COMMENT: Dr Nikki Stamp on the Federal Government’s misguided attacks on specialist fees

I am a cardiothoracic surgeon working full-time in private practice, not because it was my preference, but because poor workforce planning means many fully qualified specialists cannot secure substantive public appointments despite growing waitlists.

In my practice, I charge no gap for surgery. Whatever Medicare and the private health fund pay is what I receive. That covers long operations, 24/7 on-call work, daily ward rounds and six weeks of follow-up and all that this entails.

Most cardiac surgeons and anaesthetists work similarly – no gaps for anyone. When I break down the hourly rate for some patients, this is less than I have paid for important non-medical services recently.

The Medicare rebate for a new consult is $86.15. That must cover 45 minutes with the patient, reviewing investigations, planning surgery, liaising with colleagues, arranging bookings, admin, indemnity, software, rooms and overheads. As a new practice owner, I do all my own admin because I cannot yet afford staff. If I bulk billed consultations, I would lose money seeing patients. As it is, I often just cover my costs.

Many specialists quietly absorb costs already. Colleagues bulk bill investigations at a loss, charge minimal gaps, or accept shrinking rebates while juggling insecure temporary public contracts.

Yes, excessive fees exist and should be scrutinised. But reducing the entire discussion to “greedy specialists” ignores the structural drivers: stagnant Medicare rebates, private insurer behaviour, rising practice costs and failed workforce planning.