Sarah Simpkins SEARCHING GP job advertisements these days turns up dozens of offers for GPs to keep 80 % of their billings or more , even up to 90 % in rare cases .

Some involve a drop down to 75-80 % of billings after two or three months — but certainly not all of them .

Isn ’ t this good news despite the various forces attempting to dismantle the specialty ?

The laws of demand and supply apply amid the GP workforce shortage — so along with the end of universal bulk-billing , doesn ’ t that mean GPs can earn the sort of money seen in the other specialties ?

GP recruiter Martina Stanley says some higher offers are an alternative to the “ new GP safety net ”, where practices offer GPs

‘ We know it is not sustainable , so you start wondering why they are having to offer it .’

without a patient base a guaranteed hourly rate of $ 150 an hour or more for their first three months .

“ It is almost impossible for practices to attract doctors without an income guarantee ,” says Ms Stanley , director of Alecto Australia .

“ But a lot of lawyers have been advising practices not to do that because hourly rates

look too much like an employment relationship , which could get them into trouble with payroll tax .”

So , as an alternative income guarantee , practices are offering a higher percentage of billings for the first three months , she says .

However , she adds that continuing high billing percentages — well beyond the traditional norms of 60-70 % — might ring “ alarm bells ”.

“ We know it is not sustainable , so you start wondering why they are having to offer something that is not sustainable ,” she says . “ We would always say to a GP that , if somebody is offering a percentage that is too good to be true , it probably is .”

Canberra practice owner Dr John Deery

quips that , sure , practices could offer GPs billings of 75 % or more , “ but good luck having electricity ”.

“ Most practices are sitting at a 5-10 % profit margin on the total revenue of the GPs ,” he says .

“ Maybe they are so overwhelmed that the owner is happy to take an even lesser percentage of their take-home pay than they currently are .”

He says a lower service fee for the practice means a lesser service to contractor GPs .

“ If you want to work at practices charging a 23 % fee , that is fine , but you have to think about what service they are providing ,” he says .

“ The GP will be doing much of the

Martina Stanley .

administration work themselves .”

GP business consultant Brendan Campbell says practices offering higher percentages of billings probably have to work a certain way .

“ A typical GP will see 3.5-4 patients an hour ,” he says .

“ I would envisage that , to be profitable , where the GPs are retaining 90 % of billings as income , they would have to be private billing and seeing possibly 5-6 patients an hour using higher billing codes .”

He adds that he doesn ’ t see “ the industry benefiting from GPs trying to go to the highest percentage ”.

“ It is unsustainable . It will not benefit you in the long run .”

FROM PAGE 1 up to scratch .

Professor Brendan Murphy , former secretary of the Department of Health and Aged Care , told the board ’ s annual meeting last month that the creation of a new “ expedited specialist pathway ” bypassing the colleges was vital .

“ Despite the return to pre- COVID-19 migration levels , the shortages persist without clear evidence that the Australian training pipeline of doctors will resolve them anytime soon .”

Ministers not happy

What he did not say was that this fast-track pathway is the result of political pressure — the widespread view among ministers , both federal and state , that specialist colleges are self-serving impediments in their attempts to bring in sufficient overseas specialists to keep the system running .

It is also true that some highly qualified IMGs have faced huge challenges in securing medical registration , accusing the colleges of charging extortionate fees to go

Professor Brendan Murphy .

through their various assessment programs — often with limited prospects of success .

We are going to find out what the colleges themselves think about their new non-role in the coming weeks because , before this pathway is made a reality , there must be a formal consultation .

It is notable that , when the fasttrack concept was first flagged in last year ’ s Robyn Kruk review , RACGP president Dr Nicole Higgins warned it could lead to another so-called Dr Death scandal .

This was a reference to the manslaughter charges 20 years ago made against Dr Jayant Patel , the overseas doctor who ended up as

FAIRFAX

director of surgery at Bundaberg Base Hospital despite being the subject of a litany of complaints and limits on his practice in the US .

He was acquitted following a protracted legal process .

College control ?

But as part of the board consultation , the specialist colleges will be asked to identify what they consider comparable overseas specialist medical qualifications required by doctors before they can be fast-tracked .

Presumably , the expectation is that the list will include fellowships from New Zealand , Canada , the UK and a select list of European countries .

How forthcoming the college proves to be with their suggestions will be interesting to see .

You may be asking if the final decision on the qualifications deemed appropriate will be left solely to the colleges to decide , or will the choice be a medical board / AHPRA / minister decision ?

The answer is the board , although it will need a good reason not to follow what the specialist colleges suggest .

Once the official ‘ validated ’ list of suitable qualifications is drawn up , it will mean any overseas specialist with a relevant qualification need only to apply to the board for registration and not the college for assessment before being allowed to work as a specialist .

Under the plan , the IMG would still need to work under supervision for six months , as well as complete cultural safety training and orientation to the Australian health system .

But after that , they could be granted unconditional specialist registration .

The board ’ s media release states that “ fellowship of a specialist medical college will not be an automatic outcome of its new expedited pathway ”.

For many , that is bleeding obvious given the protective view the colleges take about their fellowships and the postnominals that go with them .

But the board says it is working with all specialist colleges via an advisory council to “ explore the implications and possible solutions ”.

Things are moving quickly , presumably because of those political pressures . The ministers apparently have a fire in their bellies about this issue .

The first target is increasing the number of overseas GPs . So AHPRA and the board say they want the GP pathway in place by October .

‘ A new expedited specialist pathway is vital .’

Then in December , it will be the pathway for anaesthetists , O & Gs and psychiatrists , before the other specialties are brought in .

No long-term fix

As a result , the board says consultation time will be “ compressed ”.

That does not sound entirely reassuring .

It is worth ending with the words of Professor Murphy .

While he said the reforms were vital , he added that enhanced migration was not a long-term solution .

He warned of a material risk of a “ sugar hit ”, with a migration boost seen as easier than what was really needed — for Australia to train enough doctors for its needs .