Introduction by Croakey: Recent articles have highlighted systemic inequities in primary healthcare, such as how the system disincentivises the care of patients with complex health and social needs, and privileges some interests over others, as well as the urgency for reform of primary healthcare funding.
Below, Professor Louise Stone, a GP and academic, investigates a related issue – the gender gap in general practice. She argues that fairer remuneration for longer, complex consultations would help to address this gap as well as being “a logical step towards improving equitable healthcare across Australia”.
“The gender pay gap in general practice is obvious and persistent,” she writes. “At its heart is the devaluing of the complex cognitive and emotional labour GPs need to manage patients with mental health, gender-based violence, women’s health and multimorbidity healthcare needs.”
Louise Stone writes:
There are multiple ways of conceptualising and estimating the gender pay gap in general practice, including this study from Ochre health, but reliable figures are elusive.
However, the systemic cause of the gap is consistent – longer, more complex cognitive work in all disciplines of medicine is undervalued in the Medicare Benefits Schedule (MBS). Women do longer consultations, with more complex, cognitive work.
The financial disadvantage and increase in emotional labour leads to attrition of female doctors, a common problem for women doctors across the world, including India, Canada, the US, the UK and Australia.
A common criticism is that women choose to have more elastic boundaries, less efficient business practices and fewer hours, and that longer consultations are a choice. These criticisms ignore a fundamental sociological truth, that across all disciplines, and all professions, from veterinary science to dentistry, “lady doctors” are seen to be kinder, more compassionate, more willing to provide cut price services for the needy, and more able to understand mental health and complex care.
If the community chooses their preferred health professional, female GPs will continue to see people needing complex care, including those with women’s health and mental health needs, requiring longer, less lucrative consultations.
Unfortunately, this work is systemically undervalued, with a steep drop in rebates for longer consultations. It is this steep drop that drives the gender pay gap in general practice.
Bluntly, a minute spent with a complex patient earns considerably less than a minute administering a flu vaccine.
The workforce
Australian GP workforce data shows male GPs constitute 49 percent of the GP workforce, and 56 percent of the full-time equivalent workforce. The proportion of GPs to the population is falling, with 120 GPs per 100,000 population in 2020, compared with 112 in 2025.
Substantial investment in other services, such as pharmacy prescribing, urgent care clinics and others, shift the focus of GPs away from straightforward consultations to more complex care.
Structural impediments to complex care have always existed in the MBS Schedule. Clearly, the optimal income is obtained if consultations are kept (very) short. The following graph shows this impact over time.**
In CPI-adjusted terms, the rebates have steadily declined.
The bulk billing bonus takes Item 3 up to slightly above its 2011 value and all of the other items up to less than the 2011 value.****
The impact on women GPs is significant. Australian GP workforce data indicate that male GPs see an average of 26 patients per day while women see an average of 22 patients per day.
Critically, the Medicare changes implemented in November 2025 have increased the gender pay gap from one percent to eight percent on rebates alone (see table below).
Importantly, these figures do not take into account practice fees, which are usually 35-40 percent, and educational, medicolegal and the cost of superannuation and leave.
This is not the whole story. The types of work done (like procedures) change these figures.
The ATO figures in 2022 show an average male GP income of $226,927 and average female GP income of $171,087 – a 26 percent gender pay gap.
Although women doctors seem to get better outcomes for their patients, they experience higher levels of occupational harm with significantly higher suicide risks than the general population. The level of risk is rising.
The National Training Survey suggests that women junior doctors have a lower work-life balance, increased bullying, harassment and racism and higher expectations and worse experiences from patients, families and carers.
There are some evidence that while women physicians increase the life of their patients, they reduce their own longevity.
In addition, they continue to manage the requirements of the “distaff economy”, gendered expectations of themselves as mothers, daughters, sisters and individual women, including their roles as consumers and carers of health services.
Other professions
Most gender pay gap calculations do not take into account the differences in working hours between genders.
