Extortionate Specialist Fees

young_dazza on 14/05/2013 - 12:08

Ive been referred to a specialist (for a relatively minor issue) by my doctor and was shocked that the specialist is charging $225 for a 30 minute consultation, and Medicare's "scheduled fee" for the service is only $128, so I'll need to pay $97 out of pocket.

Now I'm not saying that my health isn't worth it, I'm simply feeling a bit ripped off. I suspect he's charging almost double the scheduled fee to pay for his Porsche (yes I walk past every day and occasionally see him driving in).

I am with a health fund and they will pay for part of the $97 gap, but not all of it. This is not a condition that I can rock up to an emergency dept at a hospital for and get free treatment as its not an emergency. And I'm not on a pension.

Has anyone else been in this situation? I'm not looking for bargain treatment here - just a reasonable price for a reasonable service. As a regular ozbargainer I just hate feeling ripped off. Can you suggest a way to get treated by a specialist who's not going to rip me off in order to finance their luxurious lifestyles?

Financial

Comments

  • snappy1234 on 14/05/2013 - 12:15
    +1

    I believe they sometimes negotiate…not sure about your specialist tho ?

    (sorry cannot provide anything concrete on that…was info from a workmate at a previous job.)

    • bargarse on 15/05/2013 - 09:08

      Generalists and specialists earn far more than equivalent specialisations that do not have the privilege of a government protected closed shop racket. Think of someone with a Phd in biology.

      We need far more doctors. The answer is to open up entry to the profession. That means more private universities and competing private medical accreditation agencies.

      To the people who only want to be treated by "good" doctors: I know how to set that up for you. We should only admit the best medical student in the country to practice each year. Then we can proudly state that Australia has the best quality doctors in the world.

      If you realise that Drs mostly treat minor sickness and provide counselling services, then the absurdity of the previous idea becomes even more apparent.

      Rather than force everyone into dealing with "gold plated" medical practitioners, we should allow the market to determine what constitutes "good enough" and what a market rate for GPs and specialists should actually be, in the absence of coercive, parasitical organisation with the government granted power to extort money from the population.

      • Hoju on 15/05/2013 - 12:29
        +5

        I suggest you google 'internship tsunami' before making these assertions.

        • bargarse on 15/05/2013 - 13:10
          +1

          Lack of places for medical interns in this country is a feature of the uniform, over engineered educational paradigm that has been put in place by the medical establishment.

          If competing educational systems and differing levels of Dr accreditation were allowed (this is not some fantasy - in the UK nurses have taken on some of the work of GPs) then the supply of sufficiently well trained practitioners would still be far higher than it is today, internship tsunamis notwithstanding.

          Failing that, we could always import more Drs and not mandate they be forced to jump through ridiculous protectionist hurdles.

        • May4th on 15/05/2013 - 22:52

          the "hurdles" are there to ensure safety of practice of foreign doctors where the accreditation process in those countries are much less stringent than it is here. it's not a value judgment on how good foreign doctors are, but rather it is of utmost importance to make sure any medical practitioners in this country are safe. this includes language requirements and exams.

          i remember a news article on a foreign nurse who fed his patient detergent because he couldn't understand him.

          i wouldn't say these measures are protectionist.

          importing doctors isn't the answer when you consider we spend millions every year training medical students only for them to be left in the limbo with a bottleneck of training spots later in their career. ironic isn't it, that what we need so badly is specialists but now we have both a gross undersupply of them while having an oversupply of new graduates

          morally it's not good practice "stealing" labour force from third-world countries who need them vastly more than us when you consider the cost of training a doctor. i don't think many people have considered this perspective.

        • bargarse on 16/05/2013 - 09:24
          +1

          My point is that the hurdles are punitively set to restrict entry into the medical profession far beyond what prudence would necessitate.

          Don't you think it is a conflict of interest that the group which has the most to gain in restraining competition, have the power to restrain foreign entry into the profession?

          I remember a news article about foreign Drs with qualifications from far more prestigious universities than ours being asked to complete years of extra training to be allowed to practice in this country. I have known some of them.

          You need to take the blinkers off and countenance the fact that the noble medical profession may actually be composed of human beings who have been known to exploit a situation to their own advantage.

          Xbai. Your moral argument is absurd. Poor countries don't "own" their Drs (unless it's N.Korea). Drs are free human beings who can choose where they wish to live. "Stealing" implies that these Drs are the property of someone else. No human being is the property of another individual, or the collective.

          There are foreign Drs who may have the opportunity to move to a more lucrative country and choose not to. Some do. It is not a question of morality.

      • May4th on 15/05/2013 - 17:27
        +2

        are you seriously comparing specialist doctors as equivalent to an academic with a PhD in sciences?

        • leiiv on 16/05/2013 - 00:20
          -1

          Are you saying that the specialist doctor is the most prestigious, respectable, important, difficult, etc etc profession above anything else beyond comparison?

        • May4th on 16/05/2013 - 00:26

          of course not. merely the training required and the nature of work is vastly different. it's comparing apples and oranges and complaining one cost more than the other. i don't complain i have to pay more to draft a contract than to have my car serviced, the comparison is mute

        • bargarse on 16/05/2013 - 09:03

          Yes I am comparing the amount of study required to earn both specialisations in related fields. One path pays multiples of the other, simply because the government allows guilds to restrict entry into the profession.

