In 2025, the Grattan Institute called on the Federal Government to combat “extreme” specialist fees. The Institute found that an initial consultation with a cardiologist or endocrinologist can cost up to $370, and up to $670 for a psychiatrist. The Government was advised to claw back public subsidies from specialists who charge “extreme” fees.
On average, patients’ bills for specialist appointments add up to $300 a year. This excludes people who were bulk billed for every appointment, but that’s relatively rare: patients pay out-of-pocket costs for two-thirds of appointments with a specialist doctor.
“Increasing GP costs make national headlines, but specialist fees have risen even more – by 73% since 2010,” the Grattan report asserts. The report attracted pushbacks from doctors, with the latest coming from the nation’s ophthalmologists.
I agree with Australian Society of Ophthalmologists (ASO) President Peter Sumich who says the Grattan report is good, but it draws many wrong conclusions. Firstly, that bottlenecks in specialist training are caused by the Colleges. It is the public hospitals that pay for trainees and mentors, and that purse is controlled by governments, not Colleges. The College committees only select the trainees for the places deemed funded and available.
The second issue involves the Medicare rebate. Specialists have blamed out-of-pocket costs on what they see as the inadequate Medicare rebate not keeping pace with the cost of doing business. Grattan said overcharging specialists should have the rebate totally withdrawn.
The ASO says the Medicare rebate is out of date. “It has no meaning in the commercial world,” Dr Sumich said. “It’s been frozen, cut, and has never kept up with inflation or average wages. Therefore, as a metric of a medical service, it is unreferenced and meaningless.” He added that specialist fees reflect real-world costs – wages, insurance, rent, medical technology, and more – and rejected “the implied threat” to remove patient rebates.
Indeed, Medicare rebates since 2010 have failed to keep pace with inflation, growing only 0.5% to 1% annually, with a five-year freeze from 2013 to 2018. The Federal Government increased bulk-billing incentives for GPs in 2023/24 after prior prolonged underinvestment, but clearly this is not enough to right the wrongs of the past or to pay adequate respect to the difficulties faced by GPs in running a practice. Inflation, in contrast, has grown annually at a rate of 2.5-2.6% since 2010.
“The Medicare rebate belongs to the patient, not the doctor. If it is withdrawn by the Government, then specialists would go the way of dentists and charge their own fees regardless,” Dr Sumich warned. “Most patients would be furious if the rebate was withdrawn.”
And so, the debate comes back to the consumer, paying more and doubting they’re receiving value for the money they spend on their health.
Australian ophthalmologists still remember 2009, when then Health Minister Nicola Roxon threatened to halve the Cataract Medicare Fee. But after an ASO-led public campaign titled “Grandma’s not happy” and significant voter backlash, she backed down to a 12% cut. For a few months though, patients were out of pocket on average $600 even though they had private health insurance.
Earlier this year, a day after introducing legislation to publish specialist fees on the Medical Costs Finder (MCF) website, Health Minister Mark Butler said he was considering direct fee regulation of specialists to counter what he described as “spiralling out-of-pocket costs for medical services”.
The Australian Constitution explicitly disallows laws that result in the practical compulsion of doctors to provide a service in a particular way. It seems unfathomable that our noble profession could be subject to government-regulated, mandated policy.
