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August 8, 2008
One of the changes in primary care is the rise of corporate medicine over the last 10 years. The corporates hoped that by setting up medical centres with GPs, pathology and radiology facilities and sometimes allied health-care workers, these would make money from a process of internal cross-referrals. GPs would refer their patients for pathology tests and X-rays to the in-house facilities, and some referrals could also flow the other way.
 For these medical centres to work, the corporates had to get GPs into them and money was paid, sometimes quite big sums, to lure the GPs in. For a lot of older doctors and some young ones too, this was a chance for them to pay off their mortgage and have something to put into their superannuation.
The new model medical centres are often open six or seven days a week and are usually open for extended hours every day. They all bulk-bill. A lot of them don't take appointments for their doctors. Patients therefore have to queue up and wait, and if a patient chooses to see a particular doctor rather than the first doctor available, then that obviously means an even longer wait.
The emphasis is towards encouraging loyalty to the medical centre rather than loyalty to the one doctor. Tuck Meng Soo, a Canberra GP, describes how the corporates work in The Canberra Times:
If a patient comes in for a check-up for her diabetes or to discuss the complications of her latest antidepressant medication and the consultation takes 20 minutes, the GP still gets $32.80 from Medicare. So, for a corporate to maximise income for itself and the GPs working there, they need to encourage patients with chronic and complex problems to seek health care for their conditions elsewhere and to encourage as many six-minute consultations as possible. This is precisely what the structure of the corporate medical centres does.
As more GPs are seduced into working for corporates, the non-corporatised GPs are left with an increasing caseload of patients with chronic and complex problems with the ''easy'' coughs and colds that used to leaven their day taken away. At some point, the burden of work and responsibility gets too much to bear and many non-corporatised GPs just give in and leave medicine or join the corporates.
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The McDonaldisation of health care. Had to happen sooner or later, bit it doesn't sound like an improvement.