        • surethang on 16/05/2013 - 09:49
          +1

          … the comparison is mute

          "moot"

        • May4th on 16/05/2013 - 13:25
          +1

          then you dont know what you are talking about. most specialists have PhDs to get a hospital job nowadays and almost all will have multiple publications on top of their medical training especially in a competitive field

      • [Deactivated] on 16/05/2013 - 13:20
        +1

        I agree overall bargearse. The college of surgeons in particular has a lot to answer for - their policies and government complacency over many decades contributed to the current lack of Australian-trained mps and the current bottleneck. Universities are also part of the problem. The idea that a high mark equates with a good doctor or specialist is a nonsense. Medicine degree entry qualifications should be lowered so that people with desire, drive and eagerness to learn and implement are not excluded. Stealing doctors from overseas is a copout and ethically bankrupt for a wealthy nation. Compared to bankers and financial high rollers I don't begrudge most specialists their earnings - particularly surgeons. But if you vote conservative you have no right to whinge about Medicare or high medical costs. Get rid of private medical insurers and hundreds of millions more dollars could be channeled into actual delivery of medical services.

        • cannedhams on 20/05/2013 - 11:44
          +3

          As someone who has dealt with surgical colleges, believe me when I say that the Maritime Union of Australia has nothing on these guys in terms of nepotism, old boys' networks and their fierce determination to protect their own turf.

    • arcticmonkey on 18/05/2013 - 22:24
      +3

      I find it amazing that the OP whinges about having to pay a gap after a Medicare rebate AND a health benefit. How many people in the world would like to have money to get basic medical treatment, let alone a specialist?

      I hope at least your buy all your products in Australia and not from offshore companies who pay no/little tax in Australia or you will be paying much more in the future.

  • derpdeder on 14/05/2013 - 12:49
    +2

    While you direct some of your malfeasance at the specialist, why does Medicare's scheduled fee attract none of the blame? It is obviously too small for the price of the service and has not kept up with the pricing of it.

    You are not bound to visit this particular specialist either. You are welcome to shop around depending on the availability of services in your area.

    One final thing - if the issue is minor, you might find another GP who is willing to treat the problem without attending a specialist.

    • young_dazza on 14/05/2013 - 13:52
      +1

      Medicare's scheduled fee of $256 an hour seems quite generous to me. Thats $460k PA before tax assuming no breaks and no overtime. This bloke is charging almost double that. I understand theres insurance, rent, secretary etc etc but I expect he'll be banking a good portion of his fee. More than enough to splurge on a Porsche at least.

      Its interesting that you say I'm not bound to see this specialist. The referral letter explicitly names this person and at not stage did anyone at the surgery say that I could see someone else. Perhaps this is part of the reason why they charge so much - people don't know that they can shop around - so the doctor knows if he doubles his fee's he'll probably only lose 10-20% of his patients - you do the math.

      I'll take your advice about shopping around though and see whether I can do any better. If I need repeat treatments or a surgery though I think I'll have to cash in a fair chunk of my savings (which have taken quite a while to save up).

      • May4th on 15/05/2013 - 17:32
        +4

        uh no, you can ask for a referral to any specialist doctor of your choosing, i think most people know that.

        most specialists have as long as 2-3 months waiting lists to book in a non-urgent appointment. most doctors charge reasonably (a set premium above medicare rebates) and bulk-bill students/pension card holders/low income earners

        • [Deactivated] on 16/05/2013 - 13:05

          how do you know what "most doctors" charge?

    • dzhay on 15/05/2013 - 09:03

      Look up the word malfeasance.

      • derpdeder on 15/05/2013 - 16:30
        -2

        Yep, I realised it was meant to be malcontent as soon as I posted it, but I thought, I could really make some tool's day by leaving it unedited. And of the hundreds of people who have read this page, you are the winner. Please pay my good nature forwards.

        • cruise on 15/05/2013 - 17:40
          +3

          So you knew it was wrong but left it just so you could insult someone for pointing it out

    • arcticmonkey on 18/05/2013 - 22:26
      -1

      Maybe it has not kept up with the rate because overseas purchases is sending more and more money out of the country. You can't have your cake (pay cheap prices for online goods from overseas) and eat it too (health benefits staying high).

  • jeffske on 14/05/2013 - 15:09
    +11

    a specialist doctor typically studies anywhere from 8-9years so would you blame them for wanting compensation commensurate to their time and experience

    but yes that is a lot of money for the 1/2hr in anyone's figures

    • young_dazza on 14/05/2013 - 15:31
      +2

      I studied for 4 years and get much less than half that hourly rate.

      • gottacatchemall on 14/05/2013 - 16:12
        +2

        You should have studied harder and longer like this person evidently did :P

        • young_dazza on 14/05/2013 - 20:34
          +3

          Well I didnt have the option because the universities have so few places for medical students. I wonder why someone doesnt just open a private university with heaps of places just for medical students. We'd get heaps more doctors and hence lower prices for medical treatment.

        • retiredfeline on 15/05/2013 - 01:00
          +2

          So you think the reason you didn't get in was because the qualifying requirements were too high for you? So you would like universities to lower the standards so that more students can study medicine and then we get less qualified graduates and more casualties from mistreatment?

        • INFIDEL on 15/05/2013 - 07:53
          +5

          Sorry GP (first time I disagree with you!), but there is no causal link I know of between childhood performance on exams & level of medical mistreatment or competence. There is an argument to take highly competent skilled people & add medical training to have the best possible doctors & specialists. There was a book in the 1970's on the topic 'Deschooling Society'. (Last week needed to show a med student how to use a stove & he had no idea how to cook a basic meal! But obviously knew how to do well on exams.)

