21/05/2026
Why This Push to Cap Specialists’ Fees Doesn’t Sit Right
The more I sit with this conversation about capping specialists’ fees, the more uncomfortable it feels, and not for the reasons being publicly discussed. It’s not that affordability doesn’t matter, because it absolutely does. Patients are feeling real pressure, and that shouldn’t be dismissed. But the way this is being framed, and more importantly where the focus is being directed, doesn’t quite hold up when you look at how the system is actually functioning on the ground.
It starts to feel less like genuine reform and more like a redirection. A way of managing perception in a cost‑of‑living environment where people are understandably frustrated, and someone needs to be seen to be held accountable. Doctors, particularly specialists, are an easy target in that narrative. Visible, relatively small in number, and not particularly well understood by the public in terms of how their fees are actually set or what sits behind them.
If you step back even slightly and ask why out‑of‑pocket costs are rising, the answer is not especially complicated. Patients are paying more because they are being pushed, often quietly and without real choice, out of the public system and into the private one. Not by design in an explicit sense, but by absence. By services that don’t exist, clinics that were never built, waiting lists that stretch to the point of impracticality.
Joondalup is an obvious example because it is so stark. There is no public outpatient cardiology service. Not a limited service, not a long waiting list, simply no service at all. So what happens to those patients is entirely predictable. They go private. They don’t go private because they want faster coffee and nicer waiting rooms. They go because there is literally nowhere else to go. And that is not an isolated unit that doesn't exist. Gynaecology is also private fee for service clinic. Once you recognise that there are no services, it becomes much harder to sustain the argument that specialist fees are the primary problem. They are a symptom of something much deeper, which is a system that has progressively thinned out in key areas while demand has continued to rise. Instead of addressing that mismatch directly, we are talking about capping the people who have absorbed that demand.
That’s where it starts to feel like displacement rather than reform.
There is also a quiet avoidance of the Medicare conversation, which sits right at the centre of this but rarely gets the attention it deserves. Rebates have not kept pace with the cost of delivering care. Not in a marginal way, but in a sustained, compounding way over time. Anyone running a practice knows this instinctively because you see it in your numbers every single year. Costs rise, expectations rise, compliance expands, and the rebate stays largely fixed in real terms.
The idea that the gap a patient pays is purely a function of what a specialist chooses to charge ignores the other half of that equation, which is what the system is actually contributing.
That gap didn’t appear overnight. It widened gradually, policy decision by policy decision.
Increasing Medicare rebates is expensive, and it requires a level of honesty about funding that is difficult in a political environment where budgets are already under pressure. It’s much simpler, and much more effective from a messaging perspective, to say that fees are too high and something needs to be done about them.
At the same time, there is a broader pattern that’s becoming harder to ignore. We are seeing tightening and restraint across multiple areas of health and social care funding. NDIS is under increasing scrutiny and constraint. DVA has its own pressures. The system as a whole is being asked to do more with less, while demand continues to climb. In that environment, shifting part of the financial pressure onto doctors, even indirectly, starts to look less like coincidence and more like strategy.
That’s what gives this conversation its edge, because it’s not just a technical policy change. It starts to feel like a narrative is being built, one where rising healthcare costs can be attributed, at least in part, to the people delivering care, rather than the structure that underpins. That has consequences. If you actually follow this through, capping fees doesn’t simply make care more affordable and everything else stays the same. Systems adapt. People adapt. Some specialists will step away from Medicare entirