How do Australian general practitioners spend their time? A cross-sectional analysis of Medicine in Australia: Balancing Employment and Life (MABEL) data examining ‘non-billable workload’

Abstract

Background and objectiveWhile Australian general practitioners (GPs) gain most of their income from direct patient interactions, they also spend time attending to professional or practice responsibilities. The aim of this study was to determine the time Australian GPs spend on work away from direct patient care ('non-billable work'), and practice and practitioner factors associated with non-billable work. MethodsThis study was a cross-sectional analysis of GPs practising >7.5 hours/week in the 2016 Medicine in Australia: Balancing Employment and Life (MABEL) dataset. The amount of time that GPs spend on non-billable work was examined, and ordinal logistic regression was used to determine an association between the amount of this work and practice and practitioner factors. ResultsThe sample of 2907 GPs spent 5.1 hours (95% confidence interval: 4.88, 5.27), or 14.2% of their time, on non-billable activities. Non-billable work was associated with female gender, college fellowship, location of medical degree, and rural practice. DiscussionThe amount of non-billable work is likely to increase with population ageing and increasing feminisation of the GP workforce. The lack of reimbursement for much of this work challenges economic viability and GP job satisfaction.MOST AUSTRALIAN GPS are paid for their clinical services on a fee-forservice basis. Bulk-billed consultations are rebated to the GP directly by Medicare, the public insurer, and privately billed consultations are paid for by the patient, who claims a rebate from Medicare. In 2018, more than 95% of the Medicare Benefits Schedule items billed by GPs required a real-time face-to-face attendance. 1,2 However, GPs often need to perform work outside of the consultation period. This work includes coordinating patient care (eg managing investigation results or liaising with specialists or patients' families) or performing administrative tasks to meet personal and practice management requirements. [3][4][5] In 2017, it was estimated that 20% of Australian GPs' time is spent on this non-face-to-face work; 6 however, previous studies have provided estimates ranging from zero hours to more than nine hours per week. 5,7 Female practitioners report spending more time on these tasks, as do those managing patients who are elderly or have a chronic disease. 5 Work outside of the consultation period is non-billable in a fee-forservice context. Clinicians, professional bodies and government advisors have acknowledged the burden of non-billable work. [7][8][9][10] The Australian Medical Association (AMA) proposes that the current administrative workload represents an opportunity cost for more than 14 million face-to-face consultations per year. 11 International literature shows that physicians with high administrative burdens have lower job satisfaction and are more likely to consider seeing fewer patients in the future. [12][13][14] Currently, little is known about how Australian GPs' non-billable work varies with different practice and practitioner characteristics.The aim of t...

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