          I have taught students entering medicine. One Murri student I was most proud of was only 'educated' to age 15. He trained as a sheet metal fabrication apprentice. After a sports injury, he was impressed by his doctor & decided to become one. He gave up his job & first picked up medical knowledge working as an ambulance driver. Even before he started med, when we went skiing he fitted in with doctors who assumed he was one. He was so determined to become a doctor. Made a wonderful doctor & person, despite a lack of early formal education.

        • retiredfeline on 15/05/2013 - 09:11

          I wasn't thinking so much about the IQ level of those entering, I mean there isn't that much separating entrants with 99% and 99.5% but that the barrier acts as one of several filters so that the determined get in. Now one can argue about whether this scarcity is deliberately created (I believe it partly is), but I think the simplistic view that doctors are like commodities, and more suppliers means lower prices, as if doctors were widgets coming out of a factory, leaves out all the other factors that go into the training of doctors, which cost society a lot. Training goes beyond lectures in uni, trainees have to engage in praxis, and work under supervision in suitably equipped facilities. If those factors are not adjusted in line with higher medical school intakes, at higher cost to the tax system, then you will have poorer training, and poorer outcomes.

        • INFIDEL on 15/05/2013 - 10:11

          Most, but not all Unis used to use school exam results to determine entry to med. It was the cheapest & easiest way - always the best way according to administrators. Interviews & assessment of life experience is slow & expensive, but should turn out a different (hopefully better) doctor. Now a pre-med degree is necessary. Theoretically, this gives a greater chance for a broader background of doctors. But so many do med just to make big money.

          As we fund most medicine through Medicare, control of the number of provider numbers is again a favoured way to keep costs down. Less doctors, less payouts & easier to manage. Bugger market economics.

          So it's the fault of the bean counters! (And limited specialist training opportunities, as you said.)

        • Hoju on 15/05/2013 - 10:44
          +1

          A degree pre med is only a requirement for grad entry programs. Most if not all programs require an aptitude test and interview for entry, and grades either from school or prior uni study are a hurdle that needs to be passed in order to get an interview.

          It's a very holistic approach these days

        • INFIDEL on 15/05/2013 - 12:52
          +1

          (My students were all grad entry a while back, so not up on ug entry.)

          But the testing seems flawed when a med student last week asked me how to use an electric stove control in a backpacker hostel:
          "Which way is hottest?"
          (No marking on controls, so I asked how he might deduce which way to turn knob. "Don't know." He wanted someone to give him the answer, rather than think independently. I didn't know the answer and suggested turning 2 elements on, with controls set to possible max/min positions & find out.)
          "How will I know when my food will be cooked?"
          (when preparing a basic 1 pot cook up of mince, frozen peas & bottle of tomato sauce - ah student life!)

          Would have thought the UMAT aptitude test for med entry would have discovered his weakness in logical thinking! (test designed to assess applicants general attributes and skills gained through prior experience and learning.
          The test has three sections, which assess:
          Logical Reasoning and Problem Solving
          Understanding People
          Non-verbal reasoning          )

        • newox on 18/05/2013 - 22:27

          Yes, because that'll help… We've got an oversupply of med students and interns at the moment because the government decided to fund more places for med students at uni (but forgot to increase funding for placements at hospitals). Hence, why we still have a lack of doctors

      • parisienne on 15/05/2013 - 10:57
        +6

        young-dazza…Can i tell you…he studied for a crapload more than 4 years to get where he is today (he also saves lives).I am a nurse,and yes,sometimes it sucks to have to pay such fees (especially when ,at times,the Dr.i am seeing is a colleague,but i know the reality of what the Dr. has put in to get that sort of money).I have a friend/colleague who is an O&G,studied for over 20 years to become what he is today and charges a heap for his service…but i can also tell you that he doesn't get all that much after indemnity insurance comes out each year….$250,000 PA.

        • young_dazza on 15/05/2013 - 13:09

          20 years of study is ringing alarm bells for me. How much could you possibly learn about O&G (Obstetrics & Gynaecology)? Would he be paid during his studies?
          BTW I think $250k for a specialist is a little high but not ridiculous. Does this doctor usually charge roughly double the scheduled fee?

        • Hoju on 15/05/2013 - 13:38

          $250k is quite reasonable for an O&G's insurance premium, but most specialists aren't paying that, they have a particularly litigious client when things go wrong.
          20 years sounds a bit much, and yes they are paid from the moment of graduation, after 4-6 years, though not at specialist rates of course.

        • ozgriff on 15/05/2013 - 22:49

          Pretty sure the studying is part of a specialist's requirements to keep practising medicine. So after the initial long haul and expense of medical education, they have to maintain a 'points' system - continually keep honing their skills.

          This is in contrast to some degrees\trades who can switch their brains off once they get their foil stamped paper.

          The medicare gap is too high. Do a search on what it started off as, and how much it has not moved against the cost of living and other measures. You will see it growing more out of touch every year.

