Every year, two million Australians delay or skip specialist healthcare.
That number should ring alarm bells. A referral to a specialist – such as a psychiatrist, paediatrician, or ophthalmologist – usually means your GP has identified that you have a potentially serious problem that requires further investigation or treatment.
Skipping specialist care can delay diagnosis and treatment, causing pain and suffering for patients and higher costs for the health system later on.
But Australia’s long-neglected specialist system leaves some patients little choice.
People who can pay for a private appointment do. But those consultations can cost a bomb.
Bulk-billing rates are far lower than for GPs: only a third of specialist appointments are free, compared to 78 per cent of GP appointments.
For those who do have to pay, bills can add up quickly.
Average out-of-pocket costs amounted to $300 in 2023.
It’s no surprise that some people report taking on debt or skimping on other essentials to pay for seeing a specialist.
Individual appointments can cost hundreds of dollars.
One in 10 Australians who paid to see a psychiatrist in 2023 paid $400 out of pocket for their initial consultation.
Those who can’t afford the fees join the queue for an appointment at a public specialist clinic. But those wait times can extend months, or even years.
Pay or delay: it’s a painful dilemma.
Our new Grattan Institute report on specialist care shows that it’s a dilemma Territorians know well.
Our research found people living in the NT outback get fewer specialist appointments than the national average, counting both private and public, virtual and in-person appointments.
First off, they should work together to train the specialists we need, where we need them.
One of the big reasons for the lack of regional and rural specialists is that there hasn’t been enough opportunities for specialists to train in those areas.
Specialists often do their final training in their 30s – exactly the time they might be settling down and putting down roots. If they train in a big city, that’s typically where they’ll stay for the rest of their career.
Despite this, rural specialist training has languished. A third of final-year medical students say they intend to work outside the major cities, but just 14 per cent of specialist trainees actually do.
Regional hospitals have tried to provide opportunities, but can be stymied by arbitrary or inflexible rules from specialist colleges (the specialist member organisations that decide where specialists can be trained).
For example, the NT has no accredited training sites for facial trauma specialists, despite having a similar volume of cases to Victoria.
The specialist college requires that each training location have four trainees, which isn’t feasible in the Territory.
To break the impasse, governments should work together to identify future healthcare needs across the country. Then, they should only fund training positions that align with those plans.
The next step to improve people’s access to specialist care is more targeted investment in public clinics.
In areas where there aren’t enough private specialists, public clinics should step up to fill the gaps. At the moment, there are too many gaps.
The areas with the least private care gets about 26 fewer appointments, per 100 people, every year – but only an extra three public appointments.
The federal and state governments should provide a million extra services every year in the areas that are missing out.
NT’s outback needs at least a 25 per cent increase in total specialist appointments.
But Darwin is also missing out on some specialties – for example, it’s in the bottom quarter of the country for access to psychiatry services.
To make that money go further, governments should also set up systems to help GPs get quick specialist advice and avoid unnecessary referrals, and to help the public clinics improve their operations so they can see more patients.
Lastly, the federal government should tackle extreme fees.
A small number of specialist doctors charge fees that are much higher than average – triple the Medicare schedule fee, or even more.
This can be close to $400 for a single endocrinology or cardiology consultation, or up to $700 for a single psychiatry consultation.
The federal government should take back the Medicare subsidies it pays to doctors charging these extreme fees – and it should name them publicly.
A referral to a specialist should set you on a path to the care you need, not a months-long queue or a bill shock.