Tag Archives: GPs

Dr No: Why Australia’s medical practitioners are reluctant to pass the baton to pharmacists

A majority of Australia’s GPs believe some low risk tasks could be taken off their plate by pharmacists to ease their workloads. In the main, however, medical practitioners are sceptical of pharmacists’ abilities to assist with more complex diagnosing and prescribing tasks.

And while GPs assess themselves as less confident in making ethically difficult recommendations or providing potentially addictive prescriptions, their confidence in pharmacists doing the same tasks is considerably lower still.

The GP and Pharmacy Landscape

Most Australian GPs (74%) have a close working relationship with a local pharmacist. The number of GPs with these working relationships declines, however, depending on how much of their practice is bulk-billed.

For Australian medical practices that are 100% bulk-billed, only 61% of GPs claim to have a close working relationship with a local pharmacist. Practices that bulk-bill between 70-100% of the time see the figure rise to 68%, while the mid tier category of bulk-billing (30-70%) has a figure of 82% and the low tier category (0-30%) records a figure of 83%. In short, the more GPs bulk-bill, the less they interact with pharmacists.

A Preponderance of Prescriptions

It might come as a surprise to the average Australian, but a majority of a general practitioners’ consultations involve seeing patients who simply need a prescription filled, rather than diagnosing treatment for an ailment.

EKAS’s December survey revealed that for all the patients GPs treat, 60.1% require a prescription for either Schedule 4 (prescription-only medicine) or Schedule 8 (controlled drug) medications.

Just over a third (36.9%) of GP consults are spent providing advice on a medical problem or ailment for patients, while around 3% specifically require a medical certificate.

GP Confidence in Providing Treatment

The confidence of GPs in fulfilling certain tasks diminishes as the level of expertise required and identified potential risks – such as developing an addiction – escalate.

Treating the common cold (99%), giving general medical advice and recommending and prescribing treatments for low-risk ailments like asthma and heartburn (97%), saw GPs overwhelmingly comfortable.

Moving into terrain where some ethical judgement is required, the survey revealed 80% of GPs were willing to dispense medical certificates and 78% were willing to recommend vaccinations to patients.

A narrow majority of GPs (59%) were willing to recommend and prescribe Schedule 4 medications (which are addictive and liable to cause dependence), while 56% were willing to give general medical advice and prescribe treatments for more complex chronic ailments like diabetes.

Less than half of Aussie GPs are willing to prescribe vaccinations to patients, suggesting that a narrow majority of doctors believe that patients should make up their own minds about getting vaccinated, irrespective of risks.

In matters of Schedule 8 drugs (which include amphetamines, barbiturates and codeine), there was a high degree of caution around these addictive substances. Just 14% of surveyed GPs were willing to recommend and prescribe Schedule 8 medications.

Generic GPs Duties & Pharmacy Assistance

Aussie GPs overwhelmingly feel that some tasks – such as treating the common cold and ailments like hayfever – are a drain on their resources, with 87% saying time spent treating these ailments would be better spent on more technical issues.

However, much like their own concerns about the ability to treat and prescribe, GPs are sceptical about pharmacists’ ability to take the load off them for anything other than the most straightforward tasks.

There were 92% of GPs who felt pharmacists were qualified to treat the common cold, while a further 87% thought that they were able to treat low risk conditions like asthma and heartburn.

Interestingly, 82% of GPs said they were happy with pharmacists providing medical certificates to patients (2% higher than the number of GPs who were happy to issue them). Clearly it’s an occasional, but irksome, task for GPs that they would be willing to outsource.

There were 71% of GPs who said that pharmacists were qualified to recommend vaccinations, 43% who felt they could prescribe vaccinations, 36% who felt they could prescribe Schedule 4 medications, but just 5% who felt they could prescribe Schedule 8 medications.

The sceptical majority

While the consensus of the survey from GPs was that they could be relieved of some tasks by pharmacists, the general mood when assessing pharmacists’ abilities was one of pessimism.

The chief concerns of GPs centre around a lack of clinical training and knowledge on the part of pharmacists, overlooking symptoms of more serious conditions and the opportunity to practice preventive medicine with patients.

Much of this boiled down to context and, in particular, the more in-depth, private relationship formed between GPs and the patients they treat. One GP commented in the survey: “The idea of outsourcing sounds simple, but general practice is complex. A consultation is an opportunity to assess screening needs, mental health and wellbeing and develop rapport. There are no simple consultations in general practice. This does not seem to be understood by many pharmacists.”

Another cited the nature of pharmaceutical business as a red flag: “Not only are pharmacists not trained in diagnosis and treatment, they make (probably most of) their profits from up-selling complementary therapies, so they have a huge conflict of interest.”

But there are advocates of pharmacists playing a larger role. One GP cited an overseas example of progress that is helping to ease the workloads of GPs: “This integration is happening in England currently and it’s working. I wonder why we aren’t we doing it here to lessen the GP burden?”

Summary

The problem for GPs treating minor ailments such as colds, hayfever and heartburn is that the patient is the arbiter of their own healthcare treatment and ultimately decides whether they visit a doctor or not.

