When Mary\u2019s* heart began beating irregularly one evening in 2016, she was taken by ambulance to a major public hospital in Melbourne and treated by a cardiologist.<\/p>\n
She was surprised when her required follow-up appointments were in the cardiologist\u2019s private consulting rooms rather than also through the public system.<\/p>\n
Mary\u2019s out-of-pocket costs for these appointments grew to more than $100 per appointment by November 2023. On a disability pension due to myalgic encephalomyelitis\/chronic fatigue syndrome, it meant by January 2024 Mary\u2019s savings were \u201cwell and truly gone\u201d.<\/p>\n
When she told her specialist she was struggling to pay and asked if she could move to the public system, he said: \u201cI don\u2019t want you to fall through the gaps.\u201d<\/p>\n
He offered to bulk-bill every second appointment, an arrangement which worked well until March, when Mary says another staff member accused her of not respecting the doctor, loudly and in front of other patients .<\/p>\n
When Mary said she could not pay for the appointment \u2013 believing it was to be bulk billed \u2013 she says the staff member \u201cthrew the Eftpos machine down on the desk\u201d, recalling how \u201cembarrassed\u201d she felt.<\/p>\n
At her next appointment Mary\u2019s cardiologist said a change in practice ownership meant their payment arrangement could not continue.<\/p>\n
A system without protections for patients<\/p>\n
Dr Elizabeth Deveny, the chief executive of the Consumer Health Forum of Australia (CHF), says Mary\u2019s story is not isolated and reveals \u201chow fragile affordability can be for many people\u201d.<\/p>\n
\u201cWhen costs fluctuate or communication breaks down, people are forced into impossible choices. These stories highlight the need for stronger protections and better transparency. It\u2019s not about individual specialists being \u2018good\u2019 or \u2018bad\u2019 \u2013 it\u2019s about a system without effective guardrails,\u201d Deveny says.<\/p>\n
\u201cWe also see very positive examples where specialists work with patients to keep care affordable, and those examples matter. But they\u2019re not guaranteed. That inconsistency is exactly the problem.\u201d<\/p>\n
She says the CHF has long been lobbying the government to improve specialist affordability and fee consistency.<\/p>\n
\u201cFrankly, Australians can\u2019t wait any longer.\u201d<\/p>\n
The former chief medical officer and health department secretary Prof Brendan Murphy wrote an article in the Medical Journal of Australia<\/a> (MJA) in November calling for \u201cethical reflection\u201d among specialists.<\/p>\n \u201cI\u2019m not so worried about people who can afford to pay, but for low income people with chronic disease, it really is presenting a problem with access to care,\u201d Murphy told Guardian Australia.<\/p>\n Sign up: AU Breaking News email<\/a><\/p>\n He says many specialists have \u201ckneejerk reactions\u201d to the issue. But Murphy wrote in the MJA that when Medicare was introduced in 1984, there were fewer specialists than general practitioners, so the limited numbers were in high demand and often worked more than 65-hour weeks.<\/p>\n With more non-GP specialists today, they work fewer hours but \u201cstill feel the same entitlement to maintaining the relative income that the previous specialist colleagues had,\u201d Murphy says.<\/p>\n Prof Brendan Murphy says there should be \u2018more nuanced charging practices\u2019. Photograph: Bianca de Marchi\/AAP<\/p>\n He acknowledged specialists today often enter private practice with significant Hecs debts<\/a>, and at a later age due to the increasing competitiveness of specialty training positions and longer training pathways.<\/p>\n It means experienced older specialists often have some of the lowest fees, while younger doctors charge more, Murphy says.<\/p>\n Many doctors do have a concessional rate for people on health care cards and pensioners, but often that\u2019s \u201cstill quite a substantial gap and I do think there should be some more nuanced charging practices\u201d, Murphy says.<\/p>\n Forced towards unaffordable care<\/p>\n Without reforms, experts say patients will keep being pushed towards the private system \u2013 even when they can\u2019t afford it.<\/a><\/p>\n Sam, a retiree seeing nine specialists in Sydney for several conditions affecting his heart, eyes, lungs and nose, says it\u2019s not possible to get public care \u201cunless you arrive in an ambulance\u201d.<\/p>\n Respiratory issues were the beginning of Sam\u2019s \u201chealth crisis\u201d, and led to the diagnosis of several other unrelated conditions within a six-month period.<\/p>\n After months of not hearing back about a referral to a Sydney public hospital\u2019s ear, nose and throat unit, Sam\u2019s GP \u201chassled\u201d enough to secure him an appointment in six months\u2019 time.<\/p>\n But as the appointment approached, the hospital told Sam he needed to see the surgeon for an initial consultation in their private rooms. He ended up finding a different private specialist who charged him the Medicare scheduled fee, the government-set baseline, lowering the appointment cost.<\/p>\n While Sam, whose retirement income is \u201cnot far\u201d above the pension, is grateful that some specialists have done this, he says accessing affordable care is too hard.<\/p>\n Prof Owen Ung, the president of the Royal Australasian College of Surgeons, says it is common for doctors, especially in New South Wales, not to be allocated a public outpatient clinic, so the only option to see patients outside of a hospital admission is in private rooms.<\/p>\n Ung acknowledges there is a \u201cvery small minority\u201d of doctors who need to be called out for charging egregiously.<\/p>\n But he says some fees are justified even when they far exceed Medicare rebates because indexation has \u201cfallen so far behind that the country could never afford to put it to where it needs to be\u201d.<\/p>\n \u201cIn reality, there are some schedules that need to be 300% of the schedule fee,\u201d Ung says. \u201cMy rooms would cost me about 150 to $200 per hour just to keep the doors open.\u201d<\/p>\n