COMMENT: Dr Kerin Fielding on the Federal Government’s attack on specialist fees.

I am an orthopaedic surgeon in Wagga Wagga and, currently the only orthopaedic spine surgeon working in the southern NSW/northern Victoria sector – an area serving a population in excess of one million.

Many of my patients are facing three-year waiting times just for their initial consultation, not including the minimum 12-month waiting time for surgery in the public system – often waiting in debilitating pain.

With no outpatient services for my patients in rural Australia, they are forced to see me in my private office. I would happily provide a public service for my patients if this was offered in the public sector, which would be much more cost-effective for many of them, particularly those on age and disability pensions.

Too many Australians are being pushed into private care simply because they cannot access timely treatment in the public system.

The out-of-pocket costs of seeing a specialist are significant and, for a worrying proportion, so onerous that it is preventing or delaying access to the care they need.

But tackling specialist fees alone won’t fix our access issues here. As the Grattan Institute’s report: “Special treatment: Improving Australians access to specialist care”, shows we need a multi-levered approach to tackle affordability and access; more training and better workforce distribution, more public clinics and a modernisation of Medicare rebates.

We also need to expand specialist training and develop a national workforce framework to address shortages and distribution. About 80 per cent of specialist training occurs in metro cities. But if we are to retain rural specialists, we need to increase training outside major cities. We can do this by strengthening local service capability and continuity of care.

The Australian healthcare system currently relies heavily on short-term, high-cost workforce fixes such as fly-in, fly-out and locum doctors, which is costing billions of dollars and provides little continuity of care for patients in the regions.

And we know that where doctors train strongly influences where they practise. Doctors of rural origin and those who undertake substantial training in rural and regional settings are more likely to practise in rural areas throughout their careers.

Minister Mark Butler is correct to turn his sights on access to specialist care but let’s work together to take a multi-levered approach to achieve real cut-through and health equity for all, including those in the bush.