MEDICARE “BOOST”
You may have heard about changes to Medicare this month, which politicians claim should allow all GPs to bulk bill.
Unfortunately there has been a lot of misinformation around these changes. The sad fact is, if relying on Medicare rebates, doctors are paid more if they spend less time with each patient.
The rebate is the same for 6 minutes as it is for 19 minutes, leading to the term “6 minute medicine” as the system encourages quick consultations. There is no incentive for longer consultations, despite the value of time, which we know improve patient outcomes and your satisfaction with care. Only quantity, not quality of care, is being rewarded.
I prefer to offer longer consults to build rapport, gain a comprehensive patient-centred history, assessment and individualised management including education. Most perinatal care cannot be managed within a short consultation, as there are usually complexities at play, and an opportunity to provide anticipatory guidance on challenges that may arrive in the parenting journey.
In addition, antenatal care and mental health care are not eligible for the new incentives, meaning these consultations are remunerated less than any other presentation. Several mental health specific items were eliminated this month, limiting my ability to break a consultation down into the ‘physical health’ and ‘mental health’ aspects and reduce your out of pocket cost.
As much as I would love to provide bulk billing to all, it is not possible without reducing the quality of care, which isn’t something I can compromise on. I do bulk bill selectively, such as for the infant if also seeing the mother for a combined consultation, and for brief reviews. But where the majority of my consultations are undervalued by the government, I can’t do this across the board. The practice that I work within are not changing our billing policies as it would be impossible to provide the same quality of care we are proud to offer.
I understand that the cost of healthcare is a significant concern for many Australians. I encourage you to contact your local Federal Member of Parliament, to explain how these Medicare changes affect you. You could suggest that instead of forcing doctors to bulk-bill, the government should increase the Medicare rebate for all patients. That antenatal and mental health items recieve the same incentive as other consultations. And that the time spent on longer consultations is rewarded so that your complex health needs can be explored in the detailed way that you deserve.
RESET
In mid 2021 I returned from maternity leave with renewed enthusiasm to provide quality care, and a dream to achieve a better work-life balance and be present for my young children.
I recognised my passion for perinatal care, particularly caring for women in the antenatal and postnatal period, and returned with a plan to only see women and babies in this stage. I started to focus my own learnings on this, became an Internationally recognised Lactation Consultant and developed extra skills in tongue tie assessment and management.
This plan was destabilised by the many challenges to our health system during COVID, and the nature of working in a general practice setting. Long standing patients wanting to resume care, and others I met along the way wanting to continue care. My preferred style of holistic healthcare, allowing long consultations to explore all aspects of a person's wellbeing and health, attracted a loyal following of patients with a wide range of complex conditions.
Unfortunately, my patient load has become unsustainable, time management has become impossible, and Medicare changes have made it challenging to provide this style of care in an affordable way.
I’ve struggled to maintain my own wellbeing in the past year as I juggle an ever-increasing patient load, feeling like I haven’t been doing any role well.
Therefore, I have made the difficult decision to again limit my scope of practice, to ensure access for patients during challenging and vulnerable perinatal period. I hope to have the availability to assist with breastfeeding within days rather than weeks, as I know every single feed faced with pain or fussiness feels like an eternity and impacts on mental health. Rather than provide bandaid care, I want to provide more support to help families prepare for parenting, and for breastfeeding if that is their goal, with longer antenatal consultations.
To do this, I can no longer provide general GP care. I thank the wonderful patients I have had the privilege to follow through for as long as 10 years. I appreciate it is not always easy to transition to new care providers I believe there may be benefits including including better access for timely review and fresh eyes on your own healthcare challenges.
My interests, and scope of practice may change in the future, but for the next 5 months at least, while I transition my youngest into school and reset my life, I am resetting my work and focusing on providing high quality care across the perinatal period.
My ‘BLOG’ - a place for updates and reflections
Lacking the time, energy or skills to keep a social media page up to date for patient updates - and feeling overwhelmed navigating the restrictions around health professional promotions, testimonials and how we engage with patients on these platforms, I’ll use this page to provide some general information alongside updates to my practice.
With my practice reset this month, I will aim to start updates here more regularly. For more on this - see the next post
What I wish I knew before I first tried Breastfeeding..
As a friend and colleague prepared to meet her little boy in the late stages of pregnancy, I shared with her this very first blog post I initially wrote a few years ago, and thought others could benefit from these thoughts as well
REPOST - initially written for the Possums website 2022
As a GP working with lot of new mothers and babies I knew breastfeeding wasn’t always easy, but the health benefits, convenience and connection with the baby it offered always seemed worth the efforts. With my medical knowledge and attendance at classes offered locally, I thought I had enough of an understanding to get myself off to a good start.
The reality of learning this new skill after an exhaustive labour, with a steady stream of visitors, and a jaundiced baby was far from what I expected. Both me and my baby fell asleep during that first feed, hardly what I’d seen on the videos!
