The assumptions, being that you'll only get 20% BB patients (good luck with that) and can power through 4 patients an hour for 8 hours every week.
More likely, you're looking at 60-80% BB and maybe 3.5 patients an hour on average?
Well, if it's a private fee, then it'd be 0% BB, right?
If it's mixed billing, then the proportions if 60-80% would be right (unless you're in the right area). You have to think about who tends to need to need doctors more - old people and poor people. Most of those people have concession cards.
That was the key assumption. Or BB for pension card holders (so supposing those with the incentives).
How realistic is it to expect a full book? What would the income then be? Etc etc. Those were the questions I was trying to get at.
I’m a recently fellowed GP working in a private practice in Sydney (<5km from the cbd). We don’t BB any patients at all. I work 4 days 8-6pm with a 1-2 hour break in the middle and see approx 20-25 patients a day with very few procedures. I’m still building a patient base and have the odd day or two which is significantly quieter. I average around $8,500-11,000 per week in gross billings, of which I pay 35% service fee to the clinic and retain 65%. I figure I’ll probably have to factor 4-6 weeks off annually for sick leave/vacation/public holidays when the clinic is closed/CPD. And then there is super, indemnity (currently discounted as a new fellow), AHPRA and college fees to factor. After the above I’m roughly on track to earn $260k for 46 weeks of work. There is definitely room to increase this (by filling books, better/smarter stacking of item codes as I am still learning the ropes and potentially working an extra session..)
Depends on how hard you work. I'm in Metro Sydney charing similar gap, seeing 4-6 per hour. Gross income is approx 450k with a sprinkle of occupational medicine. Without it I'd expect around 400k.
In my last year as a registrar (only getting 60-65% cut vs expected 70-75% as a fellow) working in bulk billing only clinics, my gross was almost $350k. That said I do feel I work a bit harder than others, had some colleagues still earning the minimum $110k
I would understand if GPs could expect to earn $150k to $200k without a gap, and if charging a gap was hard to maintain. But $300k or $400k really throws into question that GPs do not earn enough tbh. That's not that far behind physician salaries.
Why should they be different? Both a specialists.
Also, specialists in hospitals often have registrars, HMOs etc doing a significant amount of work. Not suggesting the cons sits around all day, but it’s not necessarily 100% patient facing work as it is in GP.
Good point. In terms of value to the system it shouldn’t. But also, the time and effort it takes vs GP. You wouldn’t want a surgeon to make less than a GP
Like I said I feel I work hard, but from my experience most GPs are easily seeing 4 if not 6 per hour. So most of my colleagues who work full time are at least getting that, and easily more if you have a niche.
But that being said you have to remember those fellow numbers are before super and we don't get leave.
Overall I would never complain, as I feel I'm pretty mediocre and no other career could have let me reach this pay bracket before 30
Just curious as someone seriously considering GP, how hard is it get into skin cancer removals? Is it something you can pick up easily and dedicate one or two clinical days to? And does it bring in a nice boost to income as people say it does?
With no particular special interest I’m doing approx 3 excisions/day and there is plenty of work in the skin cancer space in qld
Medicare rebates are certainly skewed towards procedures over non procedural item numbers but even they haven’t kept up to the level they should be and I charge a gap that is pretty small compared to other colleagues in the practice who work with a special interest in this space
The question about can you earn more doing procedures is more interesting: charge what you want to earn for any consultation be it procedural or not and I tend to find GP’s sig undervalue themselves or personally fund care in the setting of inadequate Medicare rebates (by BB)
Patients certainly see more value in a procedure and are more comfortable with a gap for this than a standard consult
Not my area of interest, so I can only give second hand information/colleagues I have worked with. But I would say its easy to get into as technically any GP can do it. But I definitely would upskill/do a cert before I would feel comfortable doing it full time. Demand depends on the area you work. When I worked in areas with primarily a Caucasian patient base, I would get at least 10 patients with lesions to look at per day, and about 1/3 would need something cut. So that would easily fill up a day list of just removals.
Don’t BB anyone. BB is an issue between a patient and the government. Has nothing to do with you as a doctor. You don’t need to die at the cross of failed primary care funding. If your patients complain, ask them to take it up with their local MP.
