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

In Australia, the healthcare system is facing a significant challenge. In primary care, there are just over 30,000 AHPRA-registered general practitioners. Access to timely medical care remains a critical issue, as highlighted in the Australian Bureau of Statistics' "Patient Experiences Report 2022-23." This report reveals that nearly 50% of patients wait more than 24 hours for urgent GP care, a situation exacerbated in regional and lower socioeconomic areas. Moreover, cost prevents 20% of people from visiting a GP, and 30% report unacceptable wait times to secure an appointment.

This issue is further complicated by the nature of the most common reasons for GP visits: psychological and musculoskeletal (MSK) conditions. The Royal Australian College of General Practitioners (RACGP) reports these as the top two reasons for patient visits, areas where specialised healthcare professionals could play a significant role.

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.

A practical and transformative solution would be to adjust the funding structure to allow these allied health professionals to act as first point-of-contact practitioners within Medicare. This change would have multiple benefits:

1. Alleviate Pressure on GPs: By diverting patients with specific psychological or MSK needs directly to specialised care, we can free up GP resources for more complex medical cases, thereby improving access and reducing wait times for everyone.
2. Cost-Effective Care: Direct access to specialised practitioners can reduce overall healthcare costs by minimising the steps patients need to take to receive care, thereby decreasing the administrative burden and overhead costs associated with multiple healthcare visits.
3. Improved Patient Outcomes: Faster and more targeted access by people with expertise in these fields means quicker diagnoses and the initiation of appropriate treatments, which is particularly critical for psychological and MSK conditions known to worsen without timely intervention.

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.