Despair over practice viability as GPs eye their Australian peers’ big pay packets

“The vibe I get from Abbe Anderson is there is no future here for general practice”

Practice-owning GPs are speaking out about the despair of watching their businesses struggle as costs race ahead of their government-controlled income.

One has spoken of personally lending his business $30,000 to get through a rough patch, while another owes “$110,000 to my bank to stay open”.

The catalyst for the flurry of comments on nzdoctor.co.nz was our article in which Te Whatu Ora national commissioning director Abbe Anderson acknowledged healthcare is underfunded, but said simply pouring more money in isn’t necessarily the answer.

“We know that all of those sectors including ourselves [primary and community] and the hospital sector have for a very long time not been meeting our te tiriti obligations and we have been failing to achieve equitable health outcomes, so more of the same isn’t actually our aim,” Ms Anderson said during a Te Whatu Ora webinar.

Ms Anderson’s statement has deeply disappointed and annoyed a number of GPs. The statement has been interpreted as “gaslighting” of the sector by Whangārei specialist GP and practice co-owner Geoff Cunningham in his comment on nzdoctor.co.nz.

William Ferguson, a Kumeu practice co-owner and specialist GP, says: “I felt absolutely gutted by it.”

Dr Ferguson tells New Zealand Doctor Rata Aotearoa: “Part of the reason I can’t afford to retire is probably because I have tried to achieve equity, but it’s been at my expense.

“There wouldn’t be a GP in the country that hasn’t paid for their own patients’ care and probably made a habit of it.”

Earlier, he wrote on nzdoctor.co.nz, “Oh, now I am starting to understand. I did not manage to achieve equity in outcomes and fulfill obligations to Te Tiriti. So the fact that our medical centre is currently at the limit of its bank overdraft and I have had to keep it afloat with a further $30,000 from my completely inadequate retirement savings in order to pay staff is really of no concern to Abbe Anderson…

“I have honestly never felt closer to selling to the nearest corporate and going to Australia.”

Asked whether he is really considering selling his practice and working in Australia, Dr Ferguson says, “For me, it’s unthinkable to have even had that thought. Suddenly I’m thinking, honestly, my son is over there and the vibe I get from Abbe Anderson is there is no future here for general practice and, if I’m going to think about retiring, which is not at all possible at the moment, then maybe that’s what I have to do.”

Another Whangārei specialist GP and practice shareholder, Paula Mathieson, wrote on nzdoctor.co.nz, “I owe $110,000 now to my bank to stay open.”

Dr Mathieson declined to be interviewed, saying by email she has no energy to talk about the plight of general practice and that she needs to focus on “my family, my patients and getting out of this mess”.

“I am too deep into the ‘sunk cost fallacy’. I accelerated down the slippery slope in 2017, I thought that expanding the practice and getting in students and GP registrars will help and I love teaching.

“I looked for new rooms, couldn't find anything so added a room where I am now. I thought I could use the space for med students and GP registrars and another doctor and improve my income that way. No chance of a GP registrar, only three placed in Northland with 15 available slots. My ‘free’ HIP and health coach use the room for ‘free’.”

Dr Mathieson says there appears to be no political will to change general practice funding quickly enough to rescue many practices.

“I see all the calls to ‘do something’ on the GP to GP Facebook page. It always degenerates into a talk fest and it is now too late to organise something before the election.”

Her comments about practice viability reflect the findings of the GenPro survey of members published last month. In the survey, 35 per cent of practices made a financial loss in the past quarter of the financial year and 90 per cent of owners are concerned about their practice’s future financial viability.

GenPro chief executive Mark Liddle wrote in New Zealand Doctor last month that he had recently spoken to representatives of two practices facing the dilemma of whether to cut services or become insolvent. Many other practices were increasing their fees – and having their fees reviewed – to try to remain viable.

General Practitioners Aotearoa interim chair Buzz Burrell says Ms Anderson’s talk was “predictable corporate crap”.

Dr Burrell, a pain doctor and specialist in general practice and rural hospital medicine, says the health system needs more GPs. It needs to listen to GPs, invest heavily in GPs, train more GPs and pay GPs in line with their hospital colleagues.

Asked about the attraction for New Zealand GPs of working in Australia for higher pay, he says, “Who can blame them, when to do the same job there’s three or four times the income.”

He had just received an emailed notification from a locum agency of a job going in a northern Queensland rural hospital at a daily pay rate of $3500. Another offer several months ago was for $850,000 a year as a GP in northern Queensland.