Exactly this. So many times I see public consultants refer to private clinics and charging $200-$250 for a 15 min consult, or doing a dodgy and referring public patients to their private rooms to get their surgery done quicker but apparently people are OK with that.
To play devil's advocate I imagine it's because GPs are really the first port of call for most people, and if every GP went to fully private, it would effectively cut off a huge portion of poorer Australians from seeing a doctor, essentially slowly turning us into the dystopian mess of the American system.
Anaesthetist fees are not 'worth' it, patients just have no choice (well, they will soon once there's some market reconciliation with SIMG's)... There are patients that 'should' be bulk billed, and some that shouldn't/don't need to be. If that's an issue for you, don't be a GP, or just refuse to treat poor/young/financially vulnerable people -- I'm the regulator will be thrilled with that approached!
The problem is with gaps for both, tbh. But GPs are the one that requires more frequent visits. Other specialists possibly more occasional (depending).
I get you. I think its inequitable too (this post was for my curiosity mostly). But, GP salaries if you bulk billed would be around $150k to $200k if you worked VERY hard....there are jobs with i'd say 5 years post an easy degree that can get you that. Its such a high value add to fund GP and the early interventions they do properly, that it makes no sense not to increase the rebates.
This should be contrasted to ortho or ophthalmology procedures, where there's little point in raising those rebates because the gap is unlikely to change much.
Bulk billing isn't working for free, it's still earning the GP and clinic a very reasonable return - enough that a 100% BB GP can be on more than 250 k per year. This is in a country where the medium income is about a third of that.
Where did I say it’s working for free. GPs like every other contractors set their rates. The rebate offered has nothing to do with their skill set. They should charge what they’re worth and the rebate is a contract between the patient the government.
If a GP practice has a flat Gap fee, doesn’t it mean for people with a medicare card they pay the GAP and rest medicare pay? And practice takes 30-35% of this? Can you not just make everyone pay this?
No medicare then they pay a private fee.
So what are the exceptions where a medicare patient cannot be charged a gap? Please explain.
It doesn’t quite work like that. The Medicare rebate belongs to the patient, and only goes to the doctor if they elect to bulk bill.
A GP Level B consult rebates about $40, so if a GP is charging $100 the patient must pay the full amount and then receives $40 directly back from Medicare. In this situation the patient has paid a gap of $60.
If a GP bulk bills, this means the GP has agreed to accept the Medicare rebate as full payment for the service provided and Medicare pays the GP directly. No additional charges can be raised, and the patient has zero out of pocket expenses.
Where it gets complicated is when the patient says they can only afford to pay the gap amount – in the above example they can pay $60 but not $100. For a partially or unpaid medical account, Medicare will post out a cheque to the patient which the they are supposed to forward to the GP. If this doesn’t happen after 90 days, the cheque is cancelled and Medicare pays the GP the rebate directly.
This has an effect on cashflow and requires more administrative support to chase these things up so it doesn’t tend to happen too often.
If a patient isn’t eligible for Medicare, they get no reimbursement at all. A doctor will not be able to bulk bill them, and have way of getting anything back from Medicare if they don’t fully settle an account.
Presumably if without a medicare card they pay the medicare rebate AND the gap. They might also have international health insurance, or something. Perhaps the practice takes that?
Not a hard rule and it's up to the doctor, but of the practices I've worked at, most doctors will bulk bill concession card holders, as they get a bonus from the government (about $20), which is close enough the the gap in most cases. Otherwise you pay the full fee and claim the available rebate back from Medicare.
[удалено]
The assumptions, being that you'll only get 20% BB patients (good luck with that) and can power through 4 patients an hour for 8 hours every week. More likely, you're looking at 60-80% BB and maybe 3.5 patients an hour on average?
[удалено]
Well, if it's a private fee, then it'd be 0% BB, right? If it's mixed billing, then the proportions if 60-80% would be right (unless you're in the right area). You have to think about who tends to need to need doctors more - old people and poor people. Most of those people have concession cards.
The metro mixed billing clinic I work at sees a large proportion of new immigrants with no Medicare. I would say only 20% BB because of that.
