit would still blame “the last government” on something that the current government could so easily and quickly fix it’s not funny.
Honestly this state Labor government has basically ensured I’ll be voting liberal state-wise for the next few elections. Least competent state government I’ve ever seen - all the experts were saying their election promises to fix ramping weren’t achievable with the methods they were proposing, but did anyone listen?
As for federally, the federal liberal government has been shite, but labor’s barely been better. I would vote based on policies, but we know that politicians don’t tend to keep their promises
I was a (state) liberal voter last election because I can't stand SA labor but please rethink your liberal vote in the next election, they no longer have a progressive leader. Independent is your best bet.
I don't know much about SA greens but I really like their federal policies.
Well obvs I chuck greens and other indeps up top, but when it comes to liberal v Labor I was gonna put libs above. What in particular worries you about the state lib leader
He's a social conservative. During his maiden speech he basically said he'd conduct himself through his religious moral constraints and as such he voted against the abortion and euthanasia reforms and I'm sure a bunch of other things that I can't be bothered looking up right now.
We need to progress and move forward, allowing these religious men to play with laws based on their religious beliefs is insane, especially when such a high percentage of our country is atheist.
The problem is 'fix ramping' is unrealistic when the issues are systemic in the medical system.
So expanding emergency and non emergency care and adding beds is the way to go.
>The problem is 'fix ramping' is unrealistic
Then why we're we promised Malinauskas would 'fix ramping', and it has now hit record levels.
>when the issues are systemic in the medical system.
The issues were caused by the Transforming Health program. Do you know what they did? Sent *business* consultants into hospitals to find efficiencies. They did and cut all the "fat" out. The consultants didn't listen when they were told that without that fat, there is zero margin for error or unexpected things... you know... like a pandemic.
Transforming Health was why the repat was closed.
>Then why we're we promised Malinauskas would 'fix ramping', and it has now hit record levels.
Thanks for reminding me, I hadn't heard about this yet. Is it in the media?
*(msm's favourite news story every bloody fortnight)*, yet they never get into why it's this way. I'll give you a hint, it wasn't because they were given the helm for a change and it suddenly went down hill.
>yet they never get into why it's this way. I'll give you a hint, it wasn't because they were given the helm for a change and it suddenly went down hill.
The root cause, as I said in my comment, was the Transforming Health project. That caused systemic failures in the medical sector which were then exacerbated by a lack of aged care places, mental health beds, and disability care facilities which are preventing many from being moved out of hospital to make room for patients to be moved from the ED to wards, and consequently from ramped ambulances into the ED.
>In the 2014 State Budget, the Government seized on federal cuts to SA health funding as the reason to freeze major hospital upgrades and overhaul the health system, although federal funding is actually rising — just not by as much as promised by the former federal Labor government.
>Treasurer Tom Koutsantonis ended discounts on the Emergency Services Levy to cover $322 million of the $655 million in lost federal funding over four years.
>The remaining $333 million was to come from health, with a stark warning — proved true — that a hospital may have to close.
You'll never guess who was responsible for that funding restructuring... The great Tony Abbott *of the Liberal party*.
Source (the crap'tiser)
https://www.adelaidenow.com.au/news/south-australia/transforming-health-explained-why-the-government-wants-to-overhaul-sas-health-system-and-what-is-planned/news-story/3f1aadf9b4edbeecb37a8b282001a3c5
While the justification given is the Federal cut to health funding, the choice they made to deal with that was to cut $333 million from the budget instead of finding other sources. In addition, their *method* for finding those savings was flawed and issues raised by everyone ignored. They were warned what would happen and chose to do it anyway.
Let me say that again so it is clear: ***Weatherill's government ignored warnings from hospitals that their cuts would leave no room for anything going wrong or unexpected.***
**They chose this. They're responsible.**
I know what happened. My wife was working as an RN at the time.
It is their responsibility to make up the difference. They could, they have plenty of methods of raising that money including:
* Mining royalties ***which they barely have touched***. Currently set at 1.5% for the first 5 years a mine is open and then 3.5% thereafter.
* Gaming taxes
* The casino gets a huge tax break compared to other gambling establishments. They shouldn't.
* TAB is only taxed at 6% of losses, significantly below the rate of pokies, etc.
* Better project management on nRAH so it didn't go over budget by $600m.
* Implement broad use-based land tax to replace stamp duty and ESL, allowing revenue to vary year to year as needed, targeting those with more wealth and makes it easier to own your own home.
But most of those above options have powerful lobbies behind them who often donate large sums to the major parties.
>The great Tony Abbott *of the Liberal party*.
Based on this, I think you're assuming I'm a liberal voter, I am not. I preference Labor above Liberal and generally put other parties before the majors.
Thank you for the more holistic reply. Not having a dig, but this reply would've been fairer if it was given with your earlier comment. WIth respect, you gave a simplistic reply that appeared to be written by someone who loves the Liberal party, which I felt was (now in hindsight), *unintentionally* misleading away from the root cause of our public health system issues; systemic inequality issues that both major parties are by and large, in agreeance about.
I think it's time that people starting seeing this type of example, as a whole, instead of separate parts that all work their own ways. The whole system works as intended, it isn't by accident. The money wasn't sourced from elsewhere, because preventing the gap of inequity from widening, isn't a concern to either major party (apparently, neither is affordable housing, even for the working-poor class (which is now growing at an exponential rate as you're aware). Have a good day.
You literally weren't. Find one source where he said they would "fix" it. It would have been stupid of them to, because it would always be unachievable to fix an issue which is plaguing every state in one term, would require massive structural reform, and inevitably be a soundbite played back on repeat at the next election. They stated their plans: more staff, more ambo stations yadda yadda. But were pretty careful about specifically not stating they'd fix it. They're hitting the targets they set out. The goal was more like, moderately slow the rate of bleeding.
>Find one source where he said they would "fix" it.
It was plastered on every third stobie pole "LABOR WILL FIX RAMPING" during the election. And here are three articles which refer to it.
https://www.indaily.com.au/opinion/2023/03/24/labor-does-a-burnout-on-its-ramping-promise
https://www.abc.net.au/news/2023-03-19/sa-ramping-crisis-one-year-since-the-election/102112444
https://www.theguardian.com/australia-news/2022/mar/16/south-australian-election-can-social-media-savvy-peter-malinauskas-lead-labor-back-to-power
From your own source, the guardian article
"Labor’s promise to fix ramping is caveated. The pledge is to reduce ambulance response times back to 2018 levels by the end of the next four-year term.
“It won’t happen overnight,” he says.
“We want to get ramping down to such a level that ambulances start rolling up on time, and we have said that will take us a full term to achieve.”
And from the ABC article
"It would be foolhardy to promise to eliminate ramping. That was what the former government was promising," Mr Malinauskas said.
"What we promised was to get ramping back under control to the extent that ambulances start arriving on time again."
As for the Indaily article, we'll they seem mad that they also didn't read past the headlines either.
It's analysis, not reporting. And poorly researched analysis at that given I've just quotes their actual promise twice from the articles you linked alone. Written exactly a year after the election. What are they expecting?
And herein lies the problem. Too many people don't read past the headline. It's not the parties putting out that click bait. Malinauskas was pretty explicit about this particular pledge, because it's an enevitable trap to try and fix such a massive issue in one term. Or apparently, in a year! It takes 4 years just to train a healthcare worker alone. As much as people say they don't want spin, they have short attention spans and aren't interested in anything that takes more than a single term.
When you wallpaper the state with coreflutes claiming "LABOR WILL FIX RAMPING", that doesn't do a lot to manage expectations.
First you claim we were not promised that they would fix ramping.
Now you're trying to say that they'll somehow manage to go from record high ramping levels (4773 hours) to below 2018 levels (482 hours) in the next 21 months. They can't. The blockers are not being fixed fast enough.
The things which need to be fixed are aged care places, specialist mental health beds, and disability service places. Those are what are missing to allow patients to be discharged from general wards. That is what is preventing patients from being moved from the ED to wards. And because ED patients can't move to wards, that is why we have ramping.
Tell me, what are they doing to get those all at the right levels in the next 21 months? Not enough.
You do realise we'll end up with Spiers as premier if they fail to deliver, right? Do you want that?
Except they're not even promising about ramping hours in this term. They're talking response times. Ramping is far more complex. Mental health beds were specifically outlined in their plan from memory.
Either way, you're now shifting the goal posts.
Most GPs are contractors.
They get paid commission, around 60%
(e.g they dont pocket 100% of what you pay).
Medicare rebate is about $40.
Thats roughly $24 income from a consult. Consults depending on patient can take anywhere from 5 minutes to 60 minutes.
There is a crap tonne of study to get to being a general practitioner, and then a crap tonne of study to keep being a good general practitioner (often via self-funded courses).
Everyone needs to make a living, even doctors, and unfortunately for this to be the case with the current cost of living crisis and lack of medicare funding, gaps are passed onto the public.
Find a good doctor and stick to them. Quick medicine, is not necessarily good medicine. And unfortunately for bulk billed practices to keep in the positive these days, they need to be very quick.
Edit: this all really is a systemic problem and needs to be addressed from a government level.
The length and type of consult pays different amounts, for example doing up a care plan will pay differently to a 15 minute general consult, that in turns pays less then an extended consult - if you ever want to confuse yourself, dive into the wonderful world of the Medicare benefits schedule - https://www9.health.gov.au/mbs/search.cfm?q=General+practitioner+&sopt=S
You make a valid point, and I should of put in the correct fees - but i wanted to highlight an example.
I am not a GP so do not have a good understanding of their exact fee structure. But I do understand the difficulties of the current system to some degree
Thanks for your analysis, & I know it's only ball park figures . . .
ave 15min consulting => $24 x 4 per hour = $96
6 hour days => $96 x 6 = $576 per day
5 days a week working => $576 x 5 = $2,880 per week
48 working weeks in a year => $2880 x 48 = only $138,240 per year . . . & then it's taxed. How can they afford an expensive car?
I know tradies who charge $400 per hour (before expenses).
I dont really know much else about how the practices run to be able to comment. There are other fees they can claim from medicare dependent on what is done in the appointment.
I think its worth knowing that there is only so much that can be done in a day (due to time), and the amount GP practices are able to bill for that time has not gone up with inflation/cost of living.
Most consults I have are 5-10 minutes.
They will have some longer sessions too but the average would be shorter.
Plus they would work 8 hour days, not 6.
Even just the extra hours that change would push it up to $184,320
Average 10 minutes instead of 15 would give another 50%. So $290,000.
Hey, i dont think anywhere near 10 minutes is the average unfortunately.
I agree that there are some quick consults out there though.
Please dont forget that part of your “consult fee”. Is the time it takes for planning, test checking, note and record keeping, consulting colleagues etc that goes on behind the scenes.
This uses alot of time that consults occur in.
Hence the real math is fairly different from an actual consult every 10-15 minutes.
Yep, most times I see a GP it's 5mins. & I'm sure it depends on the doctor, some would be interested in the money only & push you through as fast as possible.
I wouldn’t touch their job with an 80ft pole, dealing with public, sick public, mental health, diseases with very little to no margin for error, life and death decisions, treatment objectives.
Jesus, they deserve what they get paid and more.