The solution appears to lie in public education – encouraging prospective patients to consult with a pharmacist first if they feel they have a mild ailment. Raising awareness in this space, combined with extra training for pharmacists could be just the tonic for Australia’s overworked doctors.

If you have a survey or research project you would like to conduct, you can visit www.ekas.com.au or contact Jaxon (jaxon@ekas.com.au) or Matt (matt@ekas.com.au) for more information

Medical industry pressures are placing an intolerable strain on staff

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An overwhelming majority (85%) of Australian medical professionals believe their peers are at a heightened risk of burnout compared to the general population, EKAS Market Research’s latest survey shows.

Complicating the issue is the finding that 84% of the same survey group said there is a strong stigma against those in the medical profession seeking help.

These recently collated views of Australia’s medical practitioners are corroborated by other sources. A landmark BeyondBlue study conducted in 2013 found one in five medical students and one in 10 doctors had suicidal thoughts in the past year.

Additionally, the BeyondBlue survey showed more than four in 10 medical students and a quarter of doctors are highly likely to have a minor psychiatric disorder, such as mild depression or anxiety. The study also found 3.4% of doctors experienced very high psychological distress, a rate far higher than the general community.

EKAS’s own survey of nearly 500 Australian medical practitioners, which delved into a range of issues, revealed several other alarming statistics.

Younger and regional doctors considered at a heightened risk

Although the medical profession at large suffers a greater mental health affliction, its youngest employees are perceived to be at greatest risk. When asked whether young practitioners are at a higher risk of burnout, 44% agreed they were, while 28% regarded the risks as the same irrespective of age. A further 22% said younger practitioners were at a lower risk, while 6% could not decide.

Remoteness was another factor observed as a key contributor to burnout. There were 46% of respondents who rated regional medical practitioners as being at a higher risk, while 31% assessed the risks as the same wherever they practiced. Only 9% rated regionally-based doctors at a lower risk and a further 14% could not decide.

Working with a mental health burden

The attitudes of medical practitioners themselves can be considered problematic, with updated BeyondBlue research from 2019 revealing 40% judged their peers with mental health concerns as less capable.

EKAS’s survey similarly showed that just 5% of medical practitioners thought a physician could practice competently while dealing with a mental health issue. There were 27% who categorically said they could not do so, while the majority (68%) said it was dependent on the severity and nature of the disorder.

As for whether the current resources were adequate for dealing with physician burnout, the view of the profession was scathing.

There were 56% of those surveyed who said the channels for help weren’t sufficient, while only 6% felt they were. Another 25% felt there were adequate resources to help but they weren’t being utilised properly and another 13% didn’t know enough about the options to comment.

Causes of burnout

The sheer number of hours that medical staff were required to work was rated as the most significant contributing factor to burnout, with 69% of those surveyed including it.

This was followed by 57% who cited a perfectionistic, high achieving personality type, 55% who saw a stigma around seeking help, 52% who flagged the relationship between patient illness and death, and 50% who said there was not enough clinical or professional help.

Almost a third (32%) said there wasn’t enough devoted mental health support, while 27% said there was inadequate resilience support and training from universities.

When asked to pick out the single most significant factor influencing burnout in medical professionals, 24% cited the length of workdays, 17% the effect of patient illness and death and 15% a perfectionistic, high achieving personality type that would not allow themselves the respite they needed.

Why do they suffer in silence?

It is well established that medical practitioners not addressing their mental health is a significant factor in burnout and suicide. It appears the contributing factors are well understood however, with roughly two thirds of respondents citing every one of the survey’s reasons for not disclosing a mental health issue.

All told, the perceived reasons for not disclosing mental health struggles included fear of judgement from colleagues (78%), fear of being deregistered (72%), the high achieving personality type of medical practitioners (66%), confusion around AHPRA reporting guidelines (65%) and the perception that doctors needed to be seen as resilient (64%).

What can be done?

A high number of respondents (83%) said better work-life balance for medical practitioners was required, followed by improved lifestyle factors like diet, health, exercise and meditation (66%) and the need for a reduced stigma around seeking clinical help (56%).

Interestingly, all three top ranking factors related to either self-care or a perceived need for more understanding among the wider profession. It points to a general insularity, and a sense that if medical practitioners can help others, they can help themselves.

Additionally, there were 53% of those polled who said clarity around AHRPA guidelines was needed and 52% who cited a stronger clinical health system.

As for having the mental health issue dealt with mandatorily, only 28% said there should be required counselling with specialised GPs or psychologists.

It’s a finding that suggests implementing step change for dealing with mental health in the medical profession would require a hearts and minds campaign of some scale. But, given the stark findings of this and other surveys, now appears to be the time.

If you need to talk to someone, you can call Lifeline on 13 11 14 or BeyondBlue on 1300 22 44 36

Footnotes

For the purposes of this study, burnout was defined as mental exhaustion and/or mild depression or anxiety.