        • parisienne on 16/05/2013 - 12:32

          Hi.When you put into place the years spent just becoming a general Dr (6 yrs),then his internship (1 yr),then residency (1 yr),then becoming a registrar (1 yr to start,then approx 5 yrs in chosen specialty under guidance,then specialist (approx another 2 yrs+ after exams etc ),then where this particular Dr is (he is the director of O&G in this area health service and surrounding areas.He is also on the nation wide board of directors in O&G ).So you can see 20 + years is viable.He does charge over the schedule fee (i've never been to him,so i don't know by how much,but i do know he is expensive…which you'd want when you are seeking sound advice/treatment when things aren't going as planned with your pregnancy).He sees some exceptionally complex cases and so his insurance is high for that reason (he also gets referrals from all over the state,and at times,from international sources).And yes,at most of the points during all that study he would be getting paid….but until he got to the qualified specialist arena he would not be earning anywhere near the big bucks (i earn more than an intern as a nurse.Hell,a manager at Maccas earns more than an intern).

        • CheapCoffee on 16/05/2013 - 20:51
          +3

          How can you be so ignorant of studying… Any medical practitioner will be and have to learn for the entirety of their career. You have to keep up with the newest journals and attend conferences. Your university study + specialisation residency is just a basics of your field of study.

          I don't expect the general public to understand how much work and effort and psychological damage that study of medicine brings to doctors, but you can at least try to be respectful. (I am currently studying veterinary medicine if you wished to know.)

      • May4th on 15/05/2013 - 17:42
        +9

        fact of the matter is studying to be a doctor requires discipline, devotion to learning and many sacrifices. where you only see his flash new porsche parked out the back what you don't see is the countless hours he spends even now updating his knowledge and keeping up with CME points, the 80 hour weeks he pulled as an intern etc.

        while you were partying hard after a hard week at work he would have been doing over-time shifts (often unpaid), have to do night-shifts while having to study for an exam that costs thousands to do and if you don't pass you may be kicked out of the training program.

        keep that kind of work-load, working+studying full time and all the stresses that comes with exams and work, and competing with some of the brightest and hardest-working people for some very few spots, for the best of 20 years, you get the picture.

        i'm not going to go into the how difficult medicine is. personally i don't think intelligence is an issue, and no one can subjectively judge how difficult a course is. but ask yourself whether you would be willing to put up with studying every day till you are 35-40, while working full-time 50 hours a week.

        consider also medicare fees hasn't kept up with inflation for the last decade or two so doctors have effectively been given a pay cut every year - this compared to rest of the workforce who have had net average wage growth of 4% per annum

        granted they are paid well, but there are lots of people who get paid more for doing a lot less. i'm looking at you politicians

        • parisienne on 16/05/2013 - 12:44
          +2

          Beautifully put xbai.That is all true.The Dr. i mentioned before owns a Lotus,lives in a really nice area and has a big boy toy or two….BUT DAMN HAS HE EARN'T IT,so i think he more than deserves a toy or ten.Anyone in medicine has worked damn hard,sacrificed much and deferred life in general (parties/travel/friends in their 20's,marriage in their 30's etc) to achieve their dream.I know i am still a little sore about what my NYE 1999-2000 was like (the world partied,i was doing my specialising as a nurse and was wiping backsides at MN,then worked the next morning).That is just one small sacrifice…these guys do that for YEARS.

        • young_dazza on 18/05/2013 - 23:23
          +1

          Yes he has done the hard yards and deserves some respect. But how many people decide to defer treatment because of the cost as a result of this doctors opulence? How many of those people suffer as a result?

      • dealman on 16/05/2013 - 08:13
        +2

        I studied for 4 years and get much less than half that hourly rate.

        You can study for 20 years but what you get in the end comes down to supply and demand, if all you studied was medieval architecture , english literature or Roman ruins, you would make squat and probably should.

        Its all about what value you bring to the table and what people are ready to pay for it.

      • Eivad on 16/05/2013 - 10:08

        Young_dazza, I studied for 5 years, have a chargeout rate at about double the specialist's rate, but get paid less than one third of his chargeout rate.

        There's a difference between how much you charge out and how much you earn at the end of the day.

  • Eivad on 14/05/2013 - 15:24
    +4

    I'm pretty sure all specialists charge around this amount. I saw an eye specialist and a rheumatologist recently and both charged $260 to $280 for a half hour session, with Medicare covering $128.

    I did some shopping around and the prices were quite similar. Of course with my condition I was more concerned with seeing a good doctor than minimising costs.

    The money doesn't go straight to their pocket. Running a specialist practice is expensive and professional indemnity insurance is a fortune.

    Keep in mind your local GP makes upwards of $90 per 15 minute consultation.

    Edit; just read that your health fund concerts part of the gap. Who are you with? I called mine up and they said specialist appointments were only covered by Medicare

    • young_dazza on 14/05/2013 - 20:44
      +2

      Yes Ive since learnt that this seems to be a fairly standard fee for an initial consultation with a specialist.

      You say you wanted to see a good doctor. How do you know if youve picked a good doctor? Simply by trusting that your GP referred you to him based on his experience, outcomes etc, rather than based on some kickbacks or the fact that they went to uni together 30 years ago? Are doctors statistics (eg mortality rate) published publicly? Or its it just word-of-mouth? I'd definitely be prepared to pay more for a doctor with lots of experience and low failure rates, but how would I find out this info?

      BTW Ive no idea whether the health fund will cover the gap. Im assuming it will depend on what particular treatments are provided.

    • viperxz on 15/05/2013 - 13:39
      +6

      I do agree the amount specialists charge initially is excessive, however from experience this is usually only on the initial consult, subsequent consults are usually half that amount or less.