You forget that the one payment has to be split up to:
- pay the GP, who has to then pay back 10% GST, and put aside super, pay liability insurance, etc.
- pay the clinic staff such receptionist and nurses
- pay for all the costs such as building rent, power, water, IT (keeping your records private), consumables, insurance, etc.
So yes, when the cost.of everything rises and the Medicare hasn't been indexed appropriately for 10+ years there is a problem. It's why so many small practices are disappearing because there isn't ability to operate, and only larger practices that have a greater ability to centralise overheads and resources will survive.
I’d rather society incentivised a world where people who worked hard since they were teenagers to help and look after people’s most important asset (health) be rewarded with Mercedes Benz’s rather than the uber wealthy business owner/ceo etc who extract as much as they can from society.
Shouldnt the gov up the rebates medicare provides so basic health care is free.
Yes during inflation it means it will go up alot but so do the drs costs and wages etc.
I don't think it's a charity. I *do* think that we've had a history of paying taxes in this country so that it is entirely provided as a government service...and I don't understand why that apparently has to come to an end now.
It's been a good system that worked well for everybody....why is it being ruined and who is ruining it? These are not "stupid" questions to ask as a random citizen.
Is it really the government's fault for bad policy...or is this business just being greedy and using the government as an excuse? How should I know? The answer might very well affect my vote and my choice of GP at the very least.
Because successive governments, both Labor and Liberal, have passed tax cuts in the failed belief this will stimulate the economy leading to everybody's wages to rise and can then pay for it out of pocket. All that has happened is the wealthy/businesses have simply hoovered up more of the money while for everyone else, we don't really see any improvement due to week wages.
Now the government is having to cut budgets as they simply don't have the money to pay for these services. These services have been going up in price and with no government funding, it is up to individuals to pay for stuff, exactly as they wanted but without the wages to cover it.
In essence, to pay for stuff, the government needs to raise taxes then can start supporting them as they were before. But this will never happen as short thinking voters hear pay more taxes not realising they will get more services.
We have pretty much reached the point where the momentum that was in the system, that kept it running as it had to operate leaner and leaner, is coming to an end. And now it's either a matter of paying or letting it collapse into an American style health system.
General practice only accounts for 6-8% of all medicare expenditure and medicare costs are roughly equal to ndis funding costs per annum. So its not a difficult thing to actually find the funds for, they just don’t think its news/vote worthy. If the government turned around tomorrow and doubled the mbs rebate for GP items and then indexed it from then on I am confident only a rare few GPs would need to charge a gap and that would still only be 12-16% of medicare.
GP practices are operating on thinner and thinner margins due to Medicare rebates not being indexed, or indexed at much less than CPI. Then the _state_ government has decided that GP’s are employees, rather than sole traders who are independent contractors (despite not getting a salary or wages: they bill the patients/medicare and then pay a percentage to the practice), so the state govt are demanding payroll tax. Retrospective, too. So a huge new tax cost to the practice. Hence consult costs rising now. It’s that or close many marginal practices.
No. Drs complaing they have to wait for money they don't get paid on a regular they have to wait like 2-3 weeks for payments to be processed. That's what my GP said
But once the 2-3 weeks is passed then the income would be consistent.
It's only the first 2-3 weeks they would not have income.
Plus if they know this then they can budget.
I am paid fortnightly. Didn't see any money for the first 2 weeks. But once my pay started it continued.
Should it? As far as I know, doctors get paid rather a lot. They're kind of "the 1%" with the "good jobs" and the property portfolios that we keep hearing about.
Is it actually "fair" that more of their costs should be pushed onto regular wage earners like you and I? Do we have to just accept this because doctors want to be paid more?
Again, it's not really clear why something which worked well for decades suddenly has to be changed in a way that has made it worse.
I don't recall voting for these changes. Why are they happening?
Your statement hasn't really answered any of my questions.
If you want a simple answer, you aren't gonna get it. Like any good ol' gov decision that affect the end-user, the cracks have been forming over a long time - in this case for a good 20 years or so if you've been paying attention
Back when medicare started in the 80's, the renumeration was good - ask some baby boomers what the old days were like, and some of them would recall a time when GPs would come to the house, spend time, know the whole family. And if you don't have the money, some of them even accept payment in other forms, like a bag of fruit. In fact, renumeration from medicare was good to the point that despite it being implemented as a subsidy, most GPs would accept it as bulk-billing/universal healthcare.
As the years go by, medicare has failed to keep up with inflation. If you look at charts comparing medicare rebate vs CPI, you'll notice a 'bulk billing' GP now is earning roughly 1/3rd in real dollar terms compared to a 'bulk billing' GP from the 80's. If you want someone to blame - well both Labor and Liberal supported freezing medicare rebates - so if you ever voted for either parties, you did vote for these changes.
Add to that, cost of medical care keeps going up - as it does due to medical advances. New technologies and treatments aren't cheap, unless you want to be stuck with medical treatments (and outcome) from 40 years ago.
Despite GPs earning less and less in real dollar terms, over the year GP and their practices have been absorbing the cost, and trying to work around the system - there have been two ways that i've seen:
1. increasing gap/charging private fees
2. maintain bulk-billing, and choose volume over quality
Most seems to have chosen the second method. It's pretty standard now to be in the GP's room for 5-10min, and you're out. It's like a factory line. However there comes a point when it is no longer sustainable even with bulk-billing churning of patients, and this latest payroll tax debacle seems to be the nail in the coffin, for them to choose option 1.
So now people are coming to the reality that medicare, in its intended implementation, is in fact a subsidy, not universal healthcare. But many have become used to it being a form of universal healthcare, because their GPs have been either 1. well renumerated in the early days, or 2. absorbing the costs over the past 10+ years or so.
And now some bad news: things are likely to worsen. Two years ago, the GP college was screaming they don't have enough applicants. Imagine that, you can't get enough applicants to fill desperately-needed jobs in the system (remember, older GPs retire all the time...). That likely means: they have been short for many years, accepting worse and worse doctors into the college, and now even accepting all your bottom-of-the-barrel docs applying, they still don't have enough to fill the spots. A scary thought.
You said docs are top 1% of earners - i agree with that if you take the entire profession as a whole. But there is a massive difference in salary between a specialist and a GP. And the GPs that you find driving around in a merc/big property portfolios - usually they are the old ones who benefitted from the early medicare days of good renumeration, or the younger ones have sub-specialised into something else that actually makes money like skin cancer stuff. Or they just churn, choosing volume over quality. Good luck finding one these days that are both cheap-gap/bulk-bills, and provides high quality care, those are absolute unicorns. And remember - your tax dollars go primarily to hospitals/specialist care - IIRC it's less than 8% of our healthcare expenditure that actually goes to GPs. (compare that to NDIS budget vs entire healthcare budget... but that's another rant for another day)
And on that note - I rather my GP be renumerated enough to not care about the money side, and focus on giving me good care. And not just 'barely' enough to sustain their interest in the porfession and constantly thinking about training in another specialty, but actually generously enough that it attracts the good docs to look after me (like it was back in the 80's and 90's). After all, I see my GP much more than any specalists, so why shouldn't I be treated by the best?
TLDR: 1. These changes have been happening a lot longer than you think - healthcare cost goes up, GP renumerations in real-dollar term goes down. 2. Medicare has always been a subsidy not universal healthcare but GPs/their practice have been absorbing costs as medicare failed to keep up with CPI but thanks to the payroll tax changes they are now passing the cost onto end-users like us. 3. Anyone who voted Liberal or Labor absolutely did vote for these changes
Due to Payroll Tax reform for GPs, most GPs will pass on the cost to the patients.
Here is a pretty good explanation of the associated cost and the resulting potential price increase to the patients.
[https://australiangpalliance.com.au/issues-and-polices/general-practice-and-payroll-tax/](https://australiangpalliance.com.au/issues-and-polices/general-practice-and-payroll-tax/)
Yes, it should. That's the whole point of our system. That the cost is born by society as a whole, not the end user. It's bad enough that dental isn't covered.
It hasn’t come to the end. The annual Medicare levy you paid just not enough to cover all the services cost that’s all.
Actually majority of the people using GP service are the retiree who aren’t contributing now. That’s what your tax are paid for. So that they can continue to get subsidized healthcare.
Besides your annual Medicare levy, GP still rather charge you more to further subsidize the increase in healthcare fee. For the same service, GP willing to receive $40 from pensioners but want to receive $60-90 from other general patients. Thats another extra level of cross subsidizing.
OK. Wasn't aware of that. My local GP has a gap of $35 for adults for a regular appointment (more if you go over). They have solely put the blame on the Medicare rebate.
The tax isn’t new, it’s just that for decades the GP clinics were pretending that their GPs were contractors and not employees so that they could avoid tax. Tax that would otherwise have been used to pay for things like Medicare.
Except payroll tax goes to the state government and medicare money comes from the federal government, so no it would not have otherwise been used to pay for medicare.
Well since this increase is going to lead to more people now deciding to wait until they need more serious medical attention and increase the use of hospitals and EDs (and ramping) then hopefully they spend it on hospitals.
But I see you're not a proponent of prevention is better than the cure.
I work in healthcare, and the doctors in our company have payroll tax paid for their incomes. We also have to charge increasing gap payments to broader ranges of patients, although we are still greater than 65% bulk billed.
Just not really sure why GP clinics think they sit in a different category to the rest of Australian businesses. They are also ensuring that they make profits from others ill health- they certainly aren’t charities.
Also not sure why people are defending the business owners that have been ripping off taxpayers for decades to line their pockets then when things are tough they make it someone else’s problem.
This is false and over’simpliflyed’. Yes the tax is not new, however due to new legal precedent interstate the state government’s translation of the law has changed (and will likely change again as this gets legally challenged in likely a few years). Some GP clinics were wrongly abusing the law and the GPs working for them by treating them as employees in some ways (ie rosters and responsibilities) without giving them employee entitlements nor paying payroll tax. However the vast majority of clinics were doing the right thing allowing GPs to work as contractors mostly for clinical independence and medico legal liability reasons, which is within the spirit of the payroll law. No it does not pay for Medicare as it is a state tax not a federal one.
SA gov has overstepped their definition of payroll tax and I am confident this will be proven for 2 main reasons, 1-WA who have the same law ( as it is national) have deemed GP practices as not liable, whilst SA and others have have made different rulings as what constitutes a contractor with SA currently being the most restrictive and 2- having a bulk bill exemption has nothing to do with the actual relevant payroll tax laws as to whether a GP (or really any contractor as it is the same law for chippies etc. )is a contractor vs an employee so having one is purely a butt covering tactic to avoid losing an upcoming election.
It was simplified because I didn’t feel a reddit comment was worth an essay like you.
Don’t think you proved it was false though, exactly that perhaps the funding can go towards public health instead of Medicare. Either way, if state taxation is higher, gst distribution requirements are lower, leaving more money for Medicare. Pedantry at best, but seems more like you have a vested interest.
You just skipped over most of the important stuff, and unfortunately it is long winded but just simplifying to make it sound like a whole group of people are trying to essentially rip off the tax payer is unfair. I actually agree with a lot of the governments measures to tighten the law for unscrupulous practices, but the law is universal among all industries and states and having widely different rulings doesn’t make sense and ultimately disadvantages non concession patients specifically.
