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When considering a move to Australia, many GP’s will often ask.

  • how much might I expect to earn?
  • and what’s better – working in a mixed billing practice or a bulk billing practice?

These are valuable questions and often help doctors to finalise their decisions about how they want to work when coming to Australia.

To give context to these questions, it is important to understand how the Australian billing process works and the upcoming changes which may impact practice billing processes.



The Australian Medicare system was introduced in 1984 by the Australian government as a means of providing ‘free’ healthcare to all Australians and is funded by taxpayers in form of a Medicare levy tax.

When visiting their doctor, patients can claim a Medicare rebate on eligible medical services.  How much the doctor gets paid for the specific type of consult, then depends upon whether the practice is bulk-billing or mixed billing, and what percentage of the fee the doctor receives.


What’s the difference between bulk billing and mixed billing?

Bulk billing means the patient doesn’t have to pay for eligible medical services. The medical practice which offers bulk billing, accepts the Medicare benefit as full payment for the service, thus being free to the patient.

Currently, a Level B Standard consult < 20minutes for any patient with a valid Medicare card is charged at $41.20.

In a bulk billing practice, no money changes hands between the patient and the GP for the consultation or visit. The practice simply bulk bills Medicare for all the patient visits. It’s simple, easy and similar to the way GPs see patients on the NHS in the UK.  GPs working in bulk billing practices see their patients entirely at the expense of the government.


What are the Advantages of Bulk Billing?

There are advantages of bulk billing for both patients and for doctors. Obviously, patients don’t have any out-of-pocket expenses when visiting a bulk billing GP because the GP gets paid by Medicare.

Accessibility to medical services is therefore available to more people, for example, families with low income. Similarly, patients who may have complex health issues requiring more regular visits are not disadvantaged based on their financial situation.

Bulk billing practices often operate part of their service on a ‘no appointment required’ system. Subsequently, they can often be busier offering more flexibility to a greater demographic of patient, (not just those from lower socio-economic backgrounds), but many from the middle to high income class who are looking for the convenience of a ‘drop in’ approach.

Many of the bulk billing practices we work with are large, well-funded practices, extremely well presented, and with state-of-the-art equipment. As such, they offer GPs the resources to diagnose a range of illnesses quickly and can be very desirable, rewarding places to work.

Not all practices choose to bulk bill and instead have a mixed billing or private billing arrangement.


Understanding how Mixed billing works

Typically, mixed billing practices will require most of their patients to privately pay an additional ‘out of pocket’ amount on top of the Medicare amount.  E.g., a Level B Standard consult fee may be $85 – meaning Medicare pays the practice the $41.20 and the patient pays the remaining top up amount of $43.80 themselves.

The practice has the discretion to keep some of their services or patients as bulk billed. Typically, you might see children, the elderly, and those on some form of government support e.g., disability pension continue to be bulk billed.  Alternatively, it may be that all patients remain bulk billed with all procedures incurring an additional payment.

Practices who require ALL patients to pay an out of pocket top up amount, often synonymously call themselves private billing practices, albeit technically it is a mixed payment system.

This should not be confused with situations where patients fully pay 100% of the fee themselves with no Medicare rebate.  This would be the case for patients without a valid Medicare card, or for services not on the Medicare Benefits Schedule e.g., cosmetic procedures such as Botox.


Which is better – Bulk Billing or Mixed Billing

Depending upon the individual practice and how they choose to bill, the percentage of privately paying patients at a mixed billing practice can vary. And it is a myth that mixed billing doctors earn more than bulk billing doctors.  This is not always the case as how much you earn will vary dependent upon factors such as

  • how much you bill,
  • who you bill,
  • how many patients you see,
  • what services you provide, and
  • what percentage you receive from the practice

Over recent years there has been a move away from 100% bulk billing to the mixed billing system as practices seek to offset the rising costs of running a practice. This has undoubtedly put additional pressures on patients and doctors.

In response the Australian government has announced the largest increase to the bulk billing incentive in the 40-year history of Medicare.

Commencing in October 2023, the new MyMedicare provides a voluntary patient registration platform aimed at formalising the relationship between patients, GPs, and primary care teams.  With this comes additional incentives for practices to offer many common GP consultations, including telehealth and videoconference to patients who register at the practice.  The aim is to make healthcare more affordable, particularly for children, pensioners, and other concession card holders.

Whilst it remains to be seen what the full impact of this initiative will be, the intention is two-fold

  • increased income to the practice and bulk billing GPs by tripling the bulk billing payments for certain types of consults, and
  • improving accessibility to quality healthcare.


Final Words in the Bulk vs Mixed Billing Debate

In the final analysis, each job opportunity needs to be evaluated on its own merits, not whether it is mixed or bulk billing.

At Alecto we have an excellent list of opportunities both mixed and bulk billing. And because we understand how important it is for you to get the right job, we will talk you through the relative strengths of each job and help you understand which opportunity will suit you best. We will never tell you mixed or bulk billing is best!


If you have any questions about this article or are looking for GP Jobs then please contact us at and a member of our team will be in touch.