As overwhelmed hospitals in Victoria battle long wait times, doctors say GP shortages and a decline in bulk-billing practices are part of the problem.
The Royal Children's Hospital said on Monday night that it was facing "unprecedented demand", while The Alfred Hospital said on Tuesday that it was pausing elective surgery.
The Royal Melbourne Hospital is also deferring some surgeries as it battles a surge in demand and staff shortages due to illness.
Patients are being told to consider seeing a GP or to use the Nurse on Call telehealth service during non-urgent situations, but GP shortages mean many patients have no choice but to go to an emergency department.
Former AMA federal president and Altona North GP Mukesh Haikerwal said his facility — in the growing suburb in Melbourne's south-west — was struggling with increasing demand.
"We've got about 4,500 people coming onto the block as they redevelop the area around us and we're not in a position to look after them right now, but we need to get there," the deputy chair of the Australian General Practice Alliance said.
"Our patients are suffering from not having enough supply."
His practice sets aside 50 appointments for same-day bookings, but that does not seem to be enough.
"We will provide 50 appointments on a morning and, within half an hour, they will sell out," he said.
And, for those he sends to hospital with serious conditions, he worries about the long wait times they will face.
"I sit in my boots quaking when somebody comes in who might be that ill as to know, 'Where am I going to send them?'" he pondered.
Victoria's Health Minister Mary-Anne Thomas said the government recognised there was a shortage of GPs in the health system.
"For a range of reasons, young graduate doctors are not choosing general practice as a specialty. This is a system-wide and nationwide challenge," she said.
The government was offering a $30,000 salary top-up for first-year GPs in training.
"We have challenges with [the] workforce and we have a plan to respond to those challenges, which is to recruit even more healthcare workers into our system," she said.
Premier Daniel Andrews told ABC Radio Melbourne's Drive program his newly elected government would deliver on its promises, including recruiting thousands of new nurses and midwives.
Asked how long Victorians would have to "put up" with the current state of the health system, Mr Andrews said Victoria's health professionals did an amazing job, but that they got sick, too.
"And when you've got hundreds and hundreds of them away at an individual health service and thousands across the board, that does have an impact," Mr Andrews said.
He defended the winding back of COVID-19 measures, saying the deal was that restrictions would ease if people got vaccinated.
"That's a fundamental deal — you play your part, and then we'll have a rules system... a structure, that basically reflects the fact that you've done the most meaningful thing and that's to go and get vaccinated," Mr Andrews said.
He said people have limits and that there is, and previously was, "a great hunger to get back to something like normal."
Mohamed waited four hours for Casey Hospital to see his baby
On Sunday, Mohamed Ahmed's seven-month-old daughter had a bad fever and was not eating nor drinking, but the family could not get in to see a GP.
"The doctor my wife takes my daughter to was closed and everywhere [else] was fully booked out," he said.
Several members of the family took rapid antigen and PCR tests on multiple occasions, which all turned up negative.
A telehealth nurse advised the family to go to an ED as soon as possible.
They waited four hours in Casey Hospital's emergency department, operated by Monash Health, before they could see a doctor.
The doctor gave Mr Ahmed's daughter medicine, and said they could leave if she was able to eat.
"Her temperature dropped, and she actually fell asleep while we were in the waiting room," he said.
They had to take her back to the ED on Tuesday night, but Mr Ahmed said they were seen quickly this time.
Mr Ahmed lives in Clyde, in Melbourne's outer south-east, and he said he had noticed GP availability worsening in the area since the pandemic began.
"Prior to COVID happening, you could ring up, even on a Sunday, and find someone [who was] available, that can see you in the next hour or two," he said.
He said this was despite more GP clinics opening up recently, and the expansion of the Casey Hospital.
"Even with this existing expansion, and the planned expansion, it still won't be enough," he said.
"There's so much construction going on with infrastructure, but we're like 10 years behind."
Patients presenting to EDs because they can't see a GP, doctor says
Gavin Wayne, a junior doctor in one of Melbourne's busiest emergency departments, said growing populations posed a challenge for the health sector.
However, he said, the pain was being felt all over the state.
"Across all geographic regions, we're seeing a massive explosion in demand and a change in our ability to deal with that demand," he said.
He said staff were stepping up during periods of high demand, but this was leading to burnout.
"They're working more, they're working longer hours, and those hours are spent with higher-acuity people, with more people," he said.
"There's no fixed finish line for any of these things."
These factors — along with COVID-19 and its associated health issues — were creating a "perfect storm" of problems for the industry, Dr Wayne said.
And, he said, many people were presenting to his emergency department because they were not able to get an appointment with their GP.
"You're seeing a population of people presenting to the only healthcare show in town, where there isn't a cost at the time of presentation, and that's open 24 hours a day."
When Amanda's local GP in Doncaster, in Melbourne's east, stopped bulk-billing, she started travelling to a clinic further away so she did not have to pay.
"I have a good salary, so I can't complain, but it's still a disincentive because it's $30 a pop to see a GP for something that could be fairly minor," she said.
"I just think, 'OK, I'll skip it'.
"It puts me off going, really."
She said her parents — who are self-funded retirees — were also leaving the clinic due to the cost.
"It just feels really hard to get affordable healthcare now," she said.
"It's not going to be long before we turn into the US."
A Grattan Institute report released on Sunday found "Medicare no longer works for patients or doctors", and recommended an overhaul of general practice in Australia.
Alfred Hospital pauses elective surgery amid staff shortages
On Tuesday, Melbourne's Alfred Hospital paused elective surgery while it battled staff shortages due to COVID-19.
As of Friday, the seven-day average of patients with COVID-19 in Victorian hospitals was 550, an increase of about 28 per cent on the week before.
The hospital expects the pause to continue for about a week.
"We apologise to all patients affected by this difficult situation," a spokesperson said in a statement.
"We know how hard this is for patients waiting for a procedure, and this is not a decision we have taken lightly.
"This change is necessary to ensure we maintain capacity to continue to care for patients in our hospitals, and those who arrive needing lifesaving emergency surgery."
The spokesperson said the hospital believed the situation would improve soon, and impacted patients were being rescheduled.
When it comes to repairing Victoria's health system, Dr Haikerwal said supporting GPs was key.
"We need a system that supports general practice to thrive. At the moment, we're finding it's withering," he said.
"We can't recruit people into the profession to train. We can't retain people within the profession, and we're losing people who are retiring and cutting their hours."
Report shows emergency departments are struggling
New data released today by the Australian Institute of Health and Welfare (AIHW) shows emergency department performance continues to decline in the nation's hospitals.
The AIHW data shows presentations at emergency departments in Victoria grew by 4.7 per cent in 2021-22, which was the biggest increase in any state or territory.
About 63 per cent of patients were seen within 20 minutes, which is down from 68 per cent the previous year.
AMA president Steve Robson said the reports this week of 12-hour waiting times at Melbourne's Royal Children's Hospital showed the system was at breaking point.
"These stories are just the tip of the iceberg," he said.
"We know from our Clear the Hospital Logjam campaign that there are hundreds of stories of patients waiting for hours on end in hospital emergency departments or in the back of an ambulance outside the hospital."