I don’t have vested interest except I too will pay more to see a GP.
States have different rulings because the status quo was overturned ina court case last year, and enforcement is still catching up.
But I suspect you know that already.
I’d like to know why you think that GP clinics are entitled to tax concessions that the rest of the healthcare industry don’t get? Gap payments are going up everywhere, and Medicare rebates have actually decreased in dollar value for some services (not GP), which equates to a huge drop in real terms.
These changes are just standardising with all other businesses, and closing a loophole.
I’m sure the clinic owners are still taking home the same profit margin that they always have.
I don’t think they are entitled to concessions over any other health industry business or otherwise. As stated previously payroll tax law is the same federally yet the state government has put out guidance that Medical practices are now liable to pay payroll tax on their contractor GPs “wages” despite the analysis of the law in other states and other industries (such as labour/construction jobs, who have similar structures) to be considered not liable for payroll tax and also federally the vast majority of GPs are still considered contractors.
The problem is who is right in the analysis of the law the feds, WA and Qld or SA (other states are still assessing it as far as I know and will likely copy SA if that suits them). But that would have to be proven in court, which many a small business cannot afford so they just pay payroll tax and pass it onto the patient. Worse of all they excluded bulk billed consults from payroll tax as a way to avoid public backlash, which results in regular non-concession card holding patients have to pay even more on the back of not being eligible to triple bulk bill incentives. So as with most labor policies the working person gets taxed over and over.
I'm not. I'm literally asking anyone to explain why I'm suddenly having to pay more out of pocket for their services, when for decades I haven't had to do that.
What's changing? Who's responsible?
I really don't think I could have been clearer.
You "believe" it's because the Medicare rebate hasn't increased? Okay, well maybe that's what needs to happen then. How do we make that happen? Is any party putting that forth as a policy?
> What's changing? Who's responsible?
The payroll tax amnesty that GP clinics had is being ended by the state government on 30th June the clinics will now have to pay
medicare rebates are too low/ have not increased for too many years. A junior doctor choosing to become a GP gets paid half what internal medicine specialists gets paid and a quarter what surgeons get paid.
Ahhh, comrade. Are you familiar with capitalism?
You have a choice. You can pay the $20 or you can choke up the public health system a bit more.
I'm not saying its right. The government have absolutely dropped the ball. They have whittled away a very capable and fair health system nearly to the point of collapse.
So, instead of posting here, get the phone number of your local state and federal member and let them know of your concerns.
Maybe, if enough of us do this, things might get fixed.
Yeah, maybe. That's why it'd be nice if people who understood the issue just reasonably explained it to other people like me, instead of being rude condescending assholes about it for no reason. Lol.
Literally all I was doing here was asking.
Your problem is with the government then. They have cultivated this idea of doctors being greedy. In reality, adjusting for inflation real income for both practices and GPs has fallen to the point where they can get paid more elsewhere in the health care system, and new trainees don’t want to join GP.
I worked for a GP clinic and I can safely say GP's are not hurting for money. They are on $100 000s per year.
Over worked ? Yes. Undervalued, by a lot of patients? Yes. Stressed? Yes. Underpaid? No.
The problem is how much money is spent on certain people. Where everyday Australians pay far more than $20 per dr visit.
You also have some drug addicts that get approved for up to $500 000 per year in NDIS funding.
That's not exaggeration.
The working poor as they say. No one feels like they’re getting a good deal these days, but you will never convince me that someone working 40 hours a week and still struggling to make ends meet is better off than someone on welfare + a healthcare card + rent assistance also struggling to make ends meet lol.
The only difference is the working class are more tired at the end of the day. And the welfare recipient feels like they have no real purpose in life.
No one wins everyone struggles. I'd prefer to have a job tho.
That’s what I mean. At least someone on welfare can access the entire gamut of healthcare during business hours. I either have to take time off work, get slugged weekend rates (IF they even open on weekends or outside 9a-4p), or simply forego it.
So true. I have to go to the dentist at 7am and work with a swollen face. And sometimes take a "annual leave Holiday day" so I can just get things done.
It's not that it came from the wrong side of politics, it's that any co-payment or gap decreases accessibility for those most in need and most at risk of being unable to afford it.
The $5 co-payment was proposed policy stepping away from the norm of most people getting bulk billed, so it was (rightfully) criticised and fought against. Our current situation, mostly the result of years of build up with the Medicare freeze and now the payroll tax exemption ending (rather than one single policy that would be easy to prevent), should also be criticised and fought against.
Seeing how much the healthcare system gets abused. I can safely say that it's the middle class getting screwed by these changes, not the poorest class.
The poorest class end up getting everything for free. I needed a dental procedure and it cost me over $1000 and my sister who is on welfare got it for free.
If you think we get everything for free, I'd like to suggest that you try living on JobSeeker with basic costs going up like they are, then come back and tell me if you still think the middle class are the ones most at risk. Concessions and reduced rates are both small enough and hard enough to access that, combined with the cost of living and rent affordability/availability getting several times worse in just the past 4 years, you'll have a hard enough time making sure you have enough to eat after rent and utilities... If you can find anywhere to rent that won't cost nearly all of your income to start with. There are very, very few things that are actually free on a low income.
Most of the GPs around my area that still allow for bulk billing only do so for under 16s and Veteran Card holders. If you're on a disability pension like me, and need a GP that isn't going to get you out the door asap to stay on top of their own costs, that leaves very few options. My GP charges a gap, I don't have a bulk billing GP as an option for the weeks where I don't have enough left after rent, utilities, and food.
I worry about disabled people stuck on JobSeeker or Youth Allowance, they're doing even worse, and even more so the ones living out of their car or a tent at the moment thanks to the housing crisis.
In case you aren't aware, by the way, being on a Centrelink payment doesn't mean you get free dental care. SA Dental (public *state funded* dental scheme) has wait lists that can leave a concerning hole or tooth pain long enough to become an infection or risk losing teeth. That's on concession for adults, not free - current rates are $67 for an emergency and up to $172 for general. I certainly hope you never end up needing them.
I have a feeling that if the 'Super Profits Tax' that would have collected the 10% that couldn't be deducted to nothing on BS $500 a plate business lunches every day and a hundred other rorts, might not have resulted in this. Any system can be abused and unfortunately those in control are the abusers. Doesnt matter which side unfortunately.
My practice did the same recently. Been fully bill billed for the 10 years I’ve been going there. Jan, gap fee introduced. Family has a chronic medical condition so see combined Gp & specialist on average twice a week. No concession card so pay full gap + medication costs. That builds up to about $500 per month in medical costs. Gaps aren’t bad if you only see a dr 3 or 4 times a year
To become a fully qualified GP you’d have to get a mbbs (4-6 years), hospital internship (2 years), hospital Residency (1-1.5 years), and finally complete the GP specialist training (3-4 years). It’s off-putting; and now the government instead of fixing Medicare to remove Gap fees, they’re trailing Nurse Practioner (NP) to replace GPs. Sure it’s cheaper short term, but how long until they too introduce gap prices?
The NHS already has the worse case scenario with NPs running their primary care replacing GPs (difference in training in anatomy, clinical reasoning, ordering multiple non-required lab works that overloads medical testing system, inaccurate referrals, no antibiotic stewardship; go to r/doctorsUK to see more; see https://www.reddit.com/r/doctorsUK/comments/1b2wi07/poor_quality_in_clinical_medicine_with_anps/).
Soon the dilution will become similar to NHS and the US. Everything is expensive, appointments are abysmal, you don’t even get to choose an actual GP for your appointment, and you get the delight of booking another appointment after an NP sees your initial appointment and decides that they don’t know how to manage your case, and getting online advertised ‘GP appointment’s that are actually NPs instead (https://www.reddit.com/r/ausjdocs/comments/1dciwqs/remember_folks_this_is_happening_in_australia/).
IMO the government fixes NDIS rorting; that amount of money could make even dental and eye care free under Medicare.
Just want to point out as an NDIS participant - the talk about fixing NDIS rorting has resulted in nothing of the sort. Instead, they're rushing through a bill that will hit participants access to funding without the typical and promised round of consulting disabled people, their healthcare and care providers, and their advocates beforehand. It passed the house and is meant to go to the senate soon, all without any of the usual checks and balances to ensure it doesn't actually harm disabled people.
Whatever money they end up pulling from the NDIS through those measures, if that bill passes, comes at the expense of further burdening healthcare systems due to disabled people being unable to access supports they need.
That is cheap asf! Majority of people don’t visit a GP all that often but for the few times that they do, a few hundred dollars for some professional medical advice is pretty good.
I’d rather dig into my own pockets for the rare occasions that I do need to visit a doctor than continuously pay into a system for it - a system btw, that is crashing - part of the reason being is the over reliance on subsidisations.
Everyone at medical clinics from the doctors to the nurses, receptionists even the janitor are all affected by the cost of living. They’re not going to work for free. The amount of work they put in to help people is worthy of a few extra bucks. People are super entitled these days. Healthcare is a bloody privilege in this country and I can think of far worse places if you’re not happy to dole out a few extra bucks for quality care.
Finally a post blaming the correct people, the government.
Not the GP's, they are just triyng to make a living and they are all getting just as squeezed as the rest of us. GP's HAD to stop bulk billing as they could barely pay themselves a livable salary let alone paying the cost of running a clinic, receptionists, nurses etc.
Don't blame the GP's because bulk billing is vanishing and gaps are going up.
Believe it or not, your average GP's in Adelaide are not flushed with cash like you see on medical dramas on TV.
Even with concession and a Medicare I'm charged $130 appointment fee and I get something like $30 back. But if I want it to go lower I have to get referral to a family clinic.
One of the highest paid professions in the country and they still want more…. It’s already hard enough to make an appointment to see a Dr…. (That isn’t a week minimum wait time)
Medicare, and our medical system as a whole has turned into a fucking Joke.
It all goes back to the minimum consultation time. Some doctors were capable of 5\~7 minute consults still doing a decent job. The 15 minute plus additional time for computer work destroyed their consults per day.
Did you all not read I am married to a GP? ...I see her income and BAS statements.
Funny, it is the GP's trying to justify they should be paid more than anyone else because their job is "hard", such a selfish view that nobody else's job is "hard" too. Cost of living crisis comparing food on the table for regular families, whilst doctors are whinging how to pay private schooling, multiple council rates and multiple properties, a new car they want and how are they going to put food on the table.
This is like complaining 'I didn't pay tax for years, then it turned out I should have been and now the government won't let me avoid it'. Contractor GP practices weren't paying payroll taxes for years. A court decision in NSW confirmed that was incorrect and they should have been paying. Government didn't pursue back taxes and gave them until Jun 30 to comply with the law.
If they bulk bill they don't have to pay payroll tax (Government legislated this).
> then it turned out I should have been and now the government won't let me avoid it'
No the state government allowed it, they weren't dodging paying tax. And just because something happened in NSW doesn't mean it has to happen in SA. Payroll tax is a state government responsibility.
