Introduction by Croakey: The earnings gap between general practice businesses and non-GP specialist medical businesses is growing, according to a new report, ‘Trends in the structure and financial health of private medical practices in Australia’.
This longstanding gap has been widening significantly over time; in 2006–07, the ratio of profits of non-GP specialists was 1.1 times that of GPs and this increased to 1.5 by 2020–21, consistent with earlier research on doctors’ earnings, the report found.
“Non-GP specialist businesses continue to be the most profitable and have the highest profit margins compared to other professional occupations such as law, accountancy and finance, as well as other industries such as construction and agriculture,” says the report.
The report may remind some Croakey readers of the 2008 Relative Value Study, and associated policy failures. This related 2015 article in The Medical Journal of Australia, discussing the study as a “lesson about the difficulties of healthcare reform”, was directed at the Medicare Benefits Schedule Review Taskforce appointed in that year by then Federal Health Minister Sussan Ley.
But, together with the new report, it might equally make timely reading for the new Strengthening Medicare Taskforce.
The report’s author, Anthony Scott, Professor of Health Economics at the University of Melbourne, gives an overview of his findings in the article below, first published at The Conversation.
Anthony Scott writes:
Almost all GPs and most non-GP specialist doctors (such as cardiologists, gynaecologists and dermatologists) run private businesses to provide medical care in Australia. Business decisions can influence the costs of medical care, the care patients receive, and access to medical care in different geographic areas.
But until now, we’ve had no national data on the costs or profitability of running a private medical practice.
Our ANZ-Melbourne Institute Health Sector Report, out today, uses data from the Australian Bureau of Statistics on all medical businesses in Australia.
We examined trends in growth, costs and profitability, and how the financial health of doctors’ businesses has been affected during the COVID pandemic.
Among our findings, we show how medical businesses, in particular for non-GP specialists, remain very profitable compared to other businesses, including law, accountancy and finance.
Why should we care about medical businesses?
Many people seeking health care do not think about the costs involved, or the profitability of, running a private medical practice.
But the sudden closure of GP practices for financial reasons reduces access to health care for communities. For others, a focus on seeking profits means out-of-pocket costs can rise.
There are also more widespread reports of reduced access to bulk billing (where there are no out-of-pocket costs).
So how doctors run their private businesses is very much in the public interest.
The growth of private practice
It was not too long ago that GPs and non-GP specialists worked largely on their own. But the benefits of working with others has led to a growth in private group medical practice.
GPs were the first doctors to do this. Now almost 90 percent of GPs report working in a group practice. But other specialists are rapidly catching up, where almost 70 percent now work in a private group practice.
The total number of doctors in a solo private practice has fallen by 0.5 percent between 2013 and 2020, while the number in group private practices has increased by 28.9 percent.
Group practices can be good in keeping costs down by sharing the costs of premises, administration, nurses, and medical equipment. Working together can improve the quality of care and access to health care, as patients can easily see another GP in the practice if their preferred one is too busy. In a group practice, doctors can also more easily share knowledge.
But if businesses get too big, this could mean less choice for patients looking for a local doctor, and less competition. This could further increase out-of-pocket costs as there is less competitive pressure to keep fees low.
While more non-GP specialists are working in group private practice, they are also on average spending less time there. In 2020 they spent about three hours per week less in private practice compared to 2013.
Rising profits and costs
We show profits rose by an average of 2.4 percent a year for GP businesses and 5.3 percent a year for non-GP specialists businesses between 2005-6 and 2020-21.
Costs for GPs rose by an average 2.7 percent a year over the same time period. Turnover from total fees charged grew by 2.9 percent.
For non-GP specialists costs rose by an average two percent a year over the same time period, while turnover grew by 3.5 percent.
Overall the growth in costs for GP businesses was higher than for other specialists, and the growth in turnover was lower. This gap between costs and turnover has grown over time.
Non-GP specialists’ businesses made 50 percent more profit than GP businesses in 2020-21 ($216,468 and $144,485), compared to 14% more in 2005-6 ($120,452 and $105,924).
Impact of COVID
Medicare coverage of telehealth meant GPs avoided losing income from the fall in face-to-face visits because of COVID. So revenue from fees continued to increase, though at a lower rate than before 2020.
Medical practices could also claim JobKeeper payments to maintain employment of practice staff. This financial support meant the number of GP and non-GP specialist businesses winding up or going bust actually fell during 2019-20. In fact, the total number of medical businesses continued to grow throughout the pandemic.
Profits initially fell during COVID by 1.9 percent for GPs and by 4.5 percent for non-GP specialists between 2018-19 and 2019-20.
But profits bounced back the following year because of the pent-up demand during the pandemic. People who were avoiding health care because of COVID or who had their elective surgeries cancelled, came back and still needed care.
This was especially the case for non-GP specialists, where profits grew by 10.8% between 2019-20 and 2020-21 compared to 2.2 percent for GPs.
However, medical businesses, especially GPs, experienced sudden increases in costs as they adapted to COVID settings. For GP businesses, costs increased by over 8 percent during the pandemic (4.1 percent between 2018-19 and 2019-20, and by 4 percent between 2019-20 and 2020-21.
It is expected demand will remain high for private medical care provided by GPs and non-GP specialists as people who delayed care and treatment during the pandemic return to seek care.
In fact, medical businesses, especially non-GP specialists, remain very profitable compared to other businesses such as law, accountancy, finance, construction and agriculture. In 2021, the median gross profit per business (turnover minus costs before tax) was $216,468 for non-GP specialists, $120,452 for GPs, and $124,431 for legal businesses.
Implications for patients
Achieving good access to high-quality medical care requires medical businesses to be located in areas of need and where out-of-pocket costs are kept to a minimum for low-income populations.
The growth in private group medical practice can mean medical businesses are run more efficiently, with continuing cost pressures leading to the formation of larger medical groups, especially for non-GP specialists.
In most cases maintaining profitability of private medical businesses is necessary to ensure their survival and maintain access to medical care, as long as out-of-pocket costs don’t increase at the same time.
Disclosure statement: Anthony Scott receives funding from the Australia and New Zealand Banking Group for the annual report series ‘ANZ-Melbourne Institute Health Sector Reports’. Professor Scott conducts the data analysis and writes the report.
See Croakey’s archive of articles on the Strengthening Medicare Taskforce
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