      From a GP perspective however, upwards of $90 is a bit of an overstatement.

      If the GP bulk bills the GP only makes around $35 for the consult, of that $35 there is the cost of running the practice (support staff, rent, electricity, medical supplies, etc.). It is estimated that a consult costs a GP $55, hence the GP is down around $20 if they choose to bulk bill exclusively which means to make money they need to charge a gap, or rely on turning around patients in less than 15mins in order to make up the short fall.

      Given that most practices do not bill pension card holders, every pension card holder they see costs the practice $20, causing them to make up the short fall in other ways.

      Typically most general practices charge a $20-$40 gap, if your not struggling financially which for a good doctor is probably worth the money. Remember like any business, what you are charged is not the amount that ends up in the vendor's pocket.

      http://www.choice.com.au/reviews-and-tests/food-and-health/g…

    • Hoju on 15/05/2013 - 13:40
      +2

      "Keep in mind your local GP makes upwards of $90 per 15 minute consultation."

      In what world? A private consult is typically $60-70, of which up to 40% goes to the practice owner. A bulk billed consult is closer to $30, of which a cut still goes to the practice owner

  • KingstonTheNotSoWise on 15/05/2013 - 00:46
    +2

    "Can you suggest a way to get treated by a specialist who's not going to rip me off in order to finance their luxurious lifestyles?" Spend 5-10 long years of your life studying medicine. Easiest way. You can even earn yourself a porsche to :P

    • May4th on 15/05/2013 - 17:52
      +10

      it's funny how people wouldn't blink twice at spending $200 for a half an hour make-up session or full-body massage but recoil in horror when their specialist charges them that much to save their life :)

      • KingstonTheNotSoWise on 16/05/2013 - 22:18
        +1

        I know right! I do think all the prices are a rip off but at the sametime I'm reminded that they did put in the hard yards to earn themselves this kind of money. I've done nothing great with my life so I can't really turn around and say a doctor doesn't deserve to earn good money. I understand why my parents wanted me to be 1 now. lol

  • porsche26c on 15/05/2013 - 06:33
    +7

    everyone is always mistaken. you did not purchase this guy a Porsche, you purchased yourself a consult and knowledge. yes they are overpriced, but at the end of the day, these guys studied for at least 10 years or more and are entitled to charging these set fees.

    however on another note, why do we pay such large medicare fees and get so little in return. I think medicare need to rein in the prices making set maximums to charge as do some for eg bupa providers.

  • Geewhizz on 15/05/2013 - 06:44

    They generally charge an initial consultation fee, with subsequent visits at a reduced rate.

    just read that your health fund concerts part of the gap. Who are you with? I called mine up and they said specialist appointments were only covered by Medicare

    Same here - no coverage whatsoever unless you're admitted to hospital.

  • Hoju on 15/05/2013 - 07:55
    +3

    You guys want to know how it works? Specialist training is typically 6 years, following 2 years hospital training, following 4-6 years medical school. Yes it's a long journey but you're paid a good salary straight out of med school for 2 years, and a very good one even during the 6 year training period.

    The Medicare payment is more than enough, but the simple fact is that specialist colleges seek to manipulate the market to provide their members (the specialists) with the highest possible income. Basically they accept a lower number of trainees in order that demand always exceeds supply.

    Take cataract surgery. It's quick, cheap and easy. Fred hollows did it for around $5. Medicare pays opthos $800 for the service but they charge $2000-3000, particularly in rural areas. And guess what? They threatened to not offer the service if Medicare tried to restrict the fees they charge.

    Specialists charge a lot because they can, and the system allows it. Think about what you get from a specialist consult vs a gp consult with a scheduled fee of $33. That's when you realise who really are the workhorses of our healthcare system.

    • viper8548 on 15/05/2013 - 12:42
      +2

      You also forgot to mention specialist training spots are extremely competitive and limited and you have to be the best of the best to even be considered a spot. Also not to mention, a lot of background work is done prior to achievement the specialist training such as years of hospital training in the RELEVANT area of the specialty of your interest, post grad research courses and published articles to support your application. And what happens if you don't get in? try again next year hence the spot becomes even more competitive (changing to a different specialty would be would be wasting all previous years of your hard work).

      "Specialist training is typically 6 years, following 2 years hospital training, following 4-6 years medical school" is probably the best and shortest possible time to become a specialist.

      • young_dazza on 15/05/2013 - 13:14
        +1

        The cynic in me thinks that the intake is being limited to either reduce health costs to the govt or to drive up wages by limiting supply.

        • tooblue on 15/05/2013 - 16:31
          +1

          Hush, don't tell the truth.

        • May4th on 15/05/2013 - 18:00
          +1

          it sounds so easy doesn't it. just coast along in your 'well paid' job for 10 years and you'll be a specialist with a porsche! i wonder why everyone aren't doctors

          you would rather have huge increase in intake of medical trainees, with less exams, less competition and sub-standard level of exposure and training which is inevitable with such dilution of resources?

          i don't know about you, but i would like someone who charges me $3000 who i know will get the job done to operate on my eye

        • INFIDEL on 15/05/2013 - 18:54

          As was pointed out a long time ago (eg Ivan Illich in 'Deschooling Society', 1971), a lot of eye surgery would probably be performed better by an unqualified but highly dexterous seamstress from a poor country. Less likely to have spent the rewards of a privileged life on substances / gadgets that may cause the hand to shake, or the mind to wander.