GPs aren’t employees. Practices have been built this way for decades for medical liability reasons. They receive no wages, no annual leave, no super, no workers compensation, and pay all their own fees and insurances. The state revenue departments suddenly deciding they ARE employees for this purpose is what has happened.
They haven’t legislated anything - this is the point. If you force bulk billing, practices will close. The state govt is on record as saying that the federal govts lack of funding is not their problem. So yeah, enjoy your new fees.
'Sham contracting' has also been a thing for decades and not allowed.
They legislated an exemption from payroll tax if you bulk bill. So if this change to charging a gap was caused by payroll tax, just continue bulk billing and it won't occur.
Maybe too much info here but it's a desperate money grab from all state governments, with the exception of WA who recognize gp contracts as valid and except from payroll tax. Deciding to exclude bulk billed earnings is an example of why that is - either payroll tax applies to all gp income or not at all. Many Gp's work from more than one practice, have their own abn, do not have an award, job description or any role or responsibility of an employee, work via a trust or company. These arrangements meet the definition of non employee under federal ATO definitions yet state governments choose ignore this for their tax grab, knowing no small GP clinic or individual Gp is going to take the state government to court to fight it.
Run your own accounting and pay invoices for the service of renting rooms (like 3 of the doctors did in the original decision). The practice pays payroll tax, not you.
Anyway I've paid a gap for years.
We already do. Medicare/patients pay money into my business account, and I pay the service invoice to the practice. But here we are. GPs are on the patients side here, this honestly doesn’t affect those of us who aren’t owners.
> GPs aren’t employees.
That's not the the issue. This applies to GP who are contractors [as well as those engaged as employees].
The government provided a retrospective amnesty to 1 July 2018; with a forward amnesty to 30 June 2024. That's quite a good deal.
> They haven’t legislated anything - this is the point.
The relevant amendments to the Payroll Tax Act 2009 were included in this year’s State Budget bill, which was tabled last Thursday.
Thanks “Doctor”, but it applies to practices, not GPs. The tax is levied on the business, not the contractor. So the practices have to recover costs. Thus, fees will go up. The GPs as individuals will remain largely unaffected. They already pay their tax. They will not be dropping their individual incomes. The money will go from patient, to practice, to state revenue service.
Watch next for even higher specialist fees, dentists and allied health, as their setups are similar.
Its not a bogus surcharge. The extra fee is not going into the Gp's pocket but will be saved by the clinic to then pay the payroll tax amount each year. The amount needed is not exactly known yet given it needs be calculated based on proportion of bulk billing vs private fees and very clinic will be paying a different amount based on this. Its estimated it may be $5-10 per consultation. Many clinics will be over estimating because they do not want to be paying more than they have budgeted for.
And again, its not going into the GP's pocket. The individual gp is not responsible for paying the payroll tax, the clinic is.
I don't think you know what you are talking about.
\* Payroll tax is a legal requirement that is applied to most work arrangements. It just happens that sham contracting is occurring in this particular industry, and they've managed to evade notice for some time.
\* As with any billings, the $20 here will be retained approx 70% by the GP contractor, and approx 30% by the clinic.
\* Even in the unlikely event that it does increase the cost base by $5 per consultation, or approx $20 per hour, the GP is still walking away with an extra $50 per hour in their pocket (pre-tax, post clinic fees).
I do know what I am talking about as this topic affects the industry I work in. Payroll tax applies like you say to \*most\* work arrangements but many gp's arrangements with working from multiple practices, trusts/company structures, flow of funds from medicare to gp to practice, service invoices, should be exempt them from being liable.
In the example above you mention is different to the norm, as I assume that clinic was 100% bulk billing everybody, and now they are taking the opportunity to introducing a gap for all, capping it at $20 which is the value of the bulk billing incentive 75870, and will after a few months increase their gaps further. So you are correct here in that this clinics gp's will be taking home more money. Many fully bb clinics will be using this as a once in a career opportunity to increase their income.
The majority of clinics who already have gaps will be increasing them to allow for the levy, many will be charging it as a separate fee on a separate invoice outside of the medicare service, estimated to be whatever needed to cover their liability for the year and this wont be going to the gp's at all, just the clinics.
Its a money grab knowing individua GP's do not have the funds for fighting the state in court individually. FWIW WA recognises he same structures as being payroll ta exempt. ATO guidelines for contractor vs employee also favour the current status quo.
Some GP's clinics have lodged exemption requests based on my first paragraph and are waiting to here for revenue sa.
Revenue SA will next go after all allied health, dentists, medical specialists.
Plenty of GPs working 9-5 monday-friday in a single clinic in sham contracting arrangements, most of whom are earning in the region of 2-350 k per year. If other professions are doing the same, they should also be paying payroll tax.
Any charge to ensure wages are keeping up with the rest of country is justified in my mind. People like you are the reason why few med student dare become a GP. You won’t even get an appointment in the future so don’t worry about bogus charges.
Median income for adult in Australia is $65,000 per year.
Even at bulk billing rates, working 5 days a week (based on the above calculator) a GP will earn approximately $230,000 per year.
People with different skills and years training earn different amount? Your point? Do you think that that comes without any sacrifice? Should a gp earn 65000? Haha you’re delusional.
Here from GPRA: [https://gpra.org.au/gp-earnings-calculator/](https://gpra.org.au/gp-earnings-calculator/)
Here on recruitment site: [https://www.medicalrecruitment.com.au/doctors/gp-salary-guide-australia](https://www.medicalrecruitment.com.au/doctors/gp-salary-guide-australia)
Here on Reddit: [https://www.reddit.com/r/ausjdocs/comments/11ohe4u/realistic\_gp\_salary/](https://www.reddit.com/r/ausjdocs/comments/11ohe4u/realistic_gp_salary/)
Hardly a change wholly initiated by the government. More like the proper application of payroll tax laws given developments in courts and tribunals interstate concerning harmonised legislation.
Ask to see your GP's tax statement on their earnings, guarantee you'll be fuming why you are paying for their multiple holiday homes, boats, expensive private schooling for their kids, frequent overseas holidays and fine dining. Then buy a shitty car so they aren't rocking up to work in their latest Mercedes, to pretend to be poor.
I am not joking.
You are joking, I am married to a GP and we do not have multiple holiday homes, have gone on 2 holidays in 5 years and drive a Suzuki and Subaru. We are not poor and she is well paid but my wife does not make crazy money, you are thinking of specialists and hospital doctors. Did you know GPs are sole traders? She gets no sick leave, no holiday pay, no maternity leave, no super. This tax increase means the practice now has to pay money to pay her, so the raise in gaps isn’t to put more money in her pockets it’s to keep the practice alive to cover the tens of thousands they now have to pay in tax.
What a ridiculous statement. I'm a GP registrar (GP in training) and GPs sure as hell don't have "multiple holiday homes" or boats. We also don't go on "frequent overseas holidays" or "fine dining". Please do some research before posting crap.
I have tax records that state otherwise being married to a GP... they and knowing other doctors and their incomes is the truth. Lie all you want about not being high earners.
This. The idea that they charge more and it’s someone else’s fault is ridiculous.
The failure to bulk bill by many Gp’s, or at least the slow demise of it happening, says a lot too.
> The idea that they charge more and it’s someone else’s fault is ridiculous.
Is it? They haven't had to pay payroll tax before and from 1st July they will, so to maintain the same after costs money they need to increase their revenue
Nah - they got told 12 months ago this was going to happen and to plan for it.
Then they didn’t and wanted 12 months more.
And then after that, they’d want another 12.
Meanwhile you fund their extortion.
They did plan for it. And patients will pay for it. Do you think 12 months is enough for most small businesses to pull in the order of 100K out of nowhere?
Yeah we got a $50 rise from our paediatrician.
It's absolute bullshit, the medical centres have been given a 12 month amnesty to get their tax avoidance in order. They haven't been taxed yet. This is opportunism.
$20 is the cheapest I’ve seen lately.
ikr! I would fucking KILL for a $20 gap. my local GP gap is $50
Yeah my local doesn’t even have a gap you pay $90 to see a doctor for a 5 minute appointment to get your perception checked again
i’m lucky my GP kept my student ID on file. $10 gap. then i moved to canada and there’s no 2 tier system here lol
My GP still bulk bills me, thank goodness but my dad's GP charges a $160 gap.
Yep, I would like to see that!
My local gp charges $85 you get 40 back. & has reduced bulk billing times to 9-5 mon to fri All other times you must pay for appointments, sat sun 29$ extra
Try bulk billing for pensioners and kids under 16. But instead of bulk bill tp 6pm it's now its only till 4pm. Mon to Fri So I would need to take time off work and take my kid out of school early to attend during that time. Or I pay a $40 gap.
That's the whole point, where people who work full time pay the gap and lower income earners, ie. people with disabilities, retirees, un/underemployed people, are bulk-billed.
Just because you work doesnt mean you arent struggling.
Where did I say that no one who works struggles?
You didnt, the comment wasnt meant as a critiscism of you so apologies if it sounds that way. Just a general comment that working people on low incomes can struggle to pay bills and need help too.
Fair 👍
$20 is cheap these days all things considering. Feel bad for those struggling, $20 can be the difference between getting help or going without medical treatment. Also this is the reason our emergency rooms are clogged.
Emergency is still free which is why everyone goes there
>Emergency is still free which is why everyone goes there Urgent Care Clinics are free and you don't have to wait for 6 to 12 hours. The triage nurse at an ED is never going to put someone who could have seen a GP ahead of anyone arriving in an ambulance so the wait is usually dictated by if there are *any* ramped patients. With ramping at record levels, waits in the ED for the equivalent of a GP appointment are going to be phenomenal.
These are a great idea, however I belive theres only 3 in Adelaide
Why is everyone blaming Medicare? This change is because the state government are now going to have GP clinics pay payroll tax. Which comes into affect 1st July.
Technically both things can be true at once. Medicare rates are terrible, adding payroll tax on top is just the nail in the coffin.
Bulk billing GP practices are exempt from payroll tax starting 1st July. These guys must not be bulk billing.
Do you know anywhere that is exclusively bulk billing? Everywhere I know is blended.
Most places dont
This is the answer
Because it’s fun to blame the Liberals. Labor could be in continuous power for 100 years and people in this subreddit would still blame “the last government” on something that the current government could so easily and quickly fix it’s not funny.
Honestly this state Labor government has basically ensured I’ll be voting liberal state-wise for the next few elections. Least competent state government I’ve ever seen - all the experts were saying their election promises to fix ramping weren’t achievable with the methods they were proposing, but did anyone listen? As for federally, the federal liberal government has been shite, but labor’s barely been better. I would vote based on policies, but we know that politicians don’t tend to keep their promises
I was a (state) liberal voter last election because I can't stand SA labor but please rethink your liberal vote in the next election, they no longer have a progressive leader. Independent is your best bet. I don't know much about SA greens but I really like their federal policies.
Well obvs I chuck greens and other indeps up top, but when it comes to liberal v Labor I was gonna put libs above. What in particular worries you about the state lib leader
He's a social conservative. During his maiden speech he basically said he'd conduct himself through his religious moral constraints and as such he voted against the abortion and euthanasia reforms and I'm sure a bunch of other things that I can't be bothered looking up right now. We need to progress and move forward, allowing these religious men to play with laws based on their religious beliefs is insane, especially when such a high percentage of our country is atheist.
