What are the different types of GP?

There are different types of GP in the sense that there are different types Dermatologist, different types of Surgeons and different types of Urologists.

For example, A Dermatologist may sub-specialise in mohs micrographic surgery, cosmetic dermatology or children’s vascular lesions (types of birthmark). A Gynaecologist may sub-specialise in Endometriosis, vulval disorders or Ovarian Cancer.

Similarly, A GP has specialised as a Family Physician and is able & willing to handle the majority of issues that come their way but be happy to refer to others for specific help.

A GP can therefore recognise, advise, treat or refer patients with any medical or emotional condition. A patient could present with Asthma or Acne, bowel problems or backache, Diabetes or depression, IBS,  High Blood Pressure or need advice about weight loss,  and expect to be helped by a highly competent, knowledgeable and skilled professional.

The GP may, like other specialists,  also take an interest in a variety of Sub-specialities of General Practice – including musculoskeletal medicine, Skin Cancer, & travel medicine. Some Skin cancer doctors focus more on skin cancer medicine whereas other skin cancer doctors focus more on skin cancer surgery … both will provide a good service but the skin cancer medical doctor is less likely themselves to perform flaps on the face than the skin cancer doctor who has specialised in flaps and grafts.

A specialist GP is strictly speaking (medicare definition) a GP who has been accredited at a higher level of training than a non-specialist GP. Most commonly this is inferred by the initials FRACGP. GP Training lasts at least 9-10 years and prepares your doctor to cater for health issues in men, womenpregnancy & kids.

A Specialist GP in Australia is considered by most people to be a GP who has developed expertise in certain areas. Different countries have different titles for this type of GP. Overseas, this type of GP is often referred to as a GPwSI (GP with Special Interest) – not a very satisfactory term in the sense that the term “interest” somehow doesn’t seem somehow to encompass the expertise that a GP with special interest has developed through formal qualifications, professional development & experience. In this sense, a Specialist GP is working at the level of a specialist in that field but is happy to refer for a second opinion, specific investigations, procedures or treatment when appropriate. This type of medical practice does often require a longer appointment than a standard GP consultation – not least to also have time to look at other areas that a specialist only that field would not look at.

Bulk Billing .v. Private Billing General Practice

A 100% bulk billed practice will mean that every patient is billed directly through medicare with no out-of-pocket cost. A private practice will incur an out-of-pocket cost which is typically around $45. Private practices are often no more profitable than bulk-billing practices. Why is this?

  • Patients expect more time with their doctor in a private practice. Appointments are generally longer.
  • Patient results coming into a private practice are often followed up over the phone which is unbilled time.
  • Patients in a private practice will often mention several problems at the same consultation. The business model of a bulk billing practice would suggest that the doctor is more likely to ask the patient to make a separate appointment for a different problem.
  • Private patients expect to come for a follow-up appointment only when they see it as necessary. The doctor in a private practice will try to  align the follow-up with the patient’s expectations. This would suggest a lower follow-up rate in a private practice.
  • Bulk Billing Practices will often do a lot more “care plans” or “management plans” than private practices.

Is quality of care better in a private general practice better than a bulk-billing practice? This cannot and should not be stated. However, the bulk billing business model strongly points towards shorter consultations. There is a lot of evidence from The UK that longer GP consultations does increase quality and improve patient satisfaction.

All Consultations at South East Medical are privately billed.

Which GP should I see?

You can source doctors with specific postgraduate specialist training qualifications from the respective college websites. You can go from word of mouth, or look at the practice or doctor’s online profiles. Australian registered Doctors are not allowed to make false promises and must always put their patient’s interests first.

The internet is now full of ratings of doctors – businesses listed on google for example. Like Tripadvisor, it’s usually best to look at the freetext description in the ratings for the reviews most likely to be trustworthy. Extremely positive reviews might be written by a friend of the practice owner, and highly negative reviews might be from a competitor. Most of us are savvy to this which is why reviews need to be read with a questioning head on.

Getting your results

You will agreed with your doctor the best way to get results at the appointment. You are welcome to a print off of your test results.

Lab Tests Online was probably the forerunner in helping people understand their pathology test results. They have an app for both Android and IOS. The apps are officially recommended apps by the UK NHS, and are Australia-specific.


