RACS welcomes report but challenges claim of excessive fees

The Royal Australasian College of Surgeons (RACS) has thrown its weight behind efforts to improve access to specialist care across Australia, while firmly rejecting what it sees as a simplistic portrayal of specialist fees as routinely excessive.

In response to Grattan Institute’s latest report, the peak surgical body said it was “saddened but not surprised” to learn that nearly a million Australians skip or delay specialist appointments due to ou-of-pocket costs.

“Not only is this problematic for a patient’s health, but this will also lead to a mounting pressure on our public hospitals and healthcare system,” the College warned in a statement.

But RACS argues that cost concerns cannot be divorced from the broader pressures choking the health system. Rising wages, ballooning demand for chronic and mental health care, inflationary pressure across pharmaceuticals, diagnostics and hospital services all contribute to the economic squeeze felt by both patients and specialists.

Behind the fee conversation lies another structural flaw: an imbalanced distribution of specialists across the country. Despite record numbers of doctors entering the system, with 8,356 new entrants in 2022–2023 and 9,490 the following year, access remains inequitable.

“This highlights not a simple shortage of skilled professionals, but rather a misalignment in the distribution of skills across the health system – particularly between rural, regional and metropolitan areas,” RACS noted.

The College welcomed the report’s recommendation for better coordination and increased funding to specialist colleges to match training capacity with actual service demand. It called for specialist medical colleges to be formally integrated into the Health Workforce Taskforce and stressed that state and territory governments must play their part.

Where RACS draws a clear line is the Grattan Institute’s framing of specialist fees. The College argues that surgery is not a one-person job – it’s a high-overhead, multidisciplinary ecosystem with a long list of costs most patients never see.

The elephant in the consultation room, according to RACS, is Medicare. Years of under-indexing the Medicare Benefits Schedule (MBS), while practice costs skyrocket, have forced patients to shoulder more of the financial burden. Meanwhile, private health insurers haven’t picked up the slack.

“There is a failure of Medicare and private health insurers (PHIs) to provide satisfactory rebates in many instances,” RACS said. “The rebate system is flawed when it takes no account of complexity or dedicated time spent with patients, and remunerates on occasions of service rather than any meaningful relationship to outcomes.”

Singling out doctors for charging practices, without addressing the system’s underlying failures is, in the College’s view, an unbalanced narrative.

RACS said it is “ready to have a conversation about ‘excessive fees’, what defines this, and its meaning in the context of inadequate patient rebate schedules.”

But it also wants a broader reckoning with health funding policy. The College has joined forces with the Australian Medical Association (AMA) in calling for an independent health authority, warning that nothing will change while fiscal agendas continue to dominate reform.

“It’s time to open serious discussion about the flaws in the private and public health systems, the problems associated with dual state and federal health underfunding, and cost shifting,” the College emphasised.

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