Survey numbers: This EKAS survey polled 474 medical professionals across all Australian states and territories. There were 51% who identified as GPs, 44% who identified as specialists and 5% who identified as surgeons. Of the total survey group, 4% identified as registrars. The average time practicing was 22.1 years.

If you are seeking content for an upcoming event or would like some preliminary information (short poll) for a client proposal, please reach out to EKAS and we’d be happy to help. EKAS received 377 responses for this survey within the first seven business days and respondents went into a draw to win a $100 prize.

GPs embrace MyHealthRecord but privacy concerns remain

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A wide ranging survey of Australian GPs by EKAS market research shows that use of the MyHealthRecord (MHR) system is high, with four out of five doctors utilising the online summary in their practices. In total 83% of GPs have been won over by the initiative, which has been up and running since 2018 following initial trials in 2016.

With a prevailing climate of concern around digital data privacy, which saw around 2.5 million Australians opt out of the scheme, the high take up rate is a strong endorsement of the initiative from Australia’s medical practitioners.

The number of GPs employing MHRs is also likely to swell with nearly half of those who said they do not currently use it stating they intend to employ it in the future. But that will leave around 7.5% of GPs not on the system – representing tens of thousands of patients Australia-wide.

What’s the take up rate and who should choose?

Following initial trials in 2016, from July 16 last year through to January 31 Australians were subject to an opt-out period where they could decline a MHR.

At the conclusion of this period, roughly 2.5 million Australians or about 10% of the population declined to have a MHR created, with the remainder automatically having a record created for them.

And while the government might have figured that an opt-out initiative was likely to see fewer people actively declining an MHR, GPs weren’t overwhelmingly convinced this was the right approach.

In fact, the question of how much autonomy individual Australians should be given over the creation of MHRs proved very divisive for the surveyed GP cohort. A roughly even split was recorded when GPs were asked whether the MHR should be opt-in (53%) as opposed to opt-out (47%), with a larger number ultimately feeling that records should not be created unless specifically asked for.

Curiously, GPs themselves seem considerably less inclined to commit details of their health to record than the general public. Just shy of half of those surveyed (48%) have personally opted out of the MHR with the remaining 52% happy to join the vast majority of their countrymen in creating an MHR.

Roughly 70% of those GPs who have opted out of an MHR said via an open-ended question that they either don’t have serious health issues or understand their own health well and don’t need to commit it to record.

Weighing up the pros and cons of the MHR

When the survey group was asked about the chief advantages of the MHR, two outcomes stood out as the perceived benefits. Some 71% of GPs could see the ‘benefit of using MyHealthRecord for travelling/itinerant patients who are expected to see several different healthcare providers, while 70% agreed that it had the ‘potential to reduce confusion and improve communication between health practitioners’. A further 49% said that it was beneficial ‘for patients with chronic or multiple medical conditions’.

In terms of the drawbacks of the MHR, the results indicated the data-privacy conscious times we live in, with GPs strongly concerned about personal information finding its way into the wrong hands. Nearly three quarters (74%) of respondents cited ‘potential privacy issues with the Australian government’.

Interestingly, the next most concerning aspect for GPs – with a full 50% citing it – was ‘potential privacy issues between health practitioners’.

Privacy concerns aside, the next biggest drawback was more functional in nature with 38% stating ‘the user interface of the MHR is too complicated’.

Sharing second party data – better health outcomes or a recipe for disaster?

The question of using de-identified data for purposes outside record keeping drew a strong response from GPs, with some sources drawing moderate approval and others near universal condemnation.

Perhaps unsurprisingly, GPs took a dim view of sharing data with pharmaceutical and insurance companies, even when de-identified. Just 8% of GPs were in favour of Big Pharma receiving such information, while 5% were happy with it in the hands of insurers.

The most approved source for willingly shared de-identified data was medical research foundations, but even these institutions only gained the backing of 59% of GPs. Another 41% of GPs were happy with data of this kind being shared with universities.

But there’s a strong school of thought amongst GPs that de-identified MHR information has no place being shared beyond the individual or doctor. Over a third of GPs (36%) opted for ‘none of the above’ when furnished with all sharing options in the survey.

Conclusions

Over 80% of Australian GPs have already welcomed patient MHRs into their practices and there are signs that this number may soon rise to over 90%, which is roughly in line with the number of Australians currently in possession of their own MHR.

High-profile data breaches which have dogged tech and other companies in recent years appear to have had an effect on GPs’ confidence in the ability to protect patient information. Roughly two in five of those surveyed are unhappy with the notion of de-identified MHR information being shared with any outside source.

Clearly, then, there is work to do for the government, technology providers and researchers to convince practitioners that they are capable of handling this most sensitive of data in order to help advance research and health outcomes.

The survey asked six questions (with two sub-questions) to Australia-based GPs who are part of EKAS market research’s medical panel. A total of 326 completed responses were received and constitute the sample for the results in this article. In terms of respondents, 59% identified as Metro GPs and 41% as regional, while 44.5% identified as male, 42.5% identified as female and 13% were unspecified.