Do I need to see a specialist?

Firstly, remember that most GPs are Fellows of The RACGP and are accredited by medicare as specialists in family medicine.

These are the primary reasons why a GP will instigate a referral to secondary care:

  • For a diagnostic procedure such as endoscopy
  • For a therapeutic procedure, or surgery
  • For treatment with powerful drugs used in conditions like rheumatoid arthritis, severe psoriasis or severe acne
  • The patient is asking for the referral

Procedures such as Iron Infusion are now routinely offered in general practices that have appropriate facilities.

Referral “for an opinion” to a private specialist is a less common scenario because The GP is trained to diagnose a vast range of conditions – including unusual conditions. To put this into perspective, GPs often arrange tests for a condition that they might see only once every 5 to 20 years. The GP is trained to be aware of their own limits and should arrange tests or refer appropriately. GPs will vary in their ability to tolerate uncertainty or willingness or ability to manage specific scenarios. Frequent reading and maintenance of knowledge helps the GP to manage uncommon conditions. Attitude towards diagnostic uncertainty also varies from patient to patient. However, most patients will accept a degree of diagnostic uncertainty in low risk situations.  General Practice is the most human of activities and outcomes will never be entirely predictable.

For referral to public hospitals the referral will only be accepted when a number of clinical criteria (often over 10) are met. Even for private referrals, a referral instigated by your GP will need to be for a stated purpose.

For long term conditions, many patients routinely ask for an annual referral letter to see a specialist for a condition that would normally be managed in general practiceThe GP is there to look after your health needs – but also to provide a service. Therefore, if you ask directly for a referral letter then the GP will likely do just that! To be clear about this, The GP will be sensitive to your anxieties. This is not a problem as long as you realize this is the reason for the referral.

If you are uncertain, or just curious, then simply ask your GP “Do I need to be seeing the specialist again?”

Which Specialist should I see?

Most specialities have “subspecialities.” Orthopaedics is the obvious one with upper limb, spinal and lower limb orthopaedics. However, even within these subspecialities there are orthopaedic surgeons who mainly do feet/ankles, or knees/hips, or shoulder/elbow, and some orthopaedic surgeons only do hands. It is not the case that a specialist who only “does” one part of the body is always the best one to see because there may be multiple issues that need to be connected together.

Specialists read their referral letters in advance so that they feel comfortable taking the referral. However, specialists each provide a range of treatment options but not necessarily all treatment options. The GP will have an idea as to which treatment options are appropriate and can match this knowledge with a referral to a specialist who provides those range of treatment options. Often, The GP will do some digging around by asking a colleague or contacting the specialist themselves for advice about the best person to see.

The GP may also get feedback from patients regarding the specialist they were referred to. Whilst the GP can’t take responsibility for everything (not least cost – see below), good feedback or bad feedback (usually attitudinal) will be something that The GP will take into consideration, particularly when such feedback is recurrent.

What is the cost & waiting time for specialists?

The GP does not have access to a list of specialist charges or waiting times. This is an issue because your GP will refer you based on what they do know about the specialist which includes specific skills you may require & professional reputation (often through reading letters back).

It is well known that there are a wide range of fees a specialist may charge for a given service. BUPA have plans to make this information available to consumers in 2016.

In the meantime, if you know that you need to see a specialist for a generic procedure then you may wish to ring around to establish waiting times and fees. This is where it gets complicated because most specialists have their own phone numbers. However, increasingly, there are groups of specialist practices with one phone number so you can establish waiting times with one phone call.

Let’s take Brisbane as an example. One phone call to South East dermatology will give you access to 7 dermatologists, a phone call to Westside dermatology will give you access to 8 dermatologists, and a phone call to Toowong dermatology will give you access to 5 dermatologists. Similarly, a phone call to Belmont will give you access to a large number of Psychiatrists. Gastroenterologists may also share the same phone number. Most private surgeons have individual numbers so you’ll need to make a number of phone calls to compare waiting times and prices.

It is a medicare requirement that referral letters go to a named person. The GP would certainly benefit from a live list of prices and live waiting-list times that can be discussed with the patient at the time of making the referral.

One can only hope that a live referral database is developed in future because it would be a huge advance to transparency and consumer choice.