Dr. GP,
This letter is to impress upon you the reason "free therapy" just doesn't work as well as it should. We understand that you have built a successful business by seeing your patients for 10-15 mins and allowing bulk bill. With this letter, I do want to tell you from a different perspective, why this doesn't work for any other practice.
The reality is that the GP has a huge influence on whether the client attends or not. The client is in a state of unsure, distress and/or fraught. By the time the client makes an appointment with the psychologist, they will be (generally) feeling better. If the GP had spent some time educating the client about this process of ebb and flow, the client would be expecting it. If the GP spoke to the client about the fact they maybe feeling better, but they should still attend, then the likelihood of the client receiving the appropriate care would increase. Free or not. What we find, with free therapy, is that the client is not as invested in something that is free. This can't be changed, until they visit the psychologists. With "free therapy" we find the client doesn't even bother to attend their first session.
By working with psychologists all over the country, a common theme is as follows:
Bulk Bill clients in a therapeutic setting are not as engaged or as motivated to attend their sessions. Whilst I have myself have not completed a study on this, I can honestly say I have worked with over 200 psychologists in Australia and this is a common theme. With that said, I have found a beautiful study (small study, but a study nonetheless) that does hit upon this massive issue. In this study, the following comments were made:
“Well there has been instances where people have not shown up for appointments. They may have had two or three times when they haven’t come and I've said, ‘Well, you know … there's no commitment to treatment so therefore I can't work with you.’ In that instance, maybe it was negative.”
“The expectation of something for nothing and not valuing it again.”
“One or two clients have taken a lot of liberty with the fact that when I bulk-bill them they don't show up sometimes. They don't even phone to tell me they are not coming. They come late, and those clients then I have to tell them the fee involved when you cancel without telling us when you just don't turn up, and they are so annoyed and so surprised that you know I am telling them this, and I tell them Medicare does not pay your cancellation fee you'll have to pay it, and it's a very small one $25 you know, and I hope that helps them to realise they are getting all this free and have some respect for the fact that this care is given to them free of charge.”
I'm positive that these clinicians were being modest and if there were to complete a full study about this, you'd find new and existing client attendance of bulk bill clients to be extremely low.
Let me get to the point of my letter. Since the GP and the specialist are to be working together, it is in your duty of care to ensure that clients understand the importance of their mental health, thus attendance to their therapy appointment. Now that I have educated you on the fact the ones who come for "free sessions" are not as engaged in starting or completing treatment, I ask a professional courtesy that you inform your patients that there will be a gap. And that gap is important to pay because we need them committed to change.
As a side note, until the psychologists across the country stand up for themselves, this awful practice will continue.
Sincerely,
Someone who feels really bad for psychologists who want to help people, but keep getting shafted.
Apply knowledge liberally #outsidetheboxthinking
