Public specialist access may be constrained as much by how jobs are designed and funded as by the number of doctors available.
“I’m getting feedback from specialists about a lack of opportunities in the public sector – i.e. many consultants want to do public work but there are few jobs,” health economist Dr Luke Slawomirski wrote on LinkedIn last month.
When people talk about wait lists in public hospitals, one of the reasons cited is usually a lack of specialist doctors. But discussions are growing about whether it’s more of a lack of public hospital opportunities rather than a lack of workforce.
While the upcoming inquiry into the access and affordability of medical specialists in Australia will feature the costs of specialist care, the inquiry’s focus on affordability also raises a parallel question about public specialist capacity.
In March, federal health minister Mark Butler referred the inquiry to the House Standing Committee on Health, Aged Care and Disability, with submissions closing on 16 October.
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Chaired by Dr Mike Freelander, it will consider the growing challenges Australians face in accessing timely and affordable specialist care.
“Access to medical specialists is critical to early diagnosis, effective treatment and better health outcomes. However, many Australians are experiencing long waiting times, high out‑of‑pocket costs and difficulties navigating referral pathways, particularly outside major cities,” Dr Freelander said.
“This inquiry will examine how the system is working in practice, where barriers exist, and what reforms or new models of care could improve access and affordability for patients.”
Dr Slawomirksi believes governments have taken their eye off the ball when it comes to public outpatient services or non-admitted services.
“They’ve been purely focusing on hospital beds and managing the crises which is fair enough because public hospitals are under a lot of pressure.
“But at the same time, they’ve taken their eye off the important aspect of providing public specialists consultations and interventions,” he told The Medical Republic.
But he said it was a false economy.
“Some people deteriorate because they can’t see a specialist for their health problem, and then they turn up to emergency and get admitted,” he continued.
But determining whether more public specialist capacity can be created first requires governments to know where the workforce gaps actually are and whether the problem is too few doctors, too few positions, or an inability to fill the positions that already exist.
Workforce planning and strategy
AMA president Dr Danielle McMullen said part of the problem is a lack of investment in whole-of-medical workforce planning and strategy.
“We just don’t have an idea across the country of how many doctors we have versus how many we need, what flavour do we need them to be? Where do we want them to work?” Dr McMullen said.
She said having that data signals to the workforce and health services and employers what they should be building.
“To make sure that you know our trainees have a pipeline and a vision of what comes at the end of that, and that we do have enough of our public specialist workforce,” she said.
While the workforce team in the department has been trying its best, Dr McMullen said since Health Workforce Australia was disbanded in 2014, there has been a lack of strategic oversight to drive the workforce agenda.
“AMA has long been calling for the reinstatement of a health workforce agency. With an ageing population we’re seeing the pressures in aged care, we’re seeing the pressures across public hospitals and in general practice and community care.
“We really need a group who brings all of that together and works out how we’re going to have a health workforce into the future,” she said.
Where are the positions?
Dr Slawomirksi admits reports of specialists wanting more public work but not being able to find it is largely anecdotal.
He cited a few studies, including June’s Whole of Medical Workforce Supply and Demand Compendium Report which hinted towards a specialist undersupply alongside prevocational oversupply as well as MABEL-based research that found specialists preferred public-sector work.
“It would be good to have some data on this,” he said.
West Australian GP Dr Simon Torvaldsen gave an anecdotal example.
“For example, I spoke to a very senior neurologist in the ACT, I think the only epilepsy subspecialist in the territory. He went private but offered to do a full day per week in the public system. But was told he must work a minimum 0.5 or they didn’t want him. So now they have no one with level of expertise in their hospitals,” he wrote.
This echoes what Port Macquarie gastroenterologist Professor Stuart Kostalas told TMR earlier in the year. He lost his public hospital appointment after repeated calls about unsafe on-call practices. Instead of working with him to solve the problem, they terminated his contract.
