By Zara Powell and Sasha Foot
An investigation by Central News has revealed a gender gap between GPs in Sydney who bulk bill, with data confirming an 8 per cent difference between female and male bulk billing GPs.
Data obtained through Clean Bill and collated by Central News shows that 46 per cent of Sydney’s bulk billing doctors are female, meaning it is easier for Sydneysiders to access a male bulk billing GP.
That means patients in metropolitan Sydney are more likely to pay an out-of-pocket cost to see a female doctor.
Sydney’s bulk billing gender gap lags behind statewide statistics: according to the Medical Board of Australia’s Registrant data, women doctors outnumber men in NSW.
This gap extends to national gender rates as well, in which nearly 49 per cent of doctors are women.
Electorates with the fewest female bulk billing GPs
Electorates with the lowest rate of female doctors in Sydney are Mackellar, Fowler and Wentworth.
Wentworth, representing the bottom of the three, has only 5 female GPs who bulk bill their service in full. And this is despite there being more than 146,000 residents living in the electorate, with 52 per cent of them identifying as female.
Kate Humphreys, a university student who rents in the electorate, says she has consistently paid an out-of-pocket cost since moving into Bondi.
“It is quite expensive where I go, and they change their fees depending on the time of day you go,” Humphreys told Central News.
“If you go during the week, such as between 9-5, it is cheaper than going on the weekends or after hours.”
On Sydney’s Northern beaches, 43 per cent of the bulk billing practices in Mackellar are without a female doctor. Central News counted only seven bulk billing practices in the electorate.
The federal member for Mackellar, Dr Sophie Scamps, is, coincidentally, a female doctor, and one of her central health policies is to reduce high out of pocket fees in her electorate.
Dr Scamps was previously a GP at Narrabeen Family Medical before being elected to parliament. This practice charges an out-of-pocket cost to patients.
Women use GP services more
The 2022 Health of the Nation Report found women use GP services more than any other patient groups.
But although women are the highest users of GP services, data suggests female patients are more likely to struggle to find a bulk-billing female doctor in Sydney.
The Health Report also revealed female doctors provide more complex consultations to their patients.
The top medical conditions female GPs treated were psychological issues, such as anxiety, depression and sleep problems.
The second most commonly treated condition by female doctors were health issues specific to women.
Comparatively, the top conditions that male doctors consult relate to musculoskeletal, respiratory and circulatory issues.
Female doctors also see patients for longer than male doctors. On average, an appointment with a female GP will run for 18 minutes, whereas appointments with male doctors usually run for 16 minutes.
This longer consultation time correlates with female GPs taking the highest proportion of mental health appointments.
Humphreys says that as a young female, she prefers to book appointments with a woman doctor yet insists she has never had a bad experience with a male physician.
“Generally, I will always book in to see a female doctor, especially if it is related to women’s health,” she said.
We often have a greater number of female patients compared to male GPs. Ultimately, who will support these women when we burn out?
“In saying that, both male and female GPs have always treated me professionally and with empathy.”
Humphreys said she “feels more at ease” seeing a female GP about mental health issues.
Young females – as outlined in the Health Report – were the group most likely to see a GP over mental health-related issues.
Former GP Katerina Holmes, who previously worked at her family-owned medical practice in Hornsby, says she was never motivated by profits when working in the care industry.
“I wanted to become a doctor to help people, not to make money,” Dr Holmes said.
“Bulk billing my patients was something I did my whole career, and I would do it again in a heartbeat.”
Dr Holmes said she understood due to the rising cost of living, GPs were grappling with increased practice costs.
“Times are considerably tough right now, so I can understand that many clinics are not able to bulk bill their patients,” she said.
But she added rising costs similarly affects patients, acknowledging it is necessary to keep providing bulk billing services to “communities in need”.
Dr Holmes also believes female GPs need increased support to close the gender gap.
“We often have a greater number of female patients compared to male GPs. Ultimately, who will support these women when we burn out?” Holmes asked.
