Happier days for doctors: is it because of health reforms?
The Labor Government‚Äôs health reforms may have failed to make¬†much impact on the public at large, but maybe they did assuage the doctors.
That‚Äôs one possible interpretation of the¬†startling improvement in GPs‚Äô views about the health system, revealed in the¬†latest Commonwealth Fund survey.
Headlines trumpeting the stressed state of Australia‚Äôs¬†health system have subsided in the past year.
One explanation maybe that the attention given to health ‚Äúreforms‚ÄĚ has¬†mollified many doctors‚Äô concerns.¬†
Philip Davies, Professor of Health¬†Systems & Policy, School of Population Health, at the University of¬†Queensland, looks at the Commonwealth Fund survey results and finds while there¬†has been a remarkable turnaround in GPs‚Äô satisfaction with their jobs,¬† still fewer than half believe the health¬†system works well.
GPs’ view of¬†health system improves but worries remain about time with patient
The latest annual survey from the US-based Commonwealth Fund offers some¬†interesting insights into how Australian GPs view our health system.
The¬†survey, which was carried out between March and July this year, involved¬†almost 10,000 ‚Äėprimary care physicians‚Äô across 11 countries (Australia, Canada,¬†France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, and¬†USA).
Overall the 500 Australian GPs who were surveyed seem to be¬†pretty happy with their lot; and getting happier! Eighty per cent reported they were either satisfied¬†or very satisfied with practising medicine.
That‚Äôs a marked improvement on the figure of fewer than half (48%) of¬†Australian GPs surveyed¬†in 2009 who reported similar levels of satisfaction at that time.
Our current rating¬†puts us on a par with New Zealand and Canada (both of which reported an¬†equivalent figure of 82%), and the UK and Switzerland (both 84%). ¬†To find the most contented GPs we need to look¬†towards the Netherlands and Norway where satisfaction rates were 88% and 87%¬†respectively.
Just one in four of the GPs surveyed in Australia claimed¬†they were somewhat or very dissatisfied with the money they earned from their¬†practice. On that measure we‚Äôre in the¬†middle of the pack (ranking 6th alongside New Zealand).¬† Norway appears to have the most financially fulfilled¬†GPs with only one in six reporting dissatisfaction.
Constraints on time¬†with patients a concern to many GPs
More disturbing, perhaps, is the fact that 40% of our GPs¬†indicated they were somewhat or very dissatisfied with the time they were able¬†to spend with their patients.¬† That seems¬†to be a general area of concern though with only two countries‚Äô GPs reporting¬†lower levels of dissatisfaction (Norway with 37% and Switzerland with 31%).
Looking at our health system as a whole, the proportion of¬†Australian GPs who reported that they considered it ‚Äėworks well‚Äô with ‚Äėonly¬†minor changes needed‚Äô was 45%, which is almost exactly double the equivalent figure¬†in the¬†Commonwealth Fund‚Äôs previous GP survey carried out in 2009.¬† That‚Äôs the largest turnaround in GPs‚Äô opinions¬†among all the countries surveyed.
The best performing systems, according to the GPs who work¬†in them, are to be found in Norway, the Netherlands and New Zealand where more¬†than half of those surveyed felt that only minor changes were needed.¬† But in the USA only 15% had such a positive¬†view.
As far as Australian GPs‚Äô use of e-health is concerned the¬†survey paints a mixed picture; ¬†¬†92% of¬†Australian GPs reported that they used electronic medical records in their¬†practice (a drop from 95% in the¬†2009 survey is probably statistically insignificant).¬† On that score we‚Äôre beaten only by the UK,¬†Norway, the Netherlands and New Zealand.
Our GPs seem also to be putting their IT systems to good use¬†when it comes to prescribing with 88% indicating they routinely receive¬†electronic prompts about potential problems with medications.
But we still seem to be struggling to capture¬†the real benefits of e-enabled networking and communication.¬† Just 27% of our GPs can electronically exchange¬†patient summaries and test results with doctors outside their practice (that‚Äôs¬†half the rate in New Zealand and only Germany and Canada do worse than us); a¬†mere 8% of practices allow patients to request a referral or appointment online¬†(only Canada at 7% reports a lower percentage); and only one in five allows¬†patients to e-mail about a medical question (again, Canada is the only country¬†with a lower rate of 11%).¬† In Sweden¬†fully ‚ÖĒ of practices offer on-line appointments or referral requests, while the¬†same proportion of Swiss practices cater for e-mail medical questions.
