Bulk or mixed billing? That is the question with any GP job.
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.
UK GPs wanting to find a GP job in Australia often ask for jobs in mixed billing practices in preference to bulk billing practices. Are mixed billing practices better places to work?
Firstly, some background.
In February 1984, the Medicare system was introduced by the Australian government, granting basic healthcare to all Australians.
While Medicare is “free”, it’s funded by tax payers in form of a Medicare levy tax. The Medicare rebate can be claimed by all Australians for eligible medical services.
What is Bulk Billing?
What does bulk billing mean? Bulk billing means that the patient doesn’t have to pay for eligible medical services. The medical practice which offers bulk billing, accepts the relevant Medicare benefit as full payment for each service.
It also means that GPs working in bulk billing practices see their patients entirely at the expense of the government through its healthcare system, Medicare, which allows $41.40 (for a standard 10-minute consult) for everyone to visit the doctor when needed. In addition to this the government continuosly introduced new ‘Bulk Billing Incentives’ which means that if you bulk bill a consultation, you may actually earn nearly double the amount per consult. In a bulk billing practice, no money changes hands between the patient and the GP for the consultation or visit. The practice simply bulk bill Medicare for all the patient visits. It’s simple and easy, and very like the way GPs see patients on the NHS in the UK.
Not all practices choose to bulk bill. If you’d like to find out if a specific practice offers bulk billing, you can generally find this on the clinic’s website.
What are the Advantages of Bulk Billing?
There are advantages of bulk billing for patients and for doctors likewise:
- Patients don’t have any out-of-pocket expenses when visiting a bulk billing GP because the GP gets paid by Medicare. 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.
- Practices are able to offer medical services to more people, for example, families with low income. Bulk billing practices are therefore busier and typically have more patients. There is a bit of a misconception that bulk billing practice only attract patients from lower socio-economic backgrounds, however that’s not true. In fact, many people from the middle to high income class, visit bulk billing practices to save money, but also to due to the convenience of a ‘no appointments’ system. Other benefits include the access to various equipment and materials that are not available to private practices.
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.
What is Private Billing?
Private billing means that patients pay the medical bill themselves. It also means that there are no restrictions on what practices can charge for their medical services, However as with many other competitive industries, practices face a lot of competition and therefore it’s not advised to charge above market rates. A purely private billing clinic is rare to see with most opting for a mixed billing option.
What’s the Difference Between Private and Bulk Billing?
As we have learnt above, the main difference is that patients pay the medical bill themselves if they opt to visit a privately billed practice. On the contrary, in bulk billing practices, Medicare covers the costs, which means patients have no out-of-pocket expenses.
In practice, there are hardly any pure private billing practices and therefore ‘private billing’ has become synonymous with ‘mixed billing’.
What is Mixed Billing?
In Mixed billing practices, a percentage of a GP’s patients will pay a private top up on the Medicare allowance, this comes from the patient’s pocket. E.g., a Level B Standard consult fee may be $90 – meaning Medicare pays the practice the $41.40 and the patient pays the remaining top up amount of $43.80 themselves. They will do this because it gives them more choice as to whom they see, when they visit, for how long, and very importantly, because they can afford it!
Does this mean a mixed billing practice is a nicer or better place to work? Much will depend on the way a GP likes to work but here are some facts and trends to take into account when thinking through your preferences:
- In all mixed billing practices, a percentage of the patient base will be bulk billing – children, the elderly and patients on some form of government support. In some cases, the percentage of privately paying patients at a mixed billing practice can be very small indeed and the differences to a bulk billing practice marginal.
- Not all bulk billing practices are in lower socio-economic areas. Indeed, many bulk billing practices offering a ‘no appointment’ system frequently attract affluent patients who will use the practice because it is convenient and they don’t need to wait for an appointment.
- Mixed billing doctors will often see more of the ‘worried well’, whereas bulk billing doctors frequently experience a wider variety of work and more interesting challenges.
- Many of the bulk billing practices we have on our books 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 more quickly. They can be very desirable and rewarding places to work.
- There is a growing trend for patients across the demographic spectrum to use bulk billing doctors. Australia is still a lucky and wealthy country but in a time of decreased economic certainty, bulk billing practices are thriving and will continue to offer good opportunities for new GPs to develop a sound patient base.
- On the question of earnings, it is a myth that mixed billing doctors earn more than bulk billing doctors.
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 Sydney GP jobs and any other city for that matter. Those opportunities are 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!