Leaders in the industry have claimed general practice is "on the precipice of completely falling apart" as fewer people take up the profession and doctor shortages hit home.
ANU Medical School Associate Professor Louise Stone said the percentage of doctors choosing to focus on general practice had dived.
Over the last 10 years, the number of junior doctors applying for general practice has dropped from 50 per cent to about 16 per cent.
With at least 12 years of training required to become a fully qualified GP, the situation has no overnight fix. Even if the number of trainees spiked tomorrow, it would still take years to fill the void.
While there is a definite shortage of practitioners across the ACT, the situation is magnified in remote and rural Australia.
New patients at multiple medical practices in the capital are waiting weeks for appointments as stretched staff try to keep up with demand.
Dr Jessica Tidemann became a fully qualified GP in 2019 after more than a decade of training.
While she now works at Women's Health Service and loves her job, she has no illusions about the many challenges the industry faces.
Comparatively low pay and a lack of entitlements often means the scales tip against general practice for junior doctors.
GP trainees - and most fully-fledged GPs - are not entitled to paternity leave, annual or sick leave and are employed as contractors. After at least seven years of medical school, work placement and then a training period to become fully qualified, the sacrifice just doesn't stack up for many.
Dr Tidemann said while established doctors had a level of autonomy, trainees were more vulnerable and needed additional support.
She said the majority of people training to become GPs were women, with the lack of maternity leave a major drawback as those years often lined up with when they wanted children.
Ironically, GPs are often the first point of contact for new parents.
Data from General Practice Registrars Australia shows that while in 2015 there were 2301 junior doctors applying for general practice training, by 2020 this figure had dropped to 1309.
What appealed to Dr Tidemann was the never-ending variety of the profession and opportunity to upskill. However, she said "the systemic and structural issues in general practice training mean that we're losing potentially fantastic, interested, passionate junior doctors to other specialties".
"It's not just about numbers, we also need those people to be well trained and having a good experience and to go on and continue working in the field.
"Frequent changes to the training program, uncertainty about how it will be funded and managed in the future, lack of employment entitlements, and lower pay compared with hospital-based specialty training programs, all mean we need to support the development of a future workforce."
Increasing out-of-pocket costs fuel 'moral distress'
For Royal College of General Practitioners chair Dr Charlotte Hespe, the situation stemmed from poor funding over the past decade.
The doctor said Canberra had one of the lowest doctor ratios in major cities around Australia.
"I think we are right on the precipice of completely falling apart with the specialty of general practice because it has been so poorly funded," she said.
"If we're heading along the trajectory that we're seeing at the moment, we're going to have significantly worse GP shortages in not just in rural, regional, and Canberra, but totally across the board.
"We are definitely seeing the long term consequences of a short sighted view around how you fund general practice and primary care as part of the health system."
Professor Stone put the dwindling number of new GPs down to several factors, including a lack of prestige for the occupation and an outdated Medicare rebate system which made general practice "a lot less financially sustainable".
"General practice rebates have not kept up with inflation and our costs continue to increase," she said.
Dr Stone said money provided by the government on a 15-minute appointment per person model doesn't cover the cost of receptionists, nurses, insurance and utilities.
As a result, medical practices across the country are faced with a dilemma: to privately charge or make consultation times shorter. Most practices opt for something in between and charge to offset costs for those in greatest need.
This brings with it a myriad of issues including a system under pressure to diagnose and treat more people in a shorter timeframe. In addition, medical access becomes more costly for patients requiring complex care.
"That doesn't go anywhere near [the time needed for] patients with complex trauma and mental health and complex chronic disease and all that sort of stuff," Dr Stone said.
"It's just not set up to achieve those outcomes. So I would say that the fee for service model is no longer fit for purpose."
Dr Stone is a firm believer that patients shouldn't be more out of pocket simply because they have additional needs.
She said many doctors were experiencing "moral distress" around the rising cost of medical care.
In addition, Dr Stone said morale in general practice had gone down with many doctors facing personal attacks from anti-vaxxers and other members of the community.