          In many medical areas, there is still little reason to educate so highly, pay so well, and hold in such regard, given a lot of the work does no deserve it. Many areas of surgery do not require the intellectual skills available to only the top 0.5% of the population.

          There is no need for a lowering of quality with a larger intake of medical candidates. Some train as doctors, but never practise - it is a gruelling training which wrecks some. Given the large amount of money spent on health care, and the possibility of lowered fees from a surplus of practitioners, there would be an economic incentive to fund more medical places.

          Demystifying the job & breaking up the restrictive work practises of medical cliques would go a long way to opening the market up, without lowering standards, and hopefully reducing fees. However it is a fierce lobby group. Trade unions seem pussycats in comparison. (The lawyer in me says to say this is my personal opinion, not based on experiences with doctors as my past clients.)

        • May4th on 15/05/2013 - 20:27
          +2

          so..the answer to our health crisis is to import poorly trained third-world labour because they are used to living on $1 a day and would not demand better conditions?

          surgeons are not technicians. i think your understanding of what doctors do is very limited as shown by your well-meaning but poorly informed suggestions.

          i think the biggest reason for the state of the health system is that policy-makers are not medical professionals. they have no idea what healthcare provision is about and the general public have little understanding and are susceptible to the spin-doctors whose only concern is cheap votes. e.g. increasing medical school numbers in the midst of an intern tsunami when the real shortage is in advanced training spots.

        • INFIDEL on 15/05/2013 - 21:49
          +1

          It was mainly my doctor/specialist clients who informed me. Grew up with hospital administration in my household.

          No it is the attitude to doctors that needs changing. Your answer is to let the powerful doctor groups become more powerful?? Time for a rethink.

          We import doctors now, often from poorer countries. A lot of basic surgery is a technicians skill. Skilled workers with fine motor control, good logical thinking, etc are to be found in many walks of life (even poor countries) and would be capable of performing many of the tasks currently performed by medical personel, freeing these highly trained people for more demanding tasks.

        • May4th on 15/05/2013 - 21:52

          well clearly they haven't presented the whole picture to you

          no, my answer is to maintain current level of training for specialists while increasing funding to increase training spots to bring down servicing cost. which is impossible because there is no political impetus for such a crucial but unpopular avenue of funding. at the moment we are wasting millions of dollars by importing oversea doctors while our locally trained students and trainees do not have internshp places or advanced training posts.

          that is already happening, i'm not sure what you your point is regarding "tasks currently performed by medical personel." this statement is just too vague. what tasks are you referring to?

        • INFIDEL on 15/05/2013 - 22:02

          Not really a technical discussion here (itemising tasks). I am sure you could identify a number of those tasks. Just a good idea to examine & rethink, rather than jump to the same old solutions offered by vested interests.
          Was referring to the idea popular among doctors of more control of policy, funding, etc you referred to as the solution, enhancing their control & power. That is rarely a solution. Best to understand the problem first.

        • May4th on 15/05/2013 - 22:09
          +1

          it's easy falling back on conceptual and emotive rhetorics like one of a sinister, controlling power out to get your money. one must wonder how you are to grasp the big picture when you do not even have insight into the reality of groundworks.

          again, i ask you to clarify as i have yet to understand exactly what your recommendations involve. you suggest menial tasks should be delegated to technicians - this is already happening: nurses do minor surgical work and dressings, nurse practitioner can do the equivalent of a doctor's job in a select field under supervision and various technicians and allied health all contribute. doctors don't control policy - if you are referring to AMA as a lobby group, they have the same influence as any trade union on working conditions.

          it is easy to formulate preconceptions from hearsays, whether from media or from family/friends but when you clearly haven't had primary exposure to the industry, whether at a ground staff or administration level i have good reason to doubt whether you are in a position to offer authoritative opinions

          the health field is the only industry left in australia, aside from defense that is tightly regulated. this is because there is too much at stake where deregulation and free-market principles, while a sound economic concept, is just not feasible for such a sensitive industry.

        • Frugal on 15/05/2013 - 22:22

          So what you're simply trying to say is … " you dont know what you're talking about".

        • May4th on 15/05/2013 - 22:26
          -1

          i did try to sugar-coat it a bit :)

        • Frugal on 15/05/2013 - 22:27

          There's a bottleneck. Consultants can only train/supervise so many regs at a time. Easy to say but in reality not so easy to implement right away. It takes time.

        • May4th on 15/05/2013 - 22:31

          yes, sadly the complexities of the system means the nature and scope of the problem will remain under the radar of the general public and politician being politicians won't do anything to address it until all shit hits the fan

        • INFIDEL on 15/05/2013 - 23:03

          It is better to pose the questions to help understanding, than propose solutions without understanding. Of course this is not what is sold by current affairs programs, and most of our culture. Still it is a nice living for me.
          I have often been told I do not understand the complex nature of a discipline, by the very people pushing their vested interests, wanting more control… Often those in the 'industry' are those least able to understand or seek real solutions.