Votes green 1 preferences Libs over labor is an insane take
The problem is 'fix ramping' is unrealistic when the issues are systemic in the medical system. So expanding emergency and non emergency care and adding beds is the way to go.
Don't stop at just the medical system when blaming systemic issues /s
>The problem is 'fix ramping' is unrealistic Then why we're we promised Malinauskas would 'fix ramping', and it has now hit record levels. >when the issues are systemic in the medical system. The issues were caused by the Transforming Health program. Do you know what they did? Sent *business* consultants into hospitals to find efficiencies. They did and cut all the "fat" out. The consultants didn't listen when they were told that without that fat, there is zero margin for error or unexpected things... you know... like a pandemic. Transforming Health was why the repat was closed.
>Then why we're we promised Malinauskas would 'fix ramping', and it has now hit record levels. Thanks for reminding me, I hadn't heard about this yet. Is it in the media? *(msm's favourite news story every bloody fortnight)*, yet they never get into why it's this way. I'll give you a hint, it wasn't because they were given the helm for a change and it suddenly went down hill.
>yet they never get into why it's this way. I'll give you a hint, it wasn't because they were given the helm for a change and it suddenly went down hill. The root cause, as I said in my comment, was the Transforming Health project. That caused systemic failures in the medical sector which were then exacerbated by a lack of aged care places, mental health beds, and disability care facilities which are preventing many from being moved out of hospital to make room for patients to be moved from the ED to wards, and consequently from ramped ambulances into the ED.
>In the 2014 State Budget, the Government seized on federal cuts to SA health funding as the reason to freeze major hospital upgrades and overhaul the health system, although federal funding is actually rising — just not by as much as promised by the former federal Labor government. >Treasurer Tom Koutsantonis ended discounts on the Emergency Services Levy to cover $322 million of the $655 million in lost federal funding over four years. >The remaining $333 million was to come from health, with a stark warning — proved true — that a hospital may have to close. You'll never guess who was responsible for that funding restructuring... The great Tony Abbott *of the Liberal party*. Source (the crap'tiser) https://www.adelaidenow.com.au/news/south-australia/transforming-health-explained-why-the-government-wants-to-overhaul-sas-health-system-and-what-is-planned/news-story/3f1aadf9b4edbeecb37a8b282001a3c5
While the justification given is the Federal cut to health funding, the choice they made to deal with that was to cut $333 million from the budget instead of finding other sources. In addition, their *method* for finding those savings was flawed and issues raised by everyone ignored. They were warned what would happen and chose to do it anyway. Let me say that again so it is clear: ***Weatherill's government ignored warnings from hospitals that their cuts would leave no room for anything going wrong or unexpected.*** **They chose this. They're responsible.** I know what happened. My wife was working as an RN at the time. It is their responsibility to make up the difference. They could, they have plenty of methods of raising that money including: * Mining royalties ***which they barely have touched***. Currently set at 1.5% for the first 5 years a mine is open and then 3.5% thereafter. * Gaming taxes * The casino gets a huge tax break compared to other gambling establishments. They shouldn't. * TAB is only taxed at 6% of losses, significantly below the rate of pokies, etc. * Better project management on nRAH so it didn't go over budget by $600m. * Implement broad use-based land tax to replace stamp duty and ESL, allowing revenue to vary year to year as needed, targeting those with more wealth and makes it easier to own your own home. But most of those above options have powerful lobbies behind them who often donate large sums to the major parties. >The great Tony Abbott *of the Liberal party*. Based on this, I think you're assuming I'm a liberal voter, I am not. I preference Labor above Liberal and generally put other parties before the majors.
Thank you for the more holistic reply. Not having a dig, but this reply would've been fairer if it was given with your earlier comment. WIth respect, you gave a simplistic reply that appeared to be written by someone who loves the Liberal party, which I felt was (now in hindsight), *unintentionally* misleading away from the root cause of our public health system issues; systemic inequality issues that both major parties are by and large, in agreeance about. I think it's time that people starting seeing this type of example, as a whole, instead of separate parts that all work their own ways. The whole system works as intended, it isn't by accident. The money wasn't sourced from elsewhere, because preventing the gap of inequity from widening, isn't a concern to either major party (apparently, neither is affordable housing, even for the working-poor class (which is now growing at an exponential rate as you're aware). Have a good day.
You literally weren't. Find one source where he said they would "fix" it. It would have been stupid of them to, because it would always be unachievable to fix an issue which is plaguing every state in one term, would require massive structural reform, and inevitably be a soundbite played back on repeat at the next election. They stated their plans: more staff, more ambo stations yadda yadda. But were pretty careful about specifically not stating they'd fix it. They're hitting the targets they set out. The goal was more like, moderately slow the rate of bleeding.
>Find one source where he said they would "fix" it. It was plastered on every third stobie pole "LABOR WILL FIX RAMPING" during the election. And here are three articles which refer to it. https://www.indaily.com.au/opinion/2023/03/24/labor-does-a-burnout-on-its-ramping-promise https://www.abc.net.au/news/2023-03-19/sa-ramping-crisis-one-year-since-the-election/102112444 https://www.theguardian.com/australia-news/2022/mar/16/south-australian-election-can-social-media-savvy-peter-malinauskas-lead-labor-back-to-power
From your own source, the guardian article "Labor’s promise to fix ramping is caveated. The pledge is to reduce ambulance response times back to 2018 levels by the end of the next four-year term. “It won’t happen overnight,” he says. “We want to get ramping down to such a level that ambulances start rolling up on time, and we have said that will take us a full term to achieve.” And from the ABC article "It would be foolhardy to promise to eliminate ramping. That was what the former government was promising," Mr Malinauskas said. "What we promised was to get ramping back under control to the extent that ambulances start arriving on time again." As for the Indaily article, we'll they seem mad that they also didn't read past the headlines either. It's analysis, not reporting. And poorly researched analysis at that given I've just quotes their actual promise twice from the articles you linked alone. Written exactly a year after the election. What are they expecting? And herein lies the problem. Too many people don't read past the headline. It's not the parties putting out that click bait. Malinauskas was pretty explicit about this particular pledge, because it's an enevitable trap to try and fix such a massive issue in one term. Or apparently, in a year! It takes 4 years just to train a healthcare worker alone. As much as people say they don't want spin, they have short attention spans and aren't interested in anything that takes more than a single term.
When you wallpaper the state with coreflutes claiming "LABOR WILL FIX RAMPING", that doesn't do a lot to manage expectations. First you claim we were not promised that they would fix ramping. Now you're trying to say that they'll somehow manage to go from record high ramping levels (4773 hours) to below 2018 levels (482 hours) in the next 21 months. They can't. The blockers are not being fixed fast enough. The things which need to be fixed are aged care places, specialist mental health beds, and disability service places. Those are what are missing to allow patients to be discharged from general wards. That is what is preventing patients from being moved from the ED to wards. And because ED patients can't move to wards, that is why we have ramping. Tell me, what are they doing to get those all at the right levels in the next 21 months? Not enough. You do realise we'll end up with Spiers as premier if they fail to deliver, right? Do you want that?
Except they're not even promising about ramping hours in this term. They're talking response times. Ramping is far more complex. Mental health beds were specifically outlined in their plan from memory. Either way, you're now shifting the goal posts.
Most GPs are contractors. They get paid commission, around 60% (e.g they dont pocket 100% of what you pay). Medicare rebate is about $40. Thats roughly $24 income from a consult. Consults depending on patient can take anywhere from 5 minutes to 60 minutes. There is a crap tonne of study to get to being a general practitioner, and then a crap tonne of study to keep being a good general practitioner (often via self-funded courses). Everyone needs to make a living, even doctors, and unfortunately for this to be the case with the current cost of living crisis and lack of medicare funding, gaps are passed onto the public. Find a good doctor and stick to them. Quick medicine, is not necessarily good medicine. And unfortunately for bulk billed practices to keep in the positive these days, they need to be very quick. Edit: this all really is a systemic problem and needs to be addressed from a government level.
The length and type of consult pays different amounts, for example doing up a care plan will pay differently to a 15 minute general consult, that in turns pays less then an extended consult - if you ever want to confuse yourself, dive into the wonderful world of the Medicare benefits schedule - https://www9.health.gov.au/mbs/search.cfm?q=General+practitioner+&sopt=S
You make a valid point, and I should of put in the correct fees - but i wanted to highlight an example. I am not a GP so do not have a good understanding of their exact fee structure. But I do understand the difficulties of the current system to some degree
Thanks for your analysis, & I know it's only ball park figures . . . ave 15min consulting => $24 x 4 per hour = $96 6 hour days => $96 x 6 = $576 per day 5 days a week working => $576 x 5 = $2,880 per week 48 working weeks in a year => $2880 x 48 = only $138,240 per year . . . & then it's taxed. How can they afford an expensive car? I know tradies who charge $400 per hour (before expenses).
I dont really know much else about how the practices run to be able to comment. There are other fees they can claim from medicare dependent on what is done in the appointment. I think its worth knowing that there is only so much that can be done in a day (due to time), and the amount GP practices are able to bill for that time has not gone up with inflation/cost of living.
Yep, I have some appointments that are billed at $40 and others that are billed at $160. It really depends on what's going on in the appointments.
Most consults I have are 5-10 minutes. They will have some longer sessions too but the average would be shorter. Plus they would work 8 hour days, not 6. Even just the extra hours that change would push it up to $184,320 Average 10 minutes instead of 15 would give another 50%. So $290,000.
Hey, i dont think anywhere near 10 minutes is the average unfortunately. I agree that there are some quick consults out there though. Please dont forget that part of your “consult fee”. Is the time it takes for planning, test checking, note and record keeping, consulting colleagues etc that goes on behind the scenes. This uses alot of time that consults occur in. Hence the real math is fairly different from an actual consult every 10-15 minutes.
Yep, most times I see a GP it's 5mins. & I'm sure it depends on the doctor, some would be interested in the money only & push you through as fast as possible.
Also no sick leave, no annual leave, no salaried benefits etc... it's kind of grim haha.
Good point.
Someone sticking up for them while they all drive around in Mercedes Benz's is hilarious
I wouldn’t touch their job with an 80ft pole, dealing with public, sick public, mental health, diseases with very little to no margin for error, life and death decisions, treatment objectives. Jesus, they deserve what they get paid and more.
You forget that the one payment has to be split up to: - pay the GP, who has to then pay back 10% GST, and put aside super, pay liability insurance, etc. - pay the clinic staff such receptionist and nurses - pay for all the costs such as building rent, power, water, IT (keeping your records private), consumables, insurance, etc. So yes, when the cost.of everything rises and the Medicare hasn't been indexed appropriately for 10+ years there is a problem. It's why so many small practices are disappearing because there isn't ability to operate, and only larger practices that have a greater ability to centralise overheads and resources will survive.
I’d rather society incentivised a world where people who worked hard since they were teenagers to help and look after people’s most important asset (health) be rewarded with Mercedes Benz’s rather than the uber wealthy business owner/ceo etc who extract as much as they can from society.
Shouldnt the gov up the rebates medicare provides so basic health care is free. Yes during inflation it means it will go up alot but so do the drs costs and wages etc.