The emotional journey of poor weight gain, waking him for feeds, nipple trauma, expressing and top-ups for weeks tested me more than my years of medical training. I had a new appreciation for why so many mothers found these early days, and the conflicting advice of well-meaning health professionals and family members, leads them away from their intention of exclusive breast feeding. Thankfully myself and many others have benefited from the support of amazing GPs and Lactation Consultants to help us through these early challenges.
Back when I first became a mum in 2018:
I wish I knew to curb the urge to share the news with everyone I knew. To put up the ‘do not disturb’ sign, postpone visitors, and silence my phone so I could focus on getting to know my babies cues and resting between feeds.
I wish I knew to be present during these early feeds, not to multitask with catch ups, texting or TV, and to notice the sensations of my nipple and breast, the fit of baby into my body, to notice the suck and swallows, and how to intervene early if things were not right.
I wish I knew how to position myself and my baby, to find our best fit together and not push through the pain which led to nipple damage.
I wish I knew not to let anybody force him on, to avoid holding the head or neck, and that clothes, bras and pillows under the baby can compromise our fit and hold .
I wish I knew how to break his strong seal with a clean finger rather than pulling against resistance and creating cracks, or to try micromovements instead.
I wish I knew how important frequent feeds were in the first few days, not letting my reluctance to wake him, or protocols for pre-feed observations delay our feeds, and getting at least 8-12 feeds in to maximise my supply
I wish I knew feeds weren’t always ‘3 hourly’ and that offering the breast frequently and flexibly is the best tool to meet their needs and aid settling.
I wish I knew to practice mindfulness strategies during pregnancy so I had the skills to be present in these amazing moments, to sit with emotional discomfort and open up to difficult thoughts and emotions that can come with the self-doubt and struggle. I wish I had found the ACT strategies earlier.
I wish I knew that it wasn’t my fault that things didn’t get off to a good start. That it is normal to have unhelpful thoughts when facing breastfeeding difficulties. And that it wasn’t helpful to beat myself up about what I could have done differently, as I lost so much more sleep and chances to connect with my baby ruminating on it.
I wish I knew that even though I questioned my instincts during this rough start, paying attention to his cues allows me to be the expert on my baby and to follow what my gut says is right.
I wish I knew there was no shame in asking for help, to push for an early lactation consultant review, and use my village so I only had to focus on bub for that first week.
As well as an amazing GP and Lactation Consultant, I was fortunate to find the the work of Dr Pamela Douglas through her book The Discontented Little Baby Book, Gestalt online breastfeeding course and the Possums approach in the first weeks of my son’s life, which covered all of the information above and got me back on track. It helped me feed my son for nearly 2 years bringing a valuable tool to aid sleep and settling, then to have a straightforward and pain-free journey with my second child for almost 3 years. I now work primarily with women in the pregnancy and postnatal period using the Possums principles and love my work.
During your pregnancy, rather than just focusing on the birth, it is worth investing time preparing for life with a newborn, breastfeeding, and your emotional health.
Consider antenatal breastfeeding education and connecting proactively with an NDC-Accredited Practitioner to help prevent problems, or to help address these if they arise. Explore the relaunched NDC programs supporting not just infant sleep, but breastfeeding and family wellbeing at www.possumssleepprogram.com (including antenatal videos and articles nested under ‘When Baby Comes Home’ )
Photo of my newest coffee mug
A gift to myself after sitting my Lactation Consultancy exams last week!
New year, new challenges…
I have been excited approaching 2024 with an opportunity to further my perinatal focus - I have fulfilled the requirements and enrolled for the April sitting of the International Board Certification of Lactation Consultants (IBCLC) exam and have changed my educational roles to be able to concentrate on mother-baby support and upskilling other health professionals in this work.
I’ve loved sinking my teeth into these new challenges, but other setbacks have appeared - gastro and COVID in the household, preparations for my final workshop with the RACGP GP Registrars, tax return deadlines, and my kids starting Prep (today!) and kinder (next week) with ease-in schedules. Unfortunately this leading to me having longer wait times than I’d like. for both new and existing patients.
However this work is my priority - and if you have concerns with your feeding journey or mental health as a parent I will do what I can to fit in these consultations into cancellations or sessions I save for this work. Take the next available “Mum & Bub” appointment, fill in the form on Hotdoc and I can triage your situation with a phone consultation.. Or speak to our amazing receptionists who will find flag it with me if they can’t find a suitable space.
Meanwhile - proof that the days are long but the years go fast - my 5 year old son (pictured below at a much younger age) started school today , running off happily with his friends to the playground talking about Pokemon! His baby self would be so proud!
I certainly am.
Make the time to take a breath, sink into the moment, notice your little ones eyes, smile, breathing and how they are regulated by and respond most to you. Remember that everything is impermanent. The challenges may not be totally forgotten but those memories are buried by the whirlwind of curiosity, creativity, and wonder they evolve into.
For now, if you need to, just hang in there. Day by day.