I admit I am tempted by the convenience of using an AI scribe. My life would probably be easier and I would be a more efficient doctor. For now, I don't use AI scribes or other forms of generative AI for a couple of reasons:

• My convenience is not worth the environmental impact

• I have seen consultation notes and letters written by other doctors with assistance from AI. I am acutely aware of how easy it is to be misheard or misunderstood and for the permanent medical record to be inaccurate if a scribe's output is not proofread carefully. I strongly suspect that the effort I put into proofreading my scribe's output would decline leading to more inaccuracies over time.

• I find the process of writing my consultation notes intentionally assists my clinical reasoning

How are GPs paid in Australia?

Many people are under the impression that GPs are employed either by a clinic or directly by the government and receive a wage or salary. While this can be true, the vast majority of GPs in Australia operate as sole traders on a fee-for-service basis, i.e. we are paid directly by our patients for the services we provide. We pay a clinic for services they provide to us, such as use of a consultation room and reception team. Like sole traders in any other industry we do not get paid annual leave, sick leave, or superannuation.

Medicare is a health insurance scheme funded by the Australian federal government. Medicare will reimburse patients a set amount of money for specific out-of-hospital health services. The amount by which the government will subsidize a service is outlined in the Medicare Benefits Schedule which is freely accessible online. Some examples of services and rebates include:

• Item 23: a typical GP consultation lasting longer than 6 minutes but less than 20 minutes

  • Medicare rebate: $43.90 (January 2026)

• Item 2715: a GP consultation for preparing a Mental Health Treatment Plan, lasting between 20 and 40 minutes

  • Medicare rebate: $106.20 (January 2026)

When a doctor 'bulk bills' a service, they are agreeing to accept the patient's rebate directly from the government instead of taking payment from the patient and having the patient claim their rebate from Medicare.

• Typical billing: patient pays the GP → Medicare pays the rebate to the patient

• Bulk billing: Medicare pays the patient's rebate directly to the GP

Bulk billing incentives and bulk billing clinics

Previously, GPs would receive a financial incentive from Medicare if they bulk-billed eligible patients (concession card holders and children 16). From 1 November 2025, the Australian Government expanded eligibility to all Medicare-card holders.

Some clinics have registered for the Bulk Billing Practice Incentive Program (BBPIP) which grants further financial incentives if they agree to bulk bill every eligible service for every eligible patient. The BBPIP pays an extra 6.25% to the GP, and 6.25% to the clinic.

For some clinics, the above increases in funding are still not enough to cover the expenses of providing care.

An example

A patient sees a GP for a standard 15 minute appointment at a non-BBPIP clinic and asks to be bulk billed.

• The doctor receives $43.90 (item 23) + $21.85 (bulk billing incentive) = $65.75.

• The doctor pays ~35% to the clinic ($23.01) for use of the room, equipment and staff.

• The doctor pays income tax of ~$15.81 to the ATO

• The doctor takes home ~$26.93

Individual doctors may find this take-home more or less acceptable depending on a variety of factors (to be discussed further in another post). What is less variable are the operational costs of running a clinic. $23.01 is often not enough to cover the clinic's operational costs for the service they provide - in this case the clinic could charge the doctor a larger service fee (e.g. 50%), or set a private fee for consultations. The former is usually not very popular with doctors, who would typically look for a different clinic with a cheaper service fee. The latter could look something like below:

• The doctor charges the patient $100 in line with the clinic's fee schedule

• The doctor pays 35% to the clinic ($35)

• The doctor pays income tax of ~$24.50

• The doctor takes home ~$40.50

The below is intended to give a general idea of what it costs to provide GP services; it does not reflect the situation of every GP or clinic. I've marked some details specific to me in italics and mandatory expenses in bold.

Individual GP costs

One-off expenses:

• Undergraduate degree - my MD was a postgraduate degree, and I did a Bachelor of Science prior

• Medical degree ($40,000) - I was much luckier than some of my friends who had to pay $280,000 for the same degree

• Specialist postgraduate training to become a GP

  • GP exams ($10,000)

• Equipment

  • Laptop, keyboard, mouse - though I'm quite particular about these things and don't expect most other GPs are buying their own computer peripherals

  • Stethoscope

  • Dermatoscope - I splurged for a DermLite DL5

  • Scrubs

Recurring expenses:

• AHPRA registration - annually

• Medical indemnity insurance - annually

• Membership with the Royal Australian College of General Practitioners - annually

• Subscription to Therapeutic Guidelines - essential for practicing up-to-date, evidence-based medicine in my opinion

• Educational materials and activities

  • AusPATH conference 2025 ($2,200) - I wanted to learn how to provide good quality gender-affirming healthcare

Miscellaneous:

• Income tax (like everyone)

• My own annual leave

• My own sick leave

• My own superannuation

Clinic operational costs

• Rent unless the building is owned by the clinic

• Staff: practice manager, reception staff, nursing staff

• Cleaning service

• Utilities:

  • Electricity, water, internet, phone

  • Website hosting

  • Security

  • IT support

• Accreditation - every 3 years

• Normal office stuff:

  • Computers, printers, server

  • Chairs, desks

  • Phones

  • Milk, tea, coffee etc.

  • Stationery etc.

• Medical equipment and furniture

  • Practice management & clinical software licenses

  • Otoscopes and ophthalmoscopes

  • Blood pressure machines, thermometers, pulse oximeters

  • Dermatoscopes

  • ECG machine

  • Electrocautery machine and other surgical instruments

  • Autoclave and ultrasonic cleaner

  • Routine servicing of above

• Medical consumables

  • Disposable components of above equipment

  • Gloves, dressings, anaesthetic, antiseptic, etc.

  • Liquid nitrogen service