He told TMR that he wanted to work publicly.
“You don’t move to a regional town not to participate in giving back to the community, right? My wife and I are deeply entrenched in that,” he said.
Health economist and health facilities planner Dr Rhonda Kerr speculated positions can be constrained by the physical capacity available to accommodate additional specialists, including beds, operating theatres, outpatient clinics, diagnostic facilities and teaching spaces.
“The restrictions on capital funding to the ‘’priorities’ and elections means most hospitals miss out on upgrades to capacity and capability. This is not the whole answer, but it is part of the answer. As in every aspect of acute healthcare the answer is always complex.
“A second aspect worthy of consideration is that because we do not have activity-based capital funding for acute care the training places are determined by the health officials in consultation with the medical colleges. Both produce lags in access to training positions for financial reasons. However, these lags have significant economic costs,” she continued.
An issue of recruitment and retention
Even where governments have funded specialist positions, there are signs that simply creating a job does not guarantee someone will take it.
Dr Slawomirksi highlighted a NSW ACI workforce survey that reported almost 60 FTE funded vacant staff specialist positions, but found public careers were more attractive in Vic and Qld.
“It suggests more of a recruitment and retention problem rather than a lack of funding because they’re funded positions,” he said.
Fellow health economist Zeinab Dolatshahi agreed.
“This suggests the issue is not just about supply or funding dear Luke Slawomirski, but about job design, working conditions, and the perceived value of public practice,” she wrote.
“Until we understand what makes public sector roles attractive – and address the barriers – we risk perpetuating a mismatch that harms both workforce sustainability and patient access.”
The question then becomes, what is stopping specialists from taking or remaining in those positions.
Dr McMullen said working conditions were part of the equation, particularly where understaffing resulted in excessive on-call requirements.
“It tends to be a symptom of overall understaffing, rather than purely a rostering problem, particularly in the senior medical workforce. It just tends to be a sign that you don’t have enough specialists,” Dr McMullen said.
She said attracting doctors sometimes even comes down to things like making sure there’s enough clerical support.
“I’ve heard stories of public hospital doctors literally having to physically post their own letters after a clinic and booking their own appointments because there wasn’t enough administrative support,” she said.
There is also the question of whether public employment models offer specialists enough flexibility.
Dr McMullen said teaching, training and research were among the things that could make public work attractive to doctors.
“That should be where the public sector can shine,” she said.
She suggested public hospitals are feeling under strain, so they’re not allowing staff to take some of those opportunities as much as they used to.
“But we know that what doctors are attracted to in the public sector.”
However, she admitted there are many issues at play.
“Concerns from doctors around the country that public hospital workforce has been underdone, underthought of, and that there would be more capacity from doctors to work in the public sector if there were roles available, the flexibility to work both public and private and also adequate remuneration,” she said.
A question for the inquiry
With the parliamentary inquiry now examining specialist access and affordability, surgeon Jillian Tomlinson has questioned whether more attention needs to be paid to the capacity of the public system itself.
“Fees are the symptom. Capacity is the cause,” she wrote on LinkedIn.
Academic haematologist Edward Cliff responded that he wished more people were asking this question.
“I have droves of friends who are recently fellowed consultants who are un- or underemployed because of our shared desire to work in the public system,” he wrote.
“Perhaps one solution to improving specialist outpatient accessibility and affordability is to have public hospitals employ un- and underemployed medical specialists to provide more outpatient consultations at no cost to patients.
“That would increase supply and access to outpatient consultations, and provide them at an affordable cost to patients. It seems odd that the Government’s focus is on the fees charged by private medical specialists when this lever is readily available to them,” Dr Tomlinson responded.
Dr Slawomirksi said there simply needs to be more investment in the sector as a whole.
“Not just financial, but also effort and thinking about how to innovate, and how to make these positions available and more attractive,” he said.
Submissions can be made to the committee until 16 October 2026.