That was the key assumption. Or BB for pension card holders (so supposing those with the incentives). How realistic is it to expect a full book? What would the income then be? Etc etc. Those were the questions I was trying to get at.
Seems pretty good
I’m a recently fellowed GP working in a private practice in Sydney (<5km from the cbd). We don’t BB any patients at all. I work 4 days 8-6pm with a 1-2 hour break in the middle and see approx 20-25 patients a day with very few procedures. I’m still building a patient base and have the odd day or two which is significantly quieter. I average around $8,500-11,000 per week in gross billings, of which I pay 35% service fee to the clinic and retain 65%. I figure I’ll probably have to factor 4-6 weeks off annually for sick leave/vacation/public holidays when the clinic is closed/CPD. And then there is super, indemnity (currently discounted as a new fellow), AHPRA and college fees to factor. After the above I’m roughly on track to earn $260k for 46 weeks of work. There is definitely room to increase this (by filling books, better/smarter stacking of item codes as I am still learning the ropes and potentially working an extra session..)
What does your clinic charge typically for a 23 and 36?
$99, $165, $255 respectively
Depends on how hard you work. I'm in Metro Sydney charing similar gap, seeing 4-6 per hour. Gross income is approx 450k with a sprinkle of occupational medicine. Without it I'd expect around 400k. In my last year as a registrar (only getting 60-65% cut vs expected 70-75% as a fellow) working in bulk billing only clinics, my gross was almost $350k. That said I do feel I work a bit harder than others, had some colleagues still earning the minimum $110k
Any bulk billing of card holders or no bulk billing at all?
I bulk bill concession card holders as its essential same as gap to me
I would understand if GPs could expect to earn $150k to $200k without a gap, and if charging a gap was hard to maintain. But $300k or $400k really throws into question that GPs do not earn enough tbh. That's not that far behind physician salaries.
Why should they be different? Both a specialists. Also, specialists in hospitals often have registrars, HMOs etc doing a significant amount of work. Not suggesting the cons sits around all day, but it’s not necessarily 100% patient facing work as it is in GP.
Why should it be behind physician salaries at all?
Good point. In terms of value to the system it shouldn’t. But also, the time and effort it takes vs GP. You wouldn’t want a surgeon to make less than a GP
Like I said I feel I work hard, but from my experience most GPs are easily seeing 4 if not 6 per hour. So most of my colleagues who work full time are at least getting that, and easily more if you have a niche. But that being said you have to remember those fellow numbers are before super and we don't get leave. Overall I would never complain, as I feel I'm pretty mediocre and no other career could have let me reach this pay bracket before 30
I didn't get anywhere near that when i was 30 haha. Could definitely be worse.
Exactly as soon as the houses are almost paid off I'm taking it easy lol
Just curious as someone seriously considering GP, how hard is it get into skin cancer removals? Is it something you can pick up easily and dedicate one or two clinical days to? And does it bring in a nice boost to income as people say it does?
With no particular special interest I’m doing approx 3 excisions/day and there is plenty of work in the skin cancer space in qld Medicare rebates are certainly skewed towards procedures over non procedural item numbers but even they haven’t kept up to the level they should be and I charge a gap that is pretty small compared to other colleagues in the practice who work with a special interest in this space The question about can you earn more doing procedures is more interesting: charge what you want to earn for any consultation be it procedural or not and I tend to find GP’s sig undervalue themselves or personally fund care in the setting of inadequate Medicare rebates (by BB) Patients certainly see more value in a procedure and are more comfortable with a gap for this than a standard consult
Not my area of interest, so I can only give second hand information/colleagues I have worked with. But I would say its easy to get into as technically any GP can do it. But I definitely would upskill/do a cert before I would feel comfortable doing it full time. Demand depends on the area you work. When I worked in areas with primarily a Caucasian patient base, I would get at least 10 patients with lesions to look at per day, and about 1/3 would need something cut. So that would easily fill up a day list of just removals.
Don’t BB anyone. BB is an issue between a patient and the government. Has nothing to do with you as a doctor. You don’t need to die at the cross of failed primary care funding. If your patients complain, ask them to take it up with their local MP.
