Corporate care: Where it started, where it’s going
Corporate care, also known as the integrated health model, radically altered the care model of General Practice. Twenty-five years later, how have multi-disciplinary practices proved their worth for patients and practitioners?
In 1996, a change in law opened the door to a new way for GPs to practice. Until then, it had been illegal for a third party to contract doctors, which meant that surgeries were privately run and generally small.
With large health corporations at last able to invest in GPs, they began purchasing surgeries and employing doctors on a contract basis, either for a salary or a percentage of the practice income. While the corporation took care of running the practice, more GPs could treat patients in well-equipped premises, often alongside fellow professionals in nursing, pathology, radiology and allied health.
According to Mark Harris, Professor of General Practice and Executive Director of the Centre for Primary Health Care and Equity at UNSW, early co-located practices pioneered important changes.
“One was a more serious approach to how practices are managed,” he says. “This led to the widespread use of practice managers, rather than relying on GPs or their partners to run the business. Larger clinics also brought a range of healthcare providers together to work as a team.”
However, bodies such as the Australian Medical Association (AMA) expressed concerns about the new business models. Over time, some of these concerns have been resolved. So what were they, how have they been addressed, and what are the current benefits of the corporate experience for practitioners and their patients?
On the change in law, of major concern was that doctors would feel more responsible to the practice owners than to their patients, and that this could lead to over-servicing and less effective care. This has come to pass in many instances.
“Some doctors find that practice owners stipulate the way they practice, such as how long they spend on consultations,” Harris says.
“They may also have to ask permission to have a student or take part in a research project – but this isn’t always the case. We deal with quite a few corporate practices through the university, research and teaching that give GPs their freedom and don’t attempt to influence them in any way.”
Freedom of choice and relationships
There were also concerns that GPs would be coerced into using particular providers for pathology or other services.
“There was some evidence of that kind of behaviour early on,” Harris says, “but these days, that kind of pressure is illegal. You often do see cross-referrals within the same practice because it’s more convenient but, if GPs want to refer elsewhere, that’s between them and their patients.”
The RACGP considers continuity of care to be a core component of high-performing primary healthcare systems, and there were fears that corporate medicine could put long-term therapeutic relationships under threat.
“In the early days of multidisciplinary practices, it could be quite difficult to see the same GP on each visit,” says Harris. “This happens far less now, as the benefits associated with long-term relationships are widely recognised.”
Bigger – and better?
A quarter century on, it appears that larger practices have now largely shrugged off the concerns to become the future of primary care. The RACGP’s General Practice: Health of the Nation report shows that, between 2008 and 2019, Australian GP practice ownership fell from 35 per cent to 25 per cent.
As a practitioner, Harris says he would struggle to work without the nurses, psychologists and other providers in his practice.
“Once you’ve worked as part of a team, you don’t want to go back,” he says. “I see this as an increasing trend, particularly among younger doctors. But having a group of people working together doesn’t automatically make them a team. Collaboration can take effort, particularly in larger groups.”
He also points out that collaboration isn’t limited to large corporate practices.
“Many GPs still work in independent practices, or small clusters of practices in a particular region, that are well managed and contain multidisciplinary teams,” he says. “However, owning a practice can bring more business-related responsibilities. Many younger doctors prefer to work for a salary or pay a portion of their income towards the upkeep of the practice rather than have to worry about that side themselves.”
Less administration can also lead to an improved work/life balance. Doctors can choose the hours they want to work, and, with other practitioners on hand to take care of their patients, there’s greater freedom to take time off.
Seeing beyond past fears
A NAB/Medfin Australian Consumer Health Survey explored co-location and found that 43 per cent of practitioners see its benefits and are already practising it. A further 27 per cent identify benefits and are considering a move to this model.
“The main appeal of co-location is the ability to provide extra care and better service, along with the benefits of collaboration,” says Kate Galvin, NAB’s Executive for Health. “Respondents also saw potential for business growth and lower costs.”
The NAB survey delved into how larger, co-located practices can meet patients’ needs.
“We found that, when they’re deciding on a GP, many patients are guided by convenience, with 81 per cent of consumers typically visiting a GP in their local area,” says Galvin. “It follows that anyone needing to see multiple practitioners, whether that’s to help with prevention or a result of chronic disease, is going to find healthcare more manageable if these providers are in the same place.”
In his work as a GP with refugees, Harris sees that co-located services provide positive experiences for culturally and linguistically diverse patients.
“They can find it very challenging if they’re referred to someone in a different location,” he says. “They feel a lot more comfortable when other services, such as psychotherapy, are available in the same place. Given that more than half of GPs in Sydney can consult in a language other than English, this is an important consideration.”
For all this, Harris recommends that any GP considering a move to a larger, co-located corporate practice does their research.
“Different people look for different things in their working environment,” he says. “As well as checking the contract carefully, it’s important to talk to other practitioners about their experiences before deciding whether a particular practice is right for you.”