        • May4th on 15/05/2013 - 23:07

          correct me if i'm wrong but you were the one who proposed to deregulate the healthcare sector and import technicians to replace doctors to correct an imbalance in the system of a nature yet to be clarified

          and by that logic i guess my authoritative position on lawyers would be that they are overpaid and legal fees capped in a centralised system named.. legalcare? ;)

        • INFIDEL on 15/05/2013 - 23:14

          Only throwing ideas into the mix to help understand the issues & find new solutions - you need to understand the problem first. What qualities do doctors / specialist have that demand so much training. What parts of their work could be done by lesser trained 'technicians', etc (eg Illich contends dexterous but unqualified could be trained to do many tasks of surgeons - a controversial idea, meant to challenge our ideas of health and education). Why do we hold these people up so high & reward them so well. All valid questions.

        • May4th on 15/05/2013 - 23:18

          it's one thing to throw ideas into the mix but another to jump prematurely to conclusions and make recommendations based on poor, false or no information

          those are valid questions, but again i ask you, what position of expertise are you in to make judgments and criticisms?

          i don't have a problem with those questions being asked and welcome the discussion, but i would frown upon taking your personal prejudice into the problem and attributing blame to a "shadowy sinister force" in the form of the big bad doctor with "vested interests" behind a systemic shortcoming

          your idea for surgeons and dexterous technicians is refreshing but your lack of insight into the profession is evident in that surgeons aren't merely there to artistically cut open your body. surgeons spent extensive training studying anatomy, its many variations and need to make clinical judgment on the best approach to a problem and deal with any unexpected complications which must be corrected often in a seconds to minutes. a simple, small operation may turn into a complex, life-threatening one and you need to be trained to deal with any unexpected mishaps.

          manual dexterity plays an important, but small part of a surgical procedure

        • bargarse on 16/05/2013 - 09:46

          Young_dazza you are right. Xbai, you are deluded. It's commonly known the lengths the medical profession has gone to in the past to line its own pockets, under the guise of serving the public interest. Don't worry, the legal profession is guilty of its own crimes.

          This is an example from the US. It would shock me greatly if it were any different here:

          https://mises.org/daily/1547

        • Hoju on 16/05/2013 - 10:16
          +1

          That article doesn't really apply here. A good portion of it discusses the financial benefit American doctors make from performing unnecessary surgeries. Doesn't happen in the our publicly funded system, we don't have the time or money.

          The US and Australian health care systems and structures are worlds and worlds apart. The only similarities are that doctor shortages occurred, however in the last 10 years we've made huge steps to alleviate that to the point that it's highly likely medical graduates could be unemployed following graduation. (Sudden increase in number of medical students trained, influx of graduates, not enough training positions/qualified doctors to train them).

          If you're a capitalist, that's a good thing. If you're someone who believes, as I do, that the bulk of medical professionals go into the field wanting to help people, then it's not.

          Xbai is not delusional, people are just bringing opposing philosophical views to the table.

        • bargarse on 16/05/2013 - 11:39

          I think the two systems share far more similarities. Centrally planned, multinational medical cartels protected by the state, gold plated licensing requirements and high barriers to entry.

          This is Ozbargain. The process by which people share info, do their homework and reward sellers who offer value when looking for ballpoint pens does not change when the product changes to a service. Any service.

          Statist philosophical views are delusional. They are false. They lead to shortages, long waiting periods and higher costs to society. The average punter in Cuba gets terrible care. Quality over there is reserved for the elite. Free markets democratise quality and bring it to the masses.

          The system we have has been abused by the vested interests in the name of securing "quality". Well guess what, people are travelling to the Phillipines to escape the medical protection racket we have here - and they are getting sufficient quality at an affordable price.

          Before anyone points to the failure of "free" markets in the US - read the article. There is no free market over there.

        • [Deactivated] on 16/05/2013 - 13:39
          +1

          Your comments suggest that all doctors and specialists are on top of their game. Couldn't be any further from fact if you tried, and I tell you that from experience. The quality of GPs and specialists varies hugely. Bruce's point is obvious. The current system controlled largely by vested interests is not providing the best outcomes for the nation or it's citizens. "Undertrained" medical staff won't necessarily do a worse job than a "lax" or overworked specialist or GP. We need to look outside the square for alternatives lest our health system become like America's - services for the wealthy.

        • May4th on 18/05/2013 - 21:33

          your argument is self-defeating. that's exactly why there is such tight control in form of exams, limiting the number of trainees under a specialist (i.e. limited numbers of training spots) and continued education requirements - to make sure all specialists and GPs have sufficient skill and knowledge to meet a minimum standard.

          this is also why we put up lots of barriers like language tests and exams for foreign doctors before they can practice too. so all of the reasons you gave really just proved my points.

          there's always the odd bad apple, that's why it's so important to regulate - to weed them out and make sure all our doctors are safe regardless of whether they seem like a good doctor. so you think things would improve with undertrained medical staff running around? there's a role for everyone in health provision and i think you underestimate the importance of doctors even in what you see as trivial matters

        • Daabido on 20/05/2013 - 09:10

          Salaried lawyers aren't generally overpaid, but the structure of the legal system with partnerships, associateships, etc leads to a very high price for the average person. Add in a barrister and the sky is the limit. If you get a self represented crazy litigant who sues 8 times in a row before being stopped by the courts, you can easily blow through $500k. Yes, that happened. You would think he would be stopped after one or two goes, but no. Those sitting on the bench don't seem too concerned that you might be going through $10 - $20k a day in court. Even if you win, the deadbeat crazy litigant won't or can't pay up.

          People don't mind paying for specialist services, but when it is out of reach of the average person, especially when it comes to health, that is what they mind.