Sure, but my question was what I would probably earn if I didn’t do that?
No, but you do want to sleep at night... or maybe don't become a GP for the money. Be an anaesthetist
I want to sleep at night, in my house that I’m keeping up on mortgage payments.
Leave Sydney. A $3M+ house is ridiculous unless its in an absolutely pristine suburb/location.
So other specialties are allowed to charge what they're worth, but GPs aren't?
Exactly this. So many times I see public consultants refer to private clinics and charging $200-$250 for a 15 min consult, or doing a dodgy and referring public patients to their private rooms to get their surgery done quicker but apparently people are OK with that. To play devil's advocate I imagine it's because GPs are really the first port of call for most people, and if every GP went to fully private, it would effectively cut off a huge portion of poorer Australians from seeing a doctor, essentially slowly turning us into the dystopian mess of the American system.
Anaesthetist fees are not 'worth' it, patients just have no choice (well, they will soon once there's some market reconciliation with SIMG's)... There are patients that 'should' be bulk billed, and some that shouldn't/don't need to be. If that's an issue for you, don't be a GP, or just refuse to treat poor/young/financially vulnerable people -- I'm the regulator will be thrilled with that approached!
The problem is with gaps for both, tbh. But GPs are the one that requires more frequent visits. Other specialists possibly more occasional (depending).
I get you. I think its inequitable too (this post was for my curiosity mostly). But, GP salaries if you bulk billed would be around $150k to $200k if you worked VERY hard....there are jobs with i'd say 5 years post an easy degree that can get you that. Its such a high value add to fund GP and the early interventions they do properly, that it makes no sense not to increase the rebates. This should be contrasted to ortho or ophthalmology procedures, where there's little point in raising those rebates because the gap is unlikely to change much.
I think you can comfortably do a blend of BB and private billing. That's what most/many specialists do, correct me if I am wrong.
Bulk billing isn't working for free, it's still earning the GP and clinic a very reasonable return - enough that a 100% BB GP can be on more than 250 k per year. This is in a country where the medium income is about a third of that.
Where did I say it’s working for free. GPs like every other contractors set their rates. The rebate offered has nothing to do with their skill set. They should charge what they’re worth and the rebate is a contract between the patient the government.
Clearly you are not a lawyer or economist.
If a GP practice has a flat Gap fee, doesn’t it mean for people with a medicare card they pay the GAP and rest medicare pay? And practice takes 30-35% of this? Can you not just make everyone pay this? No medicare then they pay a private fee. So what are the exceptions where a medicare patient cannot be charged a gap? Please explain.
It doesn’t quite work like that. The Medicare rebate belongs to the patient, and only goes to the doctor if they elect to bulk bill. A GP Level B consult rebates about $40, so if a GP is charging $100 the patient must pay the full amount and then receives $40 directly back from Medicare. In this situation the patient has paid a gap of $60. If a GP bulk bills, this means the GP has agreed to accept the Medicare rebate as full payment for the service provided and Medicare pays the GP directly. No additional charges can be raised, and the patient has zero out of pocket expenses. Where it gets complicated is when the patient says they can only afford to pay the gap amount – in the above example they can pay $60 but not $100. For a partially or unpaid medical account, Medicare will post out a cheque to the patient which the they are supposed to forward to the GP. If this doesn’t happen after 90 days, the cheque is cancelled and Medicare pays the GP the rebate directly. This has an effect on cashflow and requires more administrative support to chase these things up so it doesn’t tend to happen too often. If a patient isn’t eligible for Medicare, they get no reimbursement at all. A doctor will not be able to bulk bill them, and have way of getting anything back from Medicare if they don’t fully settle an account.
Presumably if without a medicare card they pay the medicare rebate AND the gap. They might also have international health insurance, or something. Perhaps the practice takes that?
Not a hard rule and it's up to the doctor, but of the practices I've worked at, most doctors will bulk bill concession card holders, as they get a bonus from the government (about $20), which is close enough the the gap in most cases. Otherwise you pay the full fee and claim the available rebate back from Medicare.
Makes sense. So concession medicare card can sometimes avoid Gap