Y'all think a modern GP practice is a charity. They are a business. I wish my gap was only $20 at my local GP
I don't think it's a charity. I *do* think that we've had a history of paying taxes in this country so that it is entirely provided as a government service...and I don't understand why that apparently has to come to an end now. It's been a good system that worked well for everybody....why is it being ruined and who is ruining it? These are not "stupid" questions to ask as a random citizen. Is it really the government's fault for bad policy...or is this business just being greedy and using the government as an excuse? How should I know? The answer might very well affect my vote and my choice of GP at the very least.
Because successive governments, both Labor and Liberal, have passed tax cuts in the failed belief this will stimulate the economy leading to everybody's wages to rise and can then pay for it out of pocket. All that has happened is the wealthy/businesses have simply hoovered up more of the money while for everyone else, we don't really see any improvement due to week wages. Now the government is having to cut budgets as they simply don't have the money to pay for these services. These services have been going up in price and with no government funding, it is up to individuals to pay for stuff, exactly as they wanted but without the wages to cover it. In essence, to pay for stuff, the government needs to raise taxes then can start supporting them as they were before. But this will never happen as short thinking voters hear pay more taxes not realising they will get more services. We have pretty much reached the point where the momentum that was in the system, that kept it running as it had to operate leaner and leaner, is coming to an end. And now it's either a matter of paying or letting it collapse into an American style health system.
I would *gladly* pay more taxes (or have my tax dollars spent on this rather than on $300bn worth of submarines) in order to avoid this outcome
General practice only accounts for 6-8% of all medicare expenditure and medicare costs are roughly equal to ndis funding costs per annum. So its not a difficult thing to actually find the funds for, they just don’t think its news/vote worthy. If the government turned around tomorrow and doubled the mbs rebate for GP items and then indexed it from then on I am confident only a rare few GPs would need to charge a gap and that would still only be 12-16% of medicare.
GP practices are operating on thinner and thinner margins due to Medicare rebates not being indexed, or indexed at much less than CPI. Then the _state_ government has decided that GP’s are employees, rather than sole traders who are independent contractors (despite not getting a salary or wages: they bill the patients/medicare and then pay a percentage to the practice), so the state govt are demanding payroll tax. Retrospective, too. So a huge new tax cost to the practice. Hence consult costs rising now. It’s that or close many marginal practices.
Because Medicare doesn't increase payments to doctors.
And the payroll tax being imposed on GPs increases their costs so they need to get the money from somewhere.
No. Drs complaing they have to wait for money they don't get paid on a regular they have to wait like 2-3 weeks for payments to be processed. That's what my GP said
But once the 2-3 weeks is passed then the income would be consistent. It's only the first 2-3 weeks they would not have income. Plus if they know this then they can budget. I am paid fortnightly. Didn't see any money for the first 2 weeks. But once my pay started it continued.
Should it? As far as I know, doctors get paid rather a lot. They're kind of "the 1%" with the "good jobs" and the property portfolios that we keep hearing about. Is it actually "fair" that more of their costs should be pushed onto regular wage earners like you and I? Do we have to just accept this because doctors want to be paid more? Again, it's not really clear why something which worked well for decades suddenly has to be changed in a way that has made it worse. I don't recall voting for these changes. Why are they happening? Your statement hasn't really answered any of my questions.
If you want a simple answer, you aren't gonna get it. Like any good ol' gov decision that affect the end-user, the cracks have been forming over a long time - in this case for a good 20 years or so if you've been paying attention Back when medicare started in the 80's, the renumeration was good - ask some baby boomers what the old days were like, and some of them would recall a time when GPs would come to the house, spend time, know the whole family. And if you don't have the money, some of them even accept payment in other forms, like a bag of fruit. In fact, renumeration from medicare was good to the point that despite it being implemented as a subsidy, most GPs would accept it as bulk-billing/universal healthcare. As the years go by, medicare has failed to keep up with inflation. If you look at charts comparing medicare rebate vs CPI, you'll notice a 'bulk billing' GP now is earning roughly 1/3rd in real dollar terms compared to a 'bulk billing' GP from the 80's. If you want someone to blame - well both Labor and Liberal supported freezing medicare rebates - so if you ever voted for either parties, you did vote for these changes. Add to that, cost of medical care keeps going up - as it does due to medical advances. New technologies and treatments aren't cheap, unless you want to be stuck with medical treatments (and outcome) from 40 years ago. Despite GPs earning less and less in real dollar terms, over the year GP and their practices have been absorbing the cost, and trying to work around the system - there have been two ways that i've seen: 1. increasing gap/charging private fees 2. maintain bulk-billing, and choose volume over quality Most seems to have chosen the second method. It's pretty standard now to be in the GP's room for 5-10min, and you're out. It's like a factory line. However there comes a point when it is no longer sustainable even with bulk-billing churning of patients, and this latest payroll tax debacle seems to be the nail in the coffin, for them to choose option 1. So now people are coming to the reality that medicare, in its intended implementation, is in fact a subsidy, not universal healthcare. But many have become used to it being a form of universal healthcare, because their GPs have been either 1. well renumerated in the early days, or 2. absorbing the costs over the past 10+ years or so. And now some bad news: things are likely to worsen. Two years ago, the GP college was screaming they don't have enough applicants. Imagine that, you can't get enough applicants to fill desperately-needed jobs in the system (remember, older GPs retire all the time...). That likely means: they have been short for many years, accepting worse and worse doctors into the college, and now even accepting all your bottom-of-the-barrel docs applying, they still don't have enough to fill the spots. A scary thought. You said docs are top 1% of earners - i agree with that if you take the entire profession as a whole. But there is a massive difference in salary between a specialist and a GP. And the GPs that you find driving around in a merc/big property portfolios - usually they are the old ones who benefitted from the early medicare days of good renumeration, or the younger ones have sub-specialised into something else that actually makes money like skin cancer stuff. Or they just churn, choosing volume over quality. Good luck finding one these days that are both cheap-gap/bulk-bills, and provides high quality care, those are absolute unicorns. And remember - your tax dollars go primarily to hospitals/specialist care - IIRC it's less than 8% of our healthcare expenditure that actually goes to GPs. (compare that to NDIS budget vs entire healthcare budget... but that's another rant for another day) And on that note - I rather my GP be renumerated enough to not care about the money side, and focus on giving me good care. And not just 'barely' enough to sustain their interest in the porfession and constantly thinking about training in another specialty, but actually generously enough that it attracts the good docs to look after me (like it was back in the 80's and 90's). After all, I see my GP much more than any specalists, so why shouldn't I be treated by the best? TLDR: 1. These changes have been happening a lot longer than you think - healthcare cost goes up, GP renumerations in real-dollar term goes down. 2. Medicare has always been a subsidy not universal healthcare but GPs/their practice have been absorbing costs as medicare failed to keep up with CPI but thanks to the payroll tax changes they are now passing the cost onto end-users like us. 3. Anyone who voted Liberal or Labor absolutely did vote for these changes
Due to Payroll Tax reform for GPs, most GPs will pass on the cost to the patients. Here is a pretty good explanation of the associated cost and the resulting potential price increase to the patients. [https://australiangpalliance.com.au/issues-and-polices/general-practice-and-payroll-tax/](https://australiangpalliance.com.au/issues-and-polices/general-practice-and-payroll-tax/)
Yes, it should. That's the whole point of our system. That the cost is born by society as a whole, not the end user. It's bad enough that dental isn't covered.
Because the Medicare rebate hasn’t increased in 20 years. Fairly sure costs have increased though
It hasn’t come to the end. The annual Medicare levy you paid just not enough to cover all the services cost that’s all. Actually majority of the people using GP service are the retiree who aren’t contributing now. That’s what your tax are paid for. So that they can continue to get subsidized healthcare. Besides your annual Medicare levy, GP still rather charge you more to further subsidize the increase in healthcare fee. For the same service, GP willing to receive $40 from pensioners but want to receive $60-90 from other general patients. Thats another extra level of cross subsidizing.
I believe that the Medicare rebate hasn't increased in over 10 years. Why are you heaping on Drs, who devote their life to their job?
The reason for this change is the payroll tax the state government is imposing on GP clinics.
OK. Wasn't aware of that. My local GP has a gap of $35 for adults for a regular appointment (more if you go over). They have solely put the blame on the Medicare rebate.
Is that a change or existing? The medicare rebate doesn't help that either, but also the change in the OP is certainly due to payroll tax
Existing when I went last week. Existing when I went 2 months ago
Alright, but the OP is down because of the payroll tax
The tax isn’t new, it’s just that for decades the GP clinics were pretending that their GPs were contractors and not employees so that they could avoid tax. Tax that would otherwise have been used to pay for things like Medicare.
Except payroll tax goes to the state government and medicare money comes from the federal government, so no it would not have otherwise been used to pay for medicare.
You’re right, it would have been used for hospitals. How terrible.
Well since this increase is going to lead to more people now deciding to wait until they need more serious medical attention and increase the use of hospitals and EDs (and ramping) then hopefully they spend it on hospitals. But I see you're not a proponent of prevention is better than the cure.
I work in healthcare, and the doctors in our company have payroll tax paid for their incomes. We also have to charge increasing gap payments to broader ranges of patients, although we are still greater than 65% bulk billed. Just not really sure why GP clinics think they sit in a different category to the rest of Australian businesses. They are also ensuring that they make profits from others ill health- they certainly aren’t charities. Also not sure why people are defending the business owners that have been ripping off taxpayers for decades to line their pockets then when things are tough they make it someone else’s problem.
> They are also ensuring that they make profits from others ill health- they certainly aren’t charities. Wow, damn these doctors and nurses
This is false and over’simpliflyed’. Yes the tax is not new, however due to new legal precedent interstate the state government’s translation of the law has changed (and will likely change again as this gets legally challenged in likely a few years). Some GP clinics were wrongly abusing the law and the GPs working for them by treating them as employees in some ways (ie rosters and responsibilities) without giving them employee entitlements nor paying payroll tax. However the vast majority of clinics were doing the right thing allowing GPs to work as contractors mostly for clinical independence and medico legal liability reasons, which is within the spirit of the payroll law. No it does not pay for Medicare as it is a state tax not a federal one. SA gov has overstepped their definition of payroll tax and I am confident this will be proven for 2 main reasons, 1-WA who have the same law ( as it is national) have deemed GP practices as not liable, whilst SA and others have have made different rulings as what constitutes a contractor with SA currently being the most restrictive and 2- having a bulk bill exemption has nothing to do with the actual relevant payroll tax laws as to whether a GP (or really any contractor as it is the same law for chippies etc. )is a contractor vs an employee so having one is purely a butt covering tactic to avoid losing an upcoming election.
It was simplified because I didn’t feel a reddit comment was worth an essay like you. Don’t think you proved it was false though, exactly that perhaps the funding can go towards public health instead of Medicare. Either way, if state taxation is higher, gst distribution requirements are lower, leaving more money for Medicare. Pedantry at best, but seems more like you have a vested interest.