This graph uses the health workforce data set to calculate the average number of working hours by gender, and then uses the data from the individual taxation statistics from the ABS to calculate the average income per full time equivalent by gender.
Surprisingly, the gender pay gap has worsened for some professions, including pathology, but has improved for others.
It is difficult to find the average full-time equivalent hours by gender in all professions, so the gender pay gap of other health professions can only be calculated against their average total income, supplied by the ABS.
Nevertheless, I could find no profession where the gender pay gap disappeared.
Potential solutions
Solutions to the gender pay gap in general practice are conceptually simple – modify the MBS schedule and associated incentives to ensure patients receive an equivalent rebate per minute of the GP’s time.
A minute of complex healthcare, no matter what the focus, should be supported with the same subsidy as a minute of more straightforward healthcare.
Valuing complex care is likely to have positive benefits for those with complex needs, including those who live with multiple marginalisations, multimorbidity and poor mental and/or psychosocial health.
These people have always had greater health needs but lower access to care, a longstanding problem known as the “inverse care law”. Valuing complex care would seem to be a logical step towards improving equitable healthcare across Australia.
The argument against making Medicare more equitable for patients and their GPs has always been that rewarding lengthy consultations will discourage efficient practice.
However, emergency physicians allocate less time to those with simple problems, and more to those with complex needs or multiple problems, and are salaried, with uniform pay per minute.
Even the harshest critics of emergency departments would not accuse them of “inefficiency”, simply because they are able to spend more time with the patients who need more complex care.
A second potential solution involves fragmenting complex care across multidisciplinary teams, so that longer GP consultations are not necessary. While GPs support multidisciplinary care, in the UK, where very short consultations are expected and multidisciplinary care has increased, consumers report dissatisfaction with losing continuity of care with a trusted GP.
Given that continuity is correlated with lower morbidity and mortality, this may be an unfortunate consequence of relying on this strategy. The impact on cost and healthcare efficiency is apparently mixed, and the GP workload has not changed.
What to avoid
One strategy that should be avoided is announcing new item numbers to treat specific conditions.
When the “menopause item number” was announced, the policy was lauded as a way of rewarding complex women’s healthcare. In fact, it offered little more financial support than any other consultation of equivalent length and introduced unnecessary administrative complexity. It also meant consumers had their reason for GP visits identified in Medicare data, which some consumers would prefer to avoid.
Finally, it is important to mention the impact of low value administrative tasks.
Unpaid and low value paperwork is a source of great frustration that disproportionately impact women GPs and contribute to workforce attrition. A particular concern is the impact of government processes that require high literacy, health literacy, and digital literacy, like the NDIS. GPs supporting these patients also support their growing burden of paperwork.
The gender pay gap in general practice is obvious and persistent. At its heart is the devaluing of the complex cognitive and emotional labour GPs need to manage patients with mental health, gender-based violence, women’s health and multimorbidity healthcare needs.
At the same time, women GPs continue to experience other gender-based personal and professional disadvantages.
While discriminatory practices are difficult to shift in the community, there is no reason why Medicare should impose a complexity tax on women’s work.
Notes
** The charts assume (in the absence of other reliable statistical data) expected durations for Item 3 (3-6 minutes) are 5 minutes; Item 23 (6-20 minutes) are 15 minutes; Item 36 (30-45 minutes) are 45 minutes; and Item 44 (45-60 minutes) are 50 minutes. If higher durations are chosen, the difference between items is increased.
**** The rebate is expressed in 2026 dollars calculated in each year as the nominal rebate multiplied by the ratio of CPI (CPI in a year divided by CPI in 2026).
Author details
Dr Louise Stone is a GP in Canberra, ACT and Forbes, NSW. She is the Medical Director of the Doctor’s Health Foundation in Queensland and a Professor of General Practice at Adelaide University. She is a qualitative researcher, with clinical, research, education and policy expertise in mental health, doctors’ health, professionalism and ethics. Louise writes extensively for the medical and mainstream press.
See Croakey’s archive of articles on primary healthcare and general practice
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