The Dr Tabubil Files: The Mines, the Miners and Bulk Billing

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

The patients here in Cloncurry are typical for a small town in cattle grazing country, with a high and regular flow of tourists (Grey Nomads and Backpackers) coming through. I have my regulars, who are already disappointed I’m only there for 10 weeks (yay!) and I see a fair amount of the transient population - the workers from the more remote stations, and the men and women who work in the mines nearby.

            The countryside around Cloncurry seems to be littered with mines.  The mother load around Cloncurry is copper.  Just recently, though the Great Australian Mine has just found a rich body of Gold that will yield some spectacular kilo loads per tonne and keep the mines in cash for a long time - even if (or when) the copper runs out.  These miners are young men and a few women who, once finished with school ( at 16 if they drop out, 17 or 18 if they graduate) sign a contract with the mines for a very large starting salary - AUD $80 000 a year.

            Occasionally it can be frustrating when these young miners ask for a little too much.  Occasionally they'll present to the clinic with a medical complaint, and expect to be bulk billed (Bulk billing is what happens when you are on medicare, our national health-care scheme, and the whole bill is taken care of by the medicare plan.)

            Apart from that, I  LOVE bulk billing.  This generally applies to people on a pension, or under the age of 16, or  people who have a DVA Veterans card or some other sort of concession, but up here we have some reasonable discretion about when and how to use it – like if they have come in on a recall for results, or it was a hellish day and the patient waited for 2 hours for us to be free.  Or, in my case, when I stumbled upon a patient’s recent personal tragedy, and made her cry, by saying, in a really bright voice - “Are there any preexisting conditions in your family?” 

            And she burst into tears and said “My brother is in a full body traction cast!  He fell off of a quad-bike last week!!”  and cried and cried and cried.

            I felt so awful. I spent 15 minutes just sitting there and holding her hand and listening while she told me all about it.  It was so sad.  I definitely bulk billed that one. 

People come from all over to work in the mines - from all over Australia, from all over the world.  I love my job – I meet so many people.  My favorite part of a consult is the moment when I say:

            "Hello – who are you? And where are you from?" 

            Because I get a story.  People will come up to the mines for six months, or for a year, for two years, on a sabbatical from an academic job, because they're on the run from a spouse or some other family situation, and they'll make enough money to go home for a while, and then they'll come back again.  Again and again and again.  The outback seems to get into your blood.

And then there are patients from the really wealthy cattle families.  One family in particular is the tenth richest family in Queensland.  Based out of Cloncurry, they own a full third of Queensland's grazing country.  Their trip in for a checkup is racked with hardship – do they fly their private plane to town, or drive up in their Bentley?

Bulk billing is fantastic – I really got into the swing of it, until the boss had to come and tell that I needed to ease back a little.

            "Dr Tabubil - we appreciate that you're being a compassionate doctor, but  – this is Cloncurry. Not Brisbane.  If they look like they can afford it – charge them.  If they look like they can’t afford it – charge them anyway.  Chances are their private jet is waiting for them at the airport to take them back to the muster, which is why they look like they've been rolled on by a horse and they smell like the back end of a stable.  They are working millionaires."

            Of course, there are people here in town who really can’t afford it.  But the reception staff knows who they are and they probably have a concession card anyway.

Even so,  when some eighteen year old kid comes in  after I’ve seen him throwing bills on the bar the previous night in the pub and looks at me and says -

            "SO, can ya, like, bulk bill?" 

            Well, when that eighteen year old is making 80 000 dollars a year, I generally sigh, and smile sweetly, and say “Oh, NO, I’m sooo sorry.  It’s just not applicable.”