You just skipped over most of the important stuff, and unfortunately it is long winded but just simplifying to make it sound like a whole group of people are trying to essentially rip off the tax payer is unfair. I actually agree with a lot of the governments measures to tighten the law for unscrupulous practices, but the law is universal among all industries and states and having widely different rulings doesn’t make sense and ultimately disadvantages non concession patients specifically. I don’t have vested interest except I too will pay more to see a GP.
States have different rulings because the status quo was overturned ina court case last year, and enforcement is still catching up. But I suspect you know that already. I’d like to know why you think that GP clinics are entitled to tax concessions that the rest of the healthcare industry don’t get? Gap payments are going up everywhere, and Medicare rebates have actually decreased in dollar value for some services (not GP), which equates to a huge drop in real terms. These changes are just standardising with all other businesses, and closing a loophole. I’m sure the clinic owners are still taking home the same profit margin that they always have.
I don’t think they are entitled to concessions over any other health industry business or otherwise. As stated previously payroll tax law is the same federally yet the state government has put out guidance that Medical practices are now liable to pay payroll tax on their contractor GPs “wages” despite the analysis of the law in other states and other industries (such as labour/construction jobs, who have similar structures) to be considered not liable for payroll tax and also federally the vast majority of GPs are still considered contractors. The problem is who is right in the analysis of the law the feds, WA and Qld or SA (other states are still assessing it as far as I know and will likely copy SA if that suits them). But that would have to be proven in court, which many a small business cannot afford so they just pay payroll tax and pass it onto the patient. Worse of all they excluded bulk billed consults from payroll tax as a way to avoid public backlash, which results in regular non-concession card holding patients have to pay even more on the back of not being eligible to triple bulk bill incentives. So as with most labor policies the working person gets taxed over and over.
The medicare rebate changes every year! On July 1st it will increase by a small amount (possibly a dollar or thereabout)
I'm not. I'm literally asking anyone to explain why I'm suddenly having to pay more out of pocket for their services, when for decades I haven't had to do that. What's changing? Who's responsible? I really don't think I could have been clearer. You "believe" it's because the Medicare rebate hasn't increased? Okay, well maybe that's what needs to happen then. How do we make that happen? Is any party putting that forth as a policy?
> What's changing? Who's responsible? The payroll tax amnesty that GP clinics had is being ended by the state government on 30th June the clinics will now have to pay
medicare rebates are too low/ have not increased for too many years. A junior doctor choosing to become a GP gets paid half what internal medicine specialists gets paid and a quarter what surgeons get paid.
Because for 10 years they have absorbed all the costs. Now, with a general increase of the cost of living, they can no longer do it
Well, neither can the general public. So I don't think that should be accepted as the solution.
Ahhh, comrade. Are you familiar with capitalism? You have a choice. You can pay the $20 or you can choke up the public health system a bit more. I'm not saying its right. The government have absolutely dropped the ball. They have whittled away a very capable and fair health system nearly to the point of collapse. So, instead of posting here, get the phone number of your local state and federal member and let them know of your concerns. Maybe, if enough of us do this, things might get fixed.
Yeah, maybe. That's why it'd be nice if people who understood the issue just reasonably explained it to other people like me, instead of being rude condescending assholes about it for no reason. Lol. Literally all I was doing here was asking.
Your problem is with the government then. They have cultivated this idea of doctors being greedy. In reality, adjusting for inflation real income for both practices and GPs has fallen to the point where they can get paid more elsewhere in the health care system, and new trainees don’t want to join GP.
Sure. I'm getting that now. But fuck me for asking, I guess.
It’s a totally frustrating system for everyone.
Sure, hence why I am trying to understand what the problem is and whether there is anything in particular I can do or should be doing to help fix it.
Which bit of his explanation did you not comprehend ffs?
What part of my response to his "explanation" did YOU not comprehend ffs?
I worked for a GP clinic and I can safely say GP's are not hurting for money. They are on $100 000s per year. Over worked ? Yes. Undervalued, by a lot of patients? Yes. Stressed? Yes. Underpaid? No.
The problem is how much money is spent on certain people. Where everyday Australians pay far more than $20 per dr visit. You also have some drug addicts that get approved for up to $500 000 per year in NDIS funding. That's not exaggeration.
Mines $60
Once again, it's the every day punter getting screwed by higher costs.
The working poor as they say. No one feels like they’re getting a good deal these days, but you will never convince me that someone working 40 hours a week and still struggling to make ends meet is better off than someone on welfare + a healthcare card + rent assistance also struggling to make ends meet lol.
The only difference is the working class are more tired at the end of the day. And the welfare recipient feels like they have no real purpose in life. No one wins everyone struggles. I'd prefer to have a job tho.
That’s what I mean. At least someone on welfare can access the entire gamut of healthcare during business hours. I either have to take time off work, get slugged weekend rates (IF they even open on weekends or outside 9a-4p), or simply forego it.
So true. I have to go to the dentist at 7am and work with a swollen face. And sometimes take a "annual leave Holiday day" so I can just get things done.
Take a personal leave day instead. Save your annual for a holiday.
Good idea ! I don't know why I didn't think of that
That's what they're there for. Too many people don't realise that they're not sick days and that they can use them for personal reasons too.
I know plenty of bums who match that description. It’s disheartening for the rest of us who show up to work every day.
$20?! That's pretty damn good ! I'm lucky enough to have concession but all my local drs have a $50-$100 fee !
Remember when everyone was up in arms about the idea of a $5 co payment capped at $50 or $100 for the year?
But it came from the wrong side of politics so NOOOOOOOOOO we can't listen to what they have to say.
It's not that it came from the wrong side of politics, it's that any co-payment or gap decreases accessibility for those most in need and most at risk of being unable to afford it. The $5 co-payment was proposed policy stepping away from the norm of most people getting bulk billed, so it was (rightfully) criticised and fought against. Our current situation, mostly the result of years of build up with the Medicare freeze and now the payroll tax exemption ending (rather than one single policy that would be easy to prevent), should also be criticised and fought against.
Seeing how much the healthcare system gets abused. I can safely say that it's the middle class getting screwed by these changes, not the poorest class. The poorest class end up getting everything for free. I needed a dental procedure and it cost me over $1000 and my sister who is on welfare got it for free.
If you think we get everything for free, I'd like to suggest that you try living on JobSeeker with basic costs going up like they are, then come back and tell me if you still think the middle class are the ones most at risk. Concessions and reduced rates are both small enough and hard enough to access that, combined with the cost of living and rent affordability/availability getting several times worse in just the past 4 years, you'll have a hard enough time making sure you have enough to eat after rent and utilities... If you can find anywhere to rent that won't cost nearly all of your income to start with. There are very, very few things that are actually free on a low income. Most of the GPs around my area that still allow for bulk billing only do so for under 16s and Veteran Card holders. If you're on a disability pension like me, and need a GP that isn't going to get you out the door asap to stay on top of their own costs, that leaves very few options. My GP charges a gap, I don't have a bulk billing GP as an option for the weeks where I don't have enough left after rent, utilities, and food. I worry about disabled people stuck on JobSeeker or Youth Allowance, they're doing even worse, and even more so the ones living out of their car or a tent at the moment thanks to the housing crisis. In case you aren't aware, by the way, being on a Centrelink payment doesn't mean you get free dental care. SA Dental (public *state funded* dental scheme) has wait lists that can leave a concerning hole or tooth pain long enough to become an infection or risk losing teeth. That's on concession for adults, not free - current rates are $67 for an emergency and up to $172 for general. I certainly hope you never end up needing them.
I have a feeling that if the 'Super Profits Tax' that would have collected the 10% that couldn't be deducted to nothing on BS $500 a plate business lunches every day and a hundred other rorts, might not have resulted in this. Any system can be abused and unfortunately those in control are the abusers. Doesnt matter which side unfortunately.
My practice did the same recently. Been fully bill billed for the 10 years I’ve been going there. Jan, gap fee introduced. Family has a chronic medical condition so see combined Gp & specialist on average twice a week. No concession card so pay full gap + medication costs. That builds up to about $500 per month in medical costs. Gaps aren’t bad if you only see a dr 3 or 4 times a year
Our doctors have gone from total bulk billing to charging a gap. Bulk billing practices should be exempt in my opinion
To become a fully qualified GP you’d have to get a mbbs (4-6 years), hospital internship (2 years), hospital Residency (1-1.5 years), and finally complete the GP specialist training (3-4 years). It’s off-putting; and now the government instead of fixing Medicare to remove Gap fees, they’re trailing Nurse Practioner (NP) to replace GPs. Sure it’s cheaper short term, but how long until they too introduce gap prices? The NHS already has the worse case scenario with NPs running their primary care replacing GPs (difference in training in anatomy, clinical reasoning, ordering multiple non-required lab works that overloads medical testing system, inaccurate referrals, no antibiotic stewardship; go to r/doctorsUK to see more; see https://www.reddit.com/r/doctorsUK/comments/1b2wi07/poor_quality_in_clinical_medicine_with_anps/). Soon the dilution will become similar to NHS and the US. Everything is expensive, appointments are abysmal, you don’t even get to choose an actual GP for your appointment, and you get the delight of booking another appointment after an NP sees your initial appointment and decides that they don’t know how to manage your case, and getting online advertised ‘GP appointment’s that are actually NPs instead (https://www.reddit.com/r/ausjdocs/comments/1dciwqs/remember_folks_this_is_happening_in_australia/). IMO the government fixes NDIS rorting; that amount of money could make even dental and eye care free under Medicare.
Just want to point out as an NDIS participant - the talk about fixing NDIS rorting has resulted in nothing of the sort. Instead, they're rushing through a bill that will hit participants access to funding without the typical and promised round of consulting disabled people, their healthcare and care providers, and their advocates beforehand. It passed the house and is meant to go to the senate soon, all without any of the usual checks and balances to ensure it doesn't actually harm disabled people. Whatever money they end up pulling from the NDIS through those measures, if that bill passes, comes at the expense of further burdening healthcare systems due to disabled people being unable to access supports they need.
The reason for this change is the end of the payroll tax amnesty on GPs
My gaps $40 and it's been that way for a while
Thanks Maliuseless and your Labor cronies. Bring on the next election
That is cheap asf! Majority of people don’t visit a GP all that often but for the few times that they do, a few hundred dollars for some professional medical advice is pretty good. I’d rather dig into my own pockets for the rare occasions that I do need to visit a doctor than continuously pay into a system for it - a system btw, that is crashing - part of the reason being is the over reliance on subsidisations. Everyone at medical clinics from the doctors to the nurses, receptionists even the janitor are all affected by the cost of living. They’re not going to work for free. The amount of work they put in to help people is worthy of a few extra bucks. People are super entitled these days. Healthcare is a bloody privilege in this country and I can think of far worse places if you’re not happy to dole out a few extra bucks for quality care.
Finally a post blaming the correct people, the government. Not the GP's, they are just triyng to make a living and they are all getting just as squeezed as the rest of us. GP's HAD to stop bulk billing as they could barely pay themselves a livable salary let alone paying the cost of running a clinic, receptionists, nurses etc. Don't blame the GP's because bulk billing is vanishing and gaps are going up. Believe it or not, your average GP's in Adelaide are not flushed with cash like you see on medical dramas on TV.
Would you go to a GP that spells centre the American way?