  • INFIDEL on 15/05/2013 - 08:03
    +1

    Medical fees are usually negotiable, if you have a good reason. I negotiated a bulk billed rate with my current specialist - no bill to pay.

    You are covered by the Medicare Safety Net for gap between fees & rebate. You pay up to a maximum out of pocket amount per calendar year. Google it for your amount. Can't see your health insurance also covering this.

    • Hoju on 15/05/2013 - 08:05

      Safety net is $1200, going up to $2000 in last nights budget.
      It is a great safety net, but only really for a chronic condition that needs ongoing specialist care

  • Hoju on 15/05/2013 - 08:09
    +1

    Your other option is to find a gp who has chosen to subspecialise in your problem. They're more common in rural areas because they have to be the jack of all trades out there, but they do exist.
    The reason you've been referred to a specialist is because your gp doesn't feel he has the knowledge to treat you. Find a more experienced (at least in your area of illness) gp and you might get away with no fees at all.

  • Davros on 15/05/2013 - 08:09
    +1

    I get all my doctoring done when overseas for a fraction of the cost of here and get a top notch holiday with the difference.
    And most of the time, no waiting or at worst a day or two

    Bumrungrad in Bangkok is apparently the best in the world according to this article
    http://voices.yahoo.com/the-top-5-best-hospitals-world-62884…

    Many in Malaysia have Australian, British and US trained doctors as well (you can check qualification online unlike here)

    The quality of care there vs Australia makes you realise how 3rd world we are becoming and at some of the worlds highest prices.

    • ipster on 15/05/2013 - 20:27

      So where do you go if you have a complication?

      • Davros on 15/05/2013 - 22:29

        I would like to think the few months extra I got to stay in country due to massive savings would show up any potential complications.

        If you get a procedure done in Australia and then have a trip overseas and have a complication, what do you do then?

        • May4th on 15/05/2013 - 22:41

          buy travel insurance.

          also known as medicare within australia

        • ipster on 16/05/2013 - 09:49

          Spending a 'few' months on holidays is a luxury not everyone is in a position to have, either from a financial or time perspective

  • Davros on 15/05/2013 - 08:14
    +1

    Bear in mind that with that first "specialist" consultation, you may only be seeing his nurse as my mother found out last week.
    She was still charged the specialist rate and told she has to come back next week for further consultation (gouging).

  • Candour on 15/05/2013 - 08:58
    +10

    we miss the point
    salarymen are poorly paid in oz
    trades or skills or semi-skills charge the earth
    for the time they come by a handyman can charge specialist rates even though he may not even have licenses
    eg 'plumbing' tafe graduates, it techs, mechanics, panel beaters, etc
    all gouge us for way over what they are worth.
    we devalue professionals and ignore working class business gougers.

    • Eivad on 16/05/2013 - 10:11

      So true.

  • Candour on 15/05/2013 - 09:16
    +1

    when governments cut public services so they can be seen as good managers then the fees will always outstrip the rebates
    socialist governments do not cut private health subsidies because the liberals and business will have their blood
    they then lose office
    the new guys come in
    and we complain against specialists
    we need responsible governments which charge fair fees so that the citizens of oz can get a decent wage
    not be ripped off by sleazy businesses hiding behind lawyers and spineless politicians too scared to stand up for public services.
    by cutting public services we only pay twice as much to some business sometimes and get ripped off
    abbott likes that
    so does the hockey player
    public services have been gutted in 35+ years I have seen, working

    • arcticmonkey on 08/06/2013 - 20:16

      Expect healthcare in Australia to get much much worse if Abbott gets in. His hero David Cameron has gutted the health system in the UK.

  • imcold on 15/05/2013 - 10:11

    Well i think they need to hire a receptionist.. and pay huge amounts of indemnity insurance.

    My doctor complained about it to me once lol.

    • tooblue on 15/05/2013 - 16:36
      -1

      Gerry complains online shops stole his money.

  • kangaroo on 15/05/2013 - 14:30
    +5

    My wife had to go to a specialist check (non urgent, for the peace of mind) cost $580 - $350 Medicare rebate: $230 from our funds for 1 hour check up.

    A couple of months back I had to change the outlet valve on my Hot Water tank, the plumber charged $225. It took him 10 mins to do the Job!

    • Davros on 15/05/2013 - 22:31

      Perhaps you should have done the outlet valve yourself, its a very simple task.

  • mrmarkau67 on 15/05/2013 - 18:11

    Doctors are in a caring profession and traditionally charge more for the rich than the poor. A bit like cinemas charging more less for pensioners and children, but not as transparent to the consumer. http://en.wikipedia.org/wiki/Price_discrimination

    1. When visiting the doctor, don't give a false impression of being rich. Always sound bit worried about the cost.
    2. Check the cost with the receptionist when making the appointment. (refer previous point)
    3. Ask if that estimate "includes everything" or if you might be up for more payments (see point 1)
    4. Ask if you are 100% covered by Medicare or your private Health Insurance (see point 1)
    • INFIDEL on 15/05/2013 - 19:13
      1. In my experience, it is often the rich who are more concerned about the cost.
      2. Receptionists, in my experience, often say you must discuss any reduction in price with the specialist - in the paid consult. Some will quote the reduced fee for concession card holders - usually only slightly less.
        But ask anyway.
      • leiiv on 16/05/2013 - 00:04

        Do you think gerry harvey is more concerned about the cost than the OP is?

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