The government’s bulk billing policy is worsening the gender pay gap for female GPs…

Male GPs are nearly twice as likely as their female colleagues to say their personal income has significantly improved since changing to universal bulk billing — and they’re also less likely to report that their income has worsened since making the shift.

An analysis of almost 400 responses from GPs who made the shift to bulk billing following the Government’s new incentives last year found that just 1% of male GPs said their personal income had significantly worsened, compared with 5% of female GPs.

Likewise, 53% of male GPs said their practice has become more viable since they changed to universal bulk billing, compared with only 36% of female GPs.

The male GPs were also much more likely than their female counterparts to say that quality of care and pressure on consultation time had improved since changing to universal bulk billing.

Male GPs in Healthed’s survey were also more likely than female GPs to see the change as an overall positive for themselves, their practice and their patients – and less likely to rate it as negative overall (as opposed to neutral).

Professor Louise Stone, a GP in Canberra and professor of general practice at Adelaide University, says that the rate GPs get paid per minute has been better for shorter consultations for the last 20 years – but it’s actually gotten worse under the policies championed by Health Minister Mark Butler.

“The longer the consultation, the less you earn from the rebate – but what’s happened with myMedicare is every patient you see gets an incentive, so the more patients you see, the more incentives you get. So that compounds the problem. If I see 10 patients an hour I get more money from rebates, plus I get 10 incentives. If I see one patient per hour, I get much less money from the rebate and only one incentive.”

On top of that, the bulk billing PIP for practices that universally bulk bill is 12.5% of earnings.

“You earn less per minute the longer the consultation, you earn less incentives per hour the less patients you see, and you earn less from the bulk billing PIP the less patients you see, so the disadvantage is compounded twice,” Professor Stone says.

On average, female GPs spend more time with patients and do more mental health and complex care, Professor Stone says, citing the RACGP’s Health of a Nation report.

According to AIHW statistics, a male GP sees 26 patients per day on average, while a full time equivalent female GP sees 22 patients in a day on average, she says.

“The difference is about $150 a day,” Professor Stone says. “Prior to myMedicare that was a 1% pay gap, now there’s an 8% pay gap just on the rebates and the incentives, not anything else.”

RACGP President Dr Michael Wright agrees, noting that the “built-in bias” with Medicare rebates leads to “worsening pay gap for GPs spending more time with their patients, leading to lower income, unless they introduce out-of-pocket costs to compensate.”

“The removal of mental health items and latest incentives won’t fix this fundamental problem with Medicare,” Dr Wright added.

At the National Press Club last week Minister Butler acknowledged that female GPs tend to do longer consultations, and more work with mental health and multiple co-morbidities—but was unapologetic about the policy choices that have been made.

“We’ll continue to work with the AMA and with the College of GPs about the way in which the rebates are both tiered and recompensed, I recognise that is ongoing work we have to do,” Minister Butler said.

“But I make no apology for the fact that we had an affordability crisis, it was a burning platform in general practice that we had to deal with in our first term, to deal with the plummeting rates of bulk billing that was creating huge inequity in terms of access to healthcare.”

Data analysis and visualisation by Yasmin Clarke. Reporting and writing by Lynnette Hoffman.