NEWS 5
ausdoc. com. au 12 DECEMBER 2025
NEWS 5
AAP
Professor Brendan Murphy on specialist fees
He says some specialists need to show more self-restraint.
Paul Smith WHILE we have all been focused on the Federal Government’ s attempt to reinflate GP bulk-billing, in October, The Medical Journal of Australia published Professor Brendan Murphy’ s essay on the less-discussed issue of the financial barriers to non-GP specialist care.
So far, the government’ s solution has not gone much further than a form of no-name and no-shame by offering patients( and referring GPs) its much-maligned Medical Costs Finder, a website where the identities of specialists and their actual fee schedules are largely absent. It has not bothered much with fixing rebates either, and certainly not toyed with the ludicrous notion of bulk-billing incentives, tripled or otherwise.
But Professor Murphy, health executive, nephrologist and former boss of the Department of Health, Disability and Ageing, remains unsettled by some of the fees many patients are now faced with.
He is quick to point out that his“ reflections” are not intended to be a criticism of his medical colleagues who are“ rationally responding to pressures and drivers”.
Although he does add that this is sometimes not done“ with as much consideration for consumers as would be ideal”. His article remains a fascinating read. He talks of the early days of Medicare, when incomes for the limited number of specialists working in the system were high, but the fees and the co-payments were generally affordable.
This was in part because their income was the product of working insane and no doubt dangerous 60 + hour weeks.
He also makes a point, one recently raised by Australian Doctor columnist Dr Craig Lilienthal, that their role was limited back then— usually providing opinion and advice to the GP in relation to patient management; different from what happens now, where specialists, far greater in number, take on the role of reviewing patients.
He lists other changes— the failure of the MBS to track the cost of living, the rising costs of private practice, the training debts that doctors now accrue, the long and arduous
struggle to fellowship and the cultural shift where working excessive hours is no longer a badge of honour.
All these things, he says, have contributed to the significant fees.
He quotes ATO figures on the average taxable incomes— surgeons averaging $ 460,000, anaesthetists $ 431,000 and psychiatrists $ 277,000.
There are probably important qualifications to apply to the ATO numbers, which would be more informative if they carried distributions rather than averages and had some regard to working hours and the tax shuffling that goes on.
However, he notes that the average outof-pocket gap payment for specialist attendances increased from $ 49.46 in 2010 / 11 to $ 117.18 in 2023 / 24.
“ This equates to a 136 % increase … a period over which there was a 40 % increase in CPI.
“ Many specialists now charge multiples of the MBS schedule fee for consultations and, for inpatient services, fees are sometimes thousands of dollars more than the schedule fee.”
Given his medical background, he is aware that specialists often look to the lifestyles of those plying their trade in the legal profession— that is, barristers whose fees can literally strip the breath from your lungs.
Is their attitude to remuneration so very different given what it takes to make it?
He says:“ Lawyers fall well below all doctor groups in the ATO top income chart for a simple reason. Although many lawyers can earn extremely high incomes, the market for legal services is competitive and the income distribution profile broad.
“ The highest earners will not be able to command high fees unless they are seen to offer a differentiable service.”
He claims when it comes to specialists, that competitive relationship between expertise and high fees is less apparent. Fees tend to be similar in a geographic area regardless of experience or expertise, he argues.
“ Commonly, an older, experienced specialist will charge less than their younger counterparts.”
‘ Many specialists now charge multiples of the MBS schedule fee for consults.’
$ 700,000
$ 600,000
$ 500,000
$ 400,000
$ 300,000
$ 200,000
$ 100,000
Source: Grattan Institute.
Ranked: Mean pre-tax income by profession
Ophthalmologist
Plastic and reconstructive surgeon Otorhinolaryngologist
Cardiologist
Neurosurgeon Urologist Orthopaedic specialist
Vascular surgeon Cardiothoracic surgeon
GP
Before you ask, he does provide references for some of these claims.
He suggests the call to fix the issue, often made by doctors— increasing specialist Medicare rebates— is problematic. He does not say it is because it risks kneecapping the federal health budget.
Firstly, he says the priority for any new investment in Medicare has to be primary care and reducing the income differential for GPs, which he describes as“ unjustifiable”.
For him, strengthening general practice is essential.
But he also makes the blunt point that it is hard to argue for additional Medicare investment in specialist care when their incomes are( relatively speaking) so high— five of the top six average taxable income groups back in 2021 / 22 were medical practitioners whose income ranged from $ 255,000 to $ 460,000.
He adds the kicker:“[ Initiatives ] to increase patient rebates have a history of being inflationary and are associated with further [ fee ] increases.”
As such, Professor Murphy goes on to say that increased rebates for specialist consults, where he says MBS funding is most needed, would need prior agreement by doctors not to pocket the cash for themselves.
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