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The healthcare bottleneck paradox: 30,000 GPs and 40,000 physiotherapists yet Medicare requires a GP referral to access a physio – Why?

Introduction

Australia’s healthcare system faces significant bottlenecks. With just over 30,000 AHPRA-registered general practitioners (GPs) serving millions of patients, timely access to primary care is increasingly difficult. According to the Australian Bureau of Statistics’ “Patient Experiences Report 2022-23″ nearly 50% of patients wait more than 24 hours for urgent GP care, and in regional and lower socioeconomic areas, the situation is even worse. Cost is another barrier, preventing 20% of people from visiting a GP, while 30% report unacceptable wait times to secure an appointment.

But here’s the paradox: while there are over 40,000 physiotherapists trained to address musculoskeletal (MSK) conditions, patients still need a GP referral to access them through Medicare. Why is this outdated referral system still in place when it adds unnecessary steps, costs, and delays for patients seeking care?

The Problem: Bottlenecking Care Through GP Referrals

The traditional GP referral requirement for allied health services, like physiotherapy, contributes to longer wait times and higher costs for patients. The most common reasons for GP visits are psychological and MSK conditions, as reported by the Royal Australian College of General Practitioners (RACGP). These are areas where allied health professionals (AHPs) have specialised training, yet Medicare’s funding structure requires patients to first see a GP before accessing this care.

This policy creates a “bottleneck” that forces patients to navigate a congested pathway to get the care they need. It not only delays treatment but also adds pressure to an already overstretched GP workforce.

Allied Health: An Untapped Resource

Consider this: there are nearly 80,000 allied health practitioners (self-registered and AHPRA registered), including psychologists, social workers, occupational therapists, counsellors, psychotherapists, and rehabilitation counsellors, whose core training includes the provision of specialised mental health support.

Similarly, over 60,000 allied health practitioners claim MSK care as their core area of expertise, including physiotherapists, podiatrists, chiropractors/osteopaths, exercise physiologists, and myotherapists/masseurs. These professionals undergo rigorous training, often four years or more, focused precisely on the conditions burdening our healthcare system.

The bottleneck occurs because these allied health professionals generally only receive funding through Medicare if a GP refers a patient to them. This means that before receiving specialised care, patients must first navigate the congested pathway of securing a GP appointment, which as we’ve seen, is fraught with delays and barriers, and incurs additional costs to the patient and health care system.

If patients could directly access allied health professionals without a GP referral, the healthcare system could operate more efficiently and cost-effectively.

The Solution: Direct Access to Allied Health Under Medicare

Allowing allied health practitioners to act as first point-of-contact providers under Medicare could be transformative. Here’s why:

  1. Alleviating Pressure on GPs: Direct access to allied health professionals would free up GPs to focus on more complex medical cases. This approach would reduce wait times for all patients, ensuring quicker access to care and better resource allocation.
  2. Cost-Effective Care: Allowing patients to see AHPs directly could lower healthcare costs by reducing the number of steps in the patient journey. Streamlined access to specialised care could minimise administrative overhead and decrease the need for multiple consultations.
  3. Improved Patient Outcomes: Faster, more targeted care from specialists means quicker diagnoses and treatment. This is especially important for psychological and MSK conditions, which can worsen without timely intervention.

Why Change Is Necessary

The current Medicare structure fails to fully utilise the skills of allied health professionals, limiting patient access to timely and specialised care. This is particularly detrimental in regional areas, where GP shortages are more pronounced. Direct access to AHPs would not only increase healthcare efficiency but also improve patient outcomes and lower long-term healthcare costs.

Breaking the Bottleneck: What Needs to Happen

To make this change a reality, policymakers must reconsider Medicare’s funding model and allow for direct patient access to allied health professionals. This shift would create a more sustainable and efficient healthcare system by:

  • Integrating AHPs into primary care teams, reducing the burden on GPs.
  • Implementing flexible funding models that incentivise early intervention and preventative care.
  • Enhancing training pathways for AHPs, ensuring they are well-prepared to take on expanded roles in patient care.

Conclusion: Rethinking Medicare for a Healthier Future

By rethinking our approach to Medicare funding and the role of allied health professionals, Australia can create a more efficient, responsive, and sustainable healthcare system. This shift not only promises to improve the health outcomes for millions of Australians but also supports a more strategic allocation of our healthcare workforce, ultimately leading to a stronger, more resilient healthcare system.

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