“While I no longer practice, I understand that if we want to close this gap, there needs to be greater support for female doctors.”
Practices with zero gender ratio
The gap between female and male bulk billing doctors also persists when examining clinics without gender compositions.
Mt Druitt Health Care Medical and Dental Centre has the most female doctors without a gender composition. Central News counted seven bulk-billing female GPs at this centre.
Close behind was Claremont Meadows Medical Centre – which had six women doctors.
McMahon is the electorate with the most male-only GPs; with 19 practices. Blaxland follows with 18, and then Fowler with 17.
Practices with both female and male GPs
In Sydney’s Hills district, the electorate of Mitchell has the highest number of female bulk-billing doctors who work alongside male GPs.
Greenway, an electorate in Sydney’s west, has 118 female bulk-billing GPs, making it the second highest in Sydney.
This electorate has two practices with at least 10 female doctors: Pacific Medical and Dental Centre and Kildare Road Medical Centre.
Out of 25 Sydney electorates, there are just seven electorates with more female bulk-billing GPs than males.
These include Kingsford Smith in Sydney’s east; North Sydney; Bradfield in the North Shore; Sydney in the inner-city; Reid on the Parramatta River; and Greenway and Mitchell.
In Sydney, 57 per cent of bulk billing doctors are female. This ratio exceeds Mitchell, where 55 per cent of doctors are women and Greenway at 53 per cent.
The gender composition in Kingsford Smith is marginal – there is just one extra female doctor (14 women compared to 13 men).
This is partly due to low bulk billing rates: Central News counted 27 bulk billing doctors in an electorate with 181,000 people.
Female GP says bulk-billing “unrealistic” in cost of living crisis
One of the women doctors, who wished to remain anonymous, believed all patients should be bulk billed, especially during periods of financial difficulty.
But because of rising practice costs, she said it is impossible and “unrealistic” to bulk bill all of their patients.
The family-run practice has limited its bulk billing services to pensioners, Health Care Cards holders and children aged 16 years and younger.
“I wish we could offer bulk billing to everybody, especially during this cost of living crisis, but we just can’t,” she said.
“If we were to offer bulk billing to all our patients, we would not be able to accommodate everyone, as we are already struggling.”
She said her workload was “overwhelming”, given she is the only female GP at the clinic.
“As the only female GP in this practice, I feel extremely overworked; I am the most booked out doctor, and I see the most female and under 16-year-old patients,” she said.
“I truly respect the female-owned GP practices who offer 100 per cent bulk billing. It takes a lot of compassion and a mentally strong woman.”
Females studying medicine
A student statistics report by Medical Deans Australia and New Zealand revealed in 2022 women medical students made up a higher portion of final-year enrolments at Australian universities.
Aspiring GP and third-year medical student Johanna Ritchie found the bulk billing gender gap “concerning”, considering there is a greater number of female students enrolled in medicine.
She said it is feasible that there are fewer job opportunities for female GPs, given the gender gap exists among practices that bulk-bill.
Male doctors routinely overestimated female representation and, being blind to this fact, they are then less willing than others to support gender-equality initiatives.
“As an aspiring GP, I am worried that I will not find a job. This data may suggest male GPs are more desirable to employers,” Ritchie said.
“I wonder if fewer women are bulk-billing because it is such a competitive market.”
Ritchie, a third-year UNSW student, said she “hopes to provide health services that bulk bill in full”.
But she acknowledged the “unfortunate” effects of the cost of living crisis, which has made it increasingly difficult for “many doctors, especially young doctors, to bulk bill entire services”.
Dr Christopher Begeny, an academic at the University of Exeter, says research has identified prevailing barriers to gender equity in general practice.
“Male doctors routinely overestimated female representation and, being blind to this fact, they are then less willing than others to support gender-equality initiatives,” Dr Begeny told news.com.au.
“These misperceptions can have insidious consequences, potentially undermining or even reversing the true progress made toward gender equality.”
Main image by Lynn Friedman/Flickr.