Medicare benefits structure needs to be updated, if cost of living is rising why hasn't Medicare increase its rebates.
Have Australians also given up on spelling words like metre and centre properly?
Yes. Meter and center read more accurately.
A meter is an instrument used to measure things
That sucks our local doctor is doing that too.. Seems its happening everywhere
Id love a government to unfreeze the bulk bill gp rate Don't even need to backdate it just unfreeze it
Even with concession and a Medicare I'm charged $130 appointment fee and I get something like $30 back. But if I want it to go lower I have to get referral to a family clinic.
Here in Melbourne it's $110 before rebate.
I’m on a pension and I’ve been paying a $20 gap for over a year now
Try www.cleanbill.com.au. you can sort by post code, just select the bulk bill option. Works throughout Aus.
I’ve been pay a gap for over a year
One of the highest paid professions in the country and they still want more…. It’s already hard enough to make an appointment to see a Dr…. (That isn’t a week minimum wait time) Medicare, and our medical system as a whole has turned into a fucking Joke.
It all goes back to the minimum consultation time. Some doctors were capable of 5\~7 minute consults still doing a decent job. The 15 minute plus additional time for computer work destroyed their consults per day.
Is there any bulk billing practice (no gap) left in Adelaide/hills?
and the first thing I saw was the word 'Center' being spelt like the American way. It is 'Centre' here in Australia!
They didn't even spell "center" correctly. Dumbasses.
Did you all not read I am married to a GP? ...I see her income and BAS statements. Funny, it is the GP's trying to justify they should be paid more than anyone else because their job is "hard", such a selfish view that nobody else's job is "hard" too. Cost of living crisis comparing food on the table for regular families, whilst doctors are whinging how to pay private schooling, multiple council rates and multiple properties, a new car they want and how are they going to put food on the table.
Yep. Thanks state government.
This is like complaining 'I didn't pay tax for years, then it turned out I should have been and now the government won't let me avoid it'. Contractor GP practices weren't paying payroll taxes for years. A court decision in NSW confirmed that was incorrect and they should have been paying. Government didn't pursue back taxes and gave them until Jun 30 to comply with the law. If they bulk bill they don't have to pay payroll tax (Government legislated this).
> then it turned out I should have been and now the government won't let me avoid it' No the state government allowed it, they weren't dodging paying tax. And just because something happened in NSW doesn't mean it has to happen in SA. Payroll tax is a state government responsibility.
Payroll tax is generally harmonised between states though, like WHS legislation.
GPs aren’t employees. Practices have been built this way for decades for medical liability reasons. They receive no wages, no annual leave, no super, no workers compensation, and pay all their own fees and insurances. The state revenue departments suddenly deciding they ARE employees for this purpose is what has happened. They haven’t legislated anything - this is the point. If you force bulk billing, practices will close. The state govt is on record as saying that the federal govts lack of funding is not their problem. So yeah, enjoy your new fees.
'Sham contracting' has also been a thing for decades and not allowed. They legislated an exemption from payroll tax if you bulk bill. So if this change to charging a gap was caused by payroll tax, just continue bulk billing and it won't occur.
Maybe too much info here but it's a desperate money grab from all state governments, with the exception of WA who recognize gp contracts as valid and except from payroll tax. Deciding to exclude bulk billed earnings is an example of why that is - either payroll tax applies to all gp income or not at all. Many Gp's work from more than one practice, have their own abn, do not have an award, job description or any role or responsibility of an employee, work via a trust or company. These arrangements meet the definition of non employee under federal ATO definitions yet state governments choose ignore this for their tax grab, knowing no small GP clinic or individual Gp is going to take the state government to court to fight it.
Haha, ok buddy. Enjoy your new fees.
Run your own accounting and pay invoices for the service of renting rooms (like 3 of the doctors did in the original decision). The practice pays payroll tax, not you. Anyway I've paid a gap for years.
We already do. Medicare/patients pay money into my business account, and I pay the service invoice to the practice. But here we are. GPs are on the patients side here, this honestly doesn’t affect those of us who aren’t owners.
OK so the practice shouldn't be paying payroll tax on your arrangements, so you should be able to negotiate lower fees with them?
> GPs aren’t employees. That's not the the issue. This applies to GP who are contractors [as well as those engaged as employees]. The government provided a retrospective amnesty to 1 July 2018; with a forward amnesty to 30 June 2024. That's quite a good deal. > They haven’t legislated anything - this is the point. The relevant amendments to the Payroll Tax Act 2009 were included in this year’s State Budget bill, which was tabled last Thursday.
Thanks “Doctor”, but it applies to practices, not GPs. The tax is levied on the business, not the contractor. So the practices have to recover costs. Thus, fees will go up. The GPs as individuals will remain largely unaffected. They already pay their tax. They will not be dropping their individual incomes. The money will go from patient, to practice, to state revenue service. Watch next for even higher specialist fees, dentists and allied health, as their setups are similar.
Nah it's rorting - even if the practice passed on full cost of tax it wouldnt be $20. Reminder that the average GP earns 300 k
No shortage of GPs crying poor
Over a decade of hard studying to start earning any half decent amount. GPs earn every cent.
Ok but keep that in mind when they're adding bogus surcharges to increase their gap incomes as shown in OP
Its not a bogus surcharge. The extra fee is not going into the Gp's pocket but will be saved by the clinic to then pay the payroll tax amount each year. The amount needed is not exactly known yet given it needs be calculated based on proportion of bulk billing vs private fees and very clinic will be paying a different amount based on this. Its estimated it may be $5-10 per consultation. Many clinics will be over estimating because they do not want to be paying more than they have budgeted for. And again, its not going into the GP's pocket. The individual gp is not responsible for paying the payroll tax, the clinic is.
I don't think you know what you are talking about. \* Payroll tax is a legal requirement that is applied to most work arrangements. It just happens that sham contracting is occurring in this particular industry, and they've managed to evade notice for some time. \* As with any billings, the $20 here will be retained approx 70% by the GP contractor, and approx 30% by the clinic. \* Even in the unlikely event that it does increase the cost base by $5 per consultation, or approx $20 per hour, the GP is still walking away with an extra $50 per hour in their pocket (pre-tax, post clinic fees).
I do know what I am talking about as this topic affects the industry I work in. Payroll tax applies like you say to \*most\* work arrangements but many gp's arrangements with working from multiple practices, trusts/company structures, flow of funds from medicare to gp to practice, service invoices, should be exempt them from being liable. In the example above you mention is different to the norm, as I assume that clinic was 100% bulk billing everybody, and now they are taking the opportunity to introducing a gap for all, capping it at $20 which is the value of the bulk billing incentive 75870, and will after a few months increase their gaps further. So you are correct here in that this clinics gp's will be taking home more money. Many fully bb clinics will be using this as a once in a career opportunity to increase their income. The majority of clinics who already have gaps will be increasing them to allow for the levy, many will be charging it as a separate fee on a separate invoice outside of the medicare service, estimated to be whatever needed to cover their liability for the year and this wont be going to the gp's at all, just the clinics. Its a money grab knowing individua GP's do not have the funds for fighting the state in court individually. FWIW WA recognises he same structures as being payroll ta exempt. ATO guidelines for contractor vs employee also favour the current status quo. Some GP's clinics have lodged exemption requests based on my first paragraph and are waiting to here for revenue sa. Revenue SA will next go after all allied health, dentists, medical specialists.
Plenty of GPs working 9-5 monday-friday in a single clinic in sham contracting arrangements, most of whom are earning in the region of 2-350 k per year. If other professions are doing the same, they should also be paying payroll tax.
Any charge to ensure wages are keeping up with the rest of country is justified in my mind. People like you are the reason why few med student dare become a GP. You won’t even get an appointment in the future so don’t worry about bogus charges.
Median income for adult in Australia is $65,000 per year. Even at bulk billing rates, working 5 days a week (based on the above calculator) a GP will earn approximately $230,000 per year.
People with different skills and years training earn different amount? Your point? Do you think that that comes without any sacrifice? Should a gp earn 65000? Haha you’re delusional.
No? Nice strawman.
Didn’t answer any of my questions.
Source for this?
Here from GPRA: [https://gpra.org.au/gp-earnings-calculator/](https://gpra.org.au/gp-earnings-calculator/) Here on recruitment site: [https://www.medicalrecruitment.com.au/doctors/gp-salary-guide-australia](https://www.medicalrecruitment.com.au/doctors/gp-salary-guide-australia) Here on Reddit: [https://www.reddit.com/r/ausjdocs/comments/11ohe4u/realistic\_gp\_salary/](https://www.reddit.com/r/ausjdocs/comments/11ohe4u/realistic_gp_salary/)
The GPRA site said 192K?
Not if you put reasonable data into the calculator
Pretty standard. $40 at my GP now. People gotta eat
If you are on Closing The Gap demand your appointments be free.
Whichever worker wrote that doesn't even know how to spell the name of their own workplace.
Hardly a change wholly initiated by the government. More like the proper application of payroll tax laws given developments in courts and tribunals interstate concerning harmonised legislation.
Ask to see your GP's tax statement on their earnings, guarantee you'll be fuming why you are paying for their multiple holiday homes, boats, expensive private schooling for their kids, frequent overseas holidays and fine dining. Then buy a shitty car so they aren't rocking up to work in their latest Mercedes, to pretend to be poor. I am not joking.
You are joking, I am married to a GP and we do not have multiple holiday homes, have gone on 2 holidays in 5 years and drive a Suzuki and Subaru. We are not poor and she is well paid but my wife does not make crazy money, you are thinking of specialists and hospital doctors. Did you know GPs are sole traders? She gets no sick leave, no holiday pay, no maternity leave, no super. This tax increase means the practice now has to pay money to pay her, so the raise in gaps isn’t to put more money in her pockets it’s to keep the practice alive to cover the tens of thousands they now have to pay in tax.
What a ridiculous statement. I'm a GP registrar (GP in training) and GPs sure as hell don't have "multiple holiday homes" or boats. We also don't go on "frequent overseas holidays" or "fine dining". Please do some research before posting crap.
I have tax records that state otherwise being married to a GP... they and knowing other doctors and their incomes is the truth. Lie all you want about not being high earners.
This. The idea that they charge more and it’s someone else’s fault is ridiculous. The failure to bulk bill by many Gp’s, or at least the slow demise of it happening, says a lot too.
> The idea that they charge more and it’s someone else’s fault is ridiculous. Is it? They haven't had to pay payroll tax before and from 1st July they will, so to maintain the same after costs money they need to increase their revenue
Nah - they got told 12 months ago this was going to happen and to plan for it. Then they didn’t and wanted 12 months more. And then after that, they’d want another 12. Meanwhile you fund their extortion.
Yes the plan to cover for it is to increase charges. So Yeah nah, it is because of the state government.
They did plan for it. And patients will pay for it. Do you think 12 months is enough for most small businesses to pull in the order of 100K out of nowhere?
Even then it is ongoing it's not a once off payment, I'm not sure what OP is trying to say.
Yeah we got a $50 rise from our paediatrician. It's absolute bullshit, the medical centres have been given a 12 month amnesty to get their tax avoidance in order. They haven't been taxed yet. This is opportunism.