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12 DECEMBER 2025 ausdoc. com. au

Professor Brendan Murphy on specialist fees

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The phrasing he uses in his MJA article is a little more discreet.

Like many across the profession, he is very interested in imbalances in the MBS between rebates for procedural and consultation items and the argument that this reflects the culture of medicine valuing doing rather than talking.

He makes reference to the infamous fate of the Relative Value Study of Medicare, which for younger readers, was a one-timeonly experiment in making health policy rational.

It was doomed from the beginning, obviously.

Running from 1994 to 2001, it involved a collaboration between the AMA and the health department.

In the short version of the story( current RACGP president Dr Michael Wright is an expert in the long version), the Relative Value Study was about ensuring proper funding of consultative medicine, general practice medicine in particular.

Despite its scale, it had several flaws at its heart, the biggest being the politics.

It was soon apparent that it was going to end up decreasing incomes for some proceduralists who are good at making noise when unhappy, or it was going to increase Medicare costs to the point the pips

‘ Specialists would do well to reflect on fees.’

would squeak. The third alternative was that it would do both.

It also demanded agreement on the relative value to the health system of different specialties.

Even today, that remains a prickly debate within the profession, and when it came to general practice back then, agreement proved impossible.

So the review in its final form became a policy proposal that would burn the fingers of any government stupid enough to touch it. As a result, the kryptonite got laid out in a concrete coffin and buried about six miles under a car park in Canberra, never to be exhumed again.

“ Although governments have been prepared to undertake slow and careful MBS reform,” Professor Murphy says,“ a full-scale rebalancing of the MBS probably requires a level of political courage that might be hard to find.” So are there any solutions? He touches on the Medical Costs Finder website, which has been a fiasco.

He makes the point obvious to all. It needs to start listing the fees of individual doctors to have any value; perhaps even with links to the websites of specialists where they document their skills and experience to justify their higher fees.

It is Adam Smith 101. The supply and demand forces of market economics cannot operate without information, and it does not have to be perfect( this is medicine, not cans of baked beans, it is hard), but just useful, which the cost finder website is not.

As he reaches the end of his article, Professor Murphy refers back to GPs in a way that explains why he sees it as essential to use Medicare first and foremost to strengthen general practice.

Enabling GPs and their teams to better manage chronic disease long term with less specialist input can improve the business model of specialist practice, he says, with a shift back to a greater proportion of initial consults, where the fees can be contained.

He could probably make much more of this with a few details on the ways and means of this‘ GP enabling’, but it would require space, and MJA articles have a word limit.

Beyond that, there is the darker threat of fee regulation, denying MBS benefits to specialists with excessive fees( the Grattan Institute fix).

But he says the MBS rebate is a patient benefit after all, and it is hard to deny benefit to a patient.

So, you are left with

ADVERTORIAL funded by MSD

For your at-risk adult patients who test positive for COVID-19, LAGEVRIO may be prescribed when: 2-4

1 2 3

Dr Michael Wright.

When to prescribe LAGEVRIO as the preferred * COVID-19 oral antiviral on the PBS? 1, 2

* LAGEVRIO must be for use when nirmatrelvir-ritonavir is contraindicated. 1, 2 self-regulation? He says it is the simplest option.

“ Given the community and government angst about this issue, specialists would do well to reflect on the impact of their fees on patients and potentially consider a minor trade-off in income in recognition of the now-improved working hours.

“ A voluntary acceptance of this trade-off would improve patient access and reduce the risk of government intervention.”

Med J Aust 2025; 23 Oct.

The patient has a history of clinically significant hypersensitivity reactions to nirmatrelvir-ritonavir

The patient has severe renal impairment or severe hepatic impairment

There is a risk of potential drug-drug interactions with nirmatrelvir-ritonavir that cannot be safely managed

Considerations include: 5

• Can the medicine be withheld safely?

• Can a dose adjustment be done easily?

• Can the patient be advised on adverse events to monitor for?

Why is the choice of oral antivirals relevant in patients aged ≥70 years?

50 % of Australians aged ≥65 years live with 2 or more chronic conditions 7

ABS data from the National Health Survey 2022

Scan QR code to access the Liverpool COVID-19 Drug interaction checker 6

Chronic conditions often require multiple medications, which may increase the risk of potential drug-drug interactions. 8

PBS information: Authority required( STREAMLINED): LAGEVRIO must be for use when nirmatrelvir(&) ritonavir is contraindicated. 1 The contraindications to nirmatrelvir(&) ritonavir can be found using the Liverpool COVID-19 Drug interaction checker or the TGA-approved Product Information for nirmatrelvir(&) ritonavir. 1, 4, 6 Visit www. pbs. gov. au for more information.

References: 1. Pharmaceutical Benefits Scheme. www. pbs. gov. au( accessed March 2024). 2. Pharmaceutical Benefits Scheme. Lagevrio ®( molnupiravir) Pharmaceutical Benefits Scheme Factsheet – Updated June 2024. https:// www. pbs. gov. au / publication / factsheets / covid-19-treatments / PBS-Factsheet-lagevrio-molnupiravir-June-2024. pdf( accessed September 2024). 3. LAGEVRIO Product Information, October 2023. 4. Paxlovid( nirmatrelvir-ritonavir) Product Information. September 2024. 5. University of Liverpool. COVID-19 Drug Interaction Prescribing Resources – Assessing a patient for treatment with Paxlovid. Available at www. covid19-druginteractions. org / prescribing _ resources / paxlovid-patient-assessment( accessed October 2024). 6. University of Liverpool. COVID-19 Drug Interaction Checker. Available at https:// covid19-druginteractions. org / checker( accessed March 2024). 7. Australian Bureau of Statistics. Health conditions prevalence( 2022). Available at https:// www. abs. gov. au / statistics / health / health-conditions-andrisks / health-conditions-prevalence / latest-release( accessed August 2024). 8. Shini Rubina SK et al. Diabetes Metab Syndr 2022; 16( 3): 102451. 9. Bernal AJ et al. N Engl J Med 2022; 509 – 520. 10. Van Heer C et al. Lancet Reg Health West Pac 2023; 41:100917. 11. Gentry CA et al. J Infect 2023; 86( 3): 248 – 255. 12. Lin DY et al. JAMA Netw Open 2023; 6( 9): e2335077. 13. Park HR et al Infect Chemother 2023; 55( 4): 490 – 499. 14. Ahmad WA et al. Clin Microbiol Infect 2024; 30( 10): 1305 – 1311.