Who’s the priciest specialist of them all?

3 minute read

GPs might take the political heat, but bulk billing is down and gap fees are up across the full range of specialties.

General practice remains among the highest bulk-billing specialties, as more private non-GP consultants increase their gap fees and start charging more patients.

According to the latest Department of Health statistics, GPs bulk billed 78% of non-referred attendances in the quarter to March 2023, the lowest proportion to do so since 2009.

It’s part of a continued downward trend: at the close of the 2022 March quarter, the bulk billing rate was 88%.

But while the waning GP bulk billing rate has come under intense scrutiny from patients, politicians and the media alike, it’s not the only specialty with a dramatic decrease in bulk billing rate over the last 12 months.

This time last year, the specialty with the lowest bulk billing rate for an initial appointment with a specialist consultant (MBS Item 110), according to the Medical Costs Finder, was allergy and immunology at 26%.

Today, that has decreased to 19%.

The median gap fee for an initial allergy/immunology consult has also increased from $168 to $180 in that time.

The Medical Costs Finder, a government initiative which received an overhaul late last year, is drawing data from the 2021-22 financial year, when the patient rebate for an Item 110 was $135.

Following indexation in July, the rebate for Item 110 increased to $143.

The longest GP time-based consult, a Level D (MBS Item 44), carries a rebate of $117 after indexation this year.

Item 110 does not have a minimum time requirement attached.

It covers the initial professional attendance by a consultant physician following referral in a single course of treatment.

Across the 19 specialties with bulk billing rates and median gap fees for an Item 110 listed on the Medical Costs Finder, allergy/immunology is still the one with the lowest bulk billing rate.

It’s joined near the bottom by internal medicine at 24%, paediatrics at 30% and endocrinology and respiratory/sleep medicine, both of which have a bulk billing rate of 32%.

Allergy and immunology specialist fees are also at the pointy end – the only specialists charging more for the same item are neurologists, with 66% of patients having to pay a median $195 out-of-pocket fee.

Paediatricians are next up, charging a median of $165 out of pocket, followed by rheumatologists with $155.

Oncologists and clinical geneticists charge patients a gap of $145.

Item 110 across various specialties

There are also signs that the specialties which typically sit at the other end of the bulk billing and fees spectrum are also feeling the pinch.

Last year, the specialty with the highest bulk billing rate was nuclear medicine at 86%; now, it only bulk bills 76% of patients for an Item 110 – and that’s still one of the highest rates – although its median gap fee has actually decreased from $113 to $70.

Palliative care is the biggest outlier of the specialties, with the site claiming that specialists bulk bill 100% of Item 110s.

Clinical geneticists, while charging one of the highest gap fees, rarely do so – they bulk bill 93% of the time.

Rehabilitation medicine bulk bills for Item 110 79% of the time, followed by nuclear medicine at 76% and oncology at 75%.

The specialties with the lowest median gap fees are palliative care and nuclear medicine, then nephrology at $100, geriatric medicine at $105 and general medicine, cardiology and internal medicine at $110.

To put these figures into context: 12 months ago, the median out-of-pocket cost of a geriatric medicine consult was $78, for nephrology it was $88 and for cardiology it was $93.

Other specialties with an increasing median gap fee are infectious disease, which was a median of $80 last year and is now $115, as well as respiratory/sleep, which was $115 last year but $125 this year.

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