A Queensland doctor with more than 40 years of experience is warning that Australia's doctor shortage is likely to get worse and that more medical practices could close as graduates abandon general practice as a specialty.
Susan McDonald, who has been practising in Cairns for the past 26 years, says GPs are "the domestic servants of the medical world".
Between seeing dozens of patients every day, Dr McDonald says GPs fill out ever-increasing mountains of paperwork and reports for everything from workers' compensation to jury duty excusals.
The long hours and relatively low pay – especially for bulk-billing doctors – are what Dr McDonald believes are dissuading young doctors from becoming GPs.
"It's easier to go into speciality, much easier, as it's a narrow focus," she said.
"You can be good at that one thing, and you'll get paid four times more than a GP."
Dr McDonald said the practice she worked in was three doctors short of its usual rota.
She said it, like many other medical practices, was on the precipice and warned it could have wider ramifications for patients and the community.
"If we can't get more doctors, then the practice will have to close and that's already happened to a number of other practices," Dr McDonald said.
Walking out 'in droves'
A Medical Deans of Australia and New Zealand survey found that 16.7 per cent of final year medical students listed general practice as their first preference for future specialty in 2017.
The same survey in 2021 found that numbers have dropped to 14.7 per cent, the lowest rate in 10 years.
A junior doctor who asked to remain anonymous out of concern for future career prospects said the stress GPs faced and the rate they were paid was pushing medical graduates away from the speciality.
"To be a good and safe GP requires an enormous breadth of skill," they said.
"You need to know a little bit about all there is of medicine.
"It's a huge task that doesn't just take medical school and GP training — it's something that you acquire over 15 to 20 years to do it well and feel comfortable in your knowledge.
"For all that training and all that stress and seeing hundreds of patients a week if you work full time, it's not remunerated well."
In a statement, federal Health Minister Mark Butler admitted junior doctors were "walking away from general practice in droves" and blamed the previous government for "nine long years of cuts and neglect of Medicare".
"The Albanese government is committed to investing in general practice and strengthening Medicare with almost $1 billion of investment," he said.
'Not on any salary'
Dr McDonald said it was a common misconception that GPs who bulk-billed were paid a salary.
"We're not on any salary at all," she said.
"We're private businesses — contractors.
"We have to pay our own super, holiday pay, sick pay, study leave, etc and we're not earning enough to do that.
"For the younger doctors, they'll be hard-pressed to pay back the huge loans they've got."
The junior doctor said it was well known among medical graduates that choosing the GP specialty would mean a lingering HECS debt.
"I'm working in a hospital doing my first year of GP training and as a junior doctor in the hospital, I earn more money there than I do as a first-year GP registrar actively training," they said.
"I'll take a pay cut next year to go into the community to train as a GP, but for me, it's a pathway to other career options."
Mental health presentations increase
The latest figures from the Australian Bureau of Statistics indicate that 43.7 per cent of Australians aged 16-85 had experienced a mental disorder at some time in their life.
In 2020-21, one in six Australians within the same age bracket had experienced suicidal thoughts or behaviours.
In the same year, 3.4 million Australians saw a health professional for their mental health.
Of those, 12.9 per cent saw a general practitioner.
Dr McDonald said managing the mental health concerns of patients under the current billing model was increasingly difficult.
"Psychiatrists have half an hour to an hour and we're meant to try and do it in 10 minutes," she said.
"To work out whether they're suicidal, whether it's something that's really serious, whether we can put it off or whether we can try and make another appointment time.
"It becomes a terrible juggling game to try and sort out how to do that."