The survey also focuses on ‚ÄėAccess and barriers to care‚Äô. A¬†quarter of Australian GP respondents considered their patients often reported¬†they faced difficulty in paying out of pocket costs (placing us in sixth,¬†median, position among the countries surveyed) while one in six saw patients¬†facing similar difficulties in respect of access to diagnostic tests (where we¬†again ranked sixth).
Interestingly, while New Zealand GPs saw roughly the same¬†level of difficulty posed by out of pocket costs their views on diagnostic¬†tests were significantly bleaker with 59% of respondents suggesting their patients¬†often faced access difficulties ‚Äď the highest rate among all eleven countries.
Things seem less encouraging when it comes to timeliness of¬†access though with 60% of GPs saying their patients often faced long waits to¬†see a specialist.¬† That puts us in fourth¬†place alongside Norway but is a significant deterioration from the equivalent¬†figure of 34% in the Commonwealth Fund’s 2009 survey. Again, though, it¬†was New Zealand that had the biggest reported problem with three-quarters of¬†GPs considering their patients had long waits to see a specialist.¬† Of course, such views might themselves be¬†shaped by expectations of what constitutes a ‚Äėlong‚Äô wait in the context of a¬†country‚Äôs health system.
In the same vein we appear to have little to boast about¬†when it comes to timely access to GP services.
Only 38% of Australian GPs reported that more than 80% of patients can¬†get a same-day or next-day appointment when requested.¬† That‚Äôs the third lowest figure among the¬†countries surveyed with equivalent rates of 55% in the UK, 59% in New Zealand¬†and an astonishing 86% in France.
Delays and¬†disorganisation point to challenges for Medicare Locals
The survey provides a wealth of additional data, including¬†illuminating material on care coordination and service quality.¬† Those data, together with commentaries and various¬†graphical presentations can be accessed here¬†but what conclusions, if any, can be drawn from the¬†findings outlined above?
First we need to note that this is a survey of GPs‚Äô views¬†that may not align fully with those of the wider population.¬† Second, the sample size (500 GPs) is¬†relatively small and so all results should be treated with a degree of caution.¬†And third, we need to recognise that views on health services can be influenced¬†by goings-on in the broader political environment and comparisons with other countries,¬†in particular, may be influenced by contextual factors.
Notwithstanding those caveats, a headline from the survey,¬†at least as far as Australia is concerned, is the remarkable improvement in¬†GPs‚Äô views on the overall wellbeing of the system.¬† At the time the previous survey was¬†collecting data we were eagerly awaiting the publication of the National Health¬†and Hospital Reform Commission‚Äôs final report.
It‚Äôs possible that the many new initiatives launched since the winter of¬†2009 have succeeded in building GPs confidence in the system from previously¬†low levels.¬† On the other hand it could¬†simply be that that the very existence of the Commission (and other bodies¬†looking at primary care and prevention) together with the publicity and high¬†expectations surrounding its work created a view among GPs back in 2009 that
change was needed.
There are few surprises in the survey‚Äôs findings as far as¬†IT is concerned.¬† We‚Äôve known for some
considerable time that levels of computerisation in our GP practices are high.¬† What the survey confirms, however, is that¬†we‚Äôre still not making the most of the opportunities that come from linking up
stand-alone systems and enabling patients to interact electronically with care¬†providers.
In terms of affordability, GPs seem to place us very much in¬†the middle of the road relative to our peers.
However, it is hard to reconcile their view that one in six patients¬†faces difficulties in accessing diagnostic tests with the fact that¬†bulk-billing rates for pathology and radiology services at the time of the¬†survey were around 87% and 74% respectively.
The findings also point to delays at the key interfaces in primary¬†care: when patients first approach a GP to book an appointment; and when they¬†need a specialist referral. Coupled with the observations above about IT they¬†point to a need for continued efforts to improve the ‚Äėconnectedness‚Äô of primary¬†care; to facilitate communications and planned patient journeys; and to enhance¬†the ‚Äėsystemness‚Äô of what is currently all too often experienced as a¬†disorganised sector.
Those are areas where the new Medicare Locals are expected¬†to deliver.¬† The Commonwealth Fund survey¬†makes clear the scale and scope of the challenges they face.
But if all else fails, moving to Norway looks like a smart¬†option.