The peak body for medical specialists doesn’t totally reject the recommendations from a new report on out-of-control medical fees.
On the surface, the interests of the Grattan Institute, which has just released a report entitled Out of control: How to rein in runaway specialist fees, and the interests of the Council of Presidents of Medical Colleges certainly diverge.
The Grattan report, which was released late on Sunday, levelled that each year more Australians were paying “far too much” for non-GP specialist care.
The report defined “extreme fees” as triple the MBS fee.
Because of the extreme shortages of medical specialists in some areas, lead author Peter Breadon said, patients were often left with the choice of paying a high out-of-pocket fee or waiting on what could seem like a dangerously long public hospital waitlist.
The Grattan’s proposed solution – which it said introduced protection against extreme fees, avoided penalising legitimate fees, and avoided disrupting access – was to require specialist doctors who charged, on average, more than three times the scheduled fee to repay the government the value of the Medicare rebates they claimed.
CPMC chair Associate Professor Kerin Fielding, a rural orthopaedic surgeon, told The Medical Republic that she would support targeted action on “extreme outliers”, so long as there were no unintended consequences for patients or the wider specialist workforce.
Professor Fielding zeroed in on the Grattan’s discussion of specialist training.
“Too few training places leave junior doctors stuck at the start of the pipeline,” Mr Breadon and colleagues wrote.
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In 2018, for example, around half of Australian prevocational doctors were able to move into accredited registrar roles each year; by 2024, that figure was closer to 30%.
“Specialist shortages make it harder to expand public clinics, to increase competition in the private sector, and to reduce wait times,” the report read.
“The federal government should set training targets for each specialty. The targets should dictate where training funding goes, and be used to hold colleges to account for expanding training.”
According to Professor Fielding, having the federal government move to fix specialist doctor training in the regions would result in compounded savings.
“We really welcome those sorts of comments from Grattan,” she said.
“Training specialists where patients need care is fundamental to improving access, which will bring down cost because a lot of the costs are the hidden costs.
“As a rural surgeon, I can tell you, my patients really struggle to go to the city and get pain management, stay in the city, pay for the petrol, pay for accommodation and food, lose time at work.”
She also said training funding was a “poorly understood area”.
“The colleges don’t fund any training positions,” Professor Fielding said.
“The colleges respond if a health service or a hospital reaches out and asks a college to accredit a position.
“If we’re not working in a site, we don’t know what we don’t know. The colleges might look like these all-powerful ivory towers, but they’re not that big, and they don’t have the reach to know exactly what the health departments or the area health services actually need.
“We’re listening. We’re ready to hear. We’ve got models of training and supervision that we’ve developed across all the colleges with enormous agreement and collaboration.
“But we need help. We need the government’s help, from the [state based governments] to the federal government.”
