Australian general practice: where have the GP services gone?

While the number of GP services provided in Australia increased steadily from the inception of Medicare in 1984 until the mid 1990s, it declined by 6.6% from 1997-8 to 2003-4. This reflects a decline in average number of services provided per GP of 8.0%. In Australia, as in the US and Canada, there has been a change in the composition of the GP workforce in recent years, in particular an increased feminisation and aging of the GP workforce. We explore whether the decline in average level of services per GP is an inevitable outcome of changes in the composition of the GP workforce, or due to changes in the behaviour of individual GPs driven by attitudinal or economic factors.

Using 8 years of data on the levels of GP activity within the Medicare system, we apply standardisation techniques to examine the expected impact of changes in the composition of the GP workforce. We show that the increasing feminisation of the GP workforce over this period would lead to a reduction in overall GP activity levels, everything else being equal, but that the effect is small (1.9%). Aging of workforce would have led to an increase in overall activity levels (7.5%), as would increases in levels of vocational registration (4.2%) and increases in the proportion of overseas-trained GPs (0.6%).

Overall, if GPs of a given age-sex-education/training category had continued to provide services at the same average level in 2003 as in 1996, the change in composition from 1996 to 2003 would have led to increases in the levels of services per GP of 3.9%. This is 11.4% above the level of services per GP actually observed. We have examined changes in the number of services per GP within 'pseudo cohorts' of GPs, and observe that young cohorts of GPs provide fewer services on average than previous young cohorts. Middle-aged GPs, particularly middle-aged male GPs, have reduced the number of services they individually provide. While this reduced level of activity of individual GPs could be due to changes in the underlying need for services, it is more likely to be as a result of reduced demand due to higher prices being charged (consistent with the observed increases in charging levels), or to changing attitudes of GPs seeking more family time.

In planning for the future GP workforce, policy makers need to consider many factors. These include not only the demographic factors that influence the volume of GP activity, but also the changing behaviour of GPs and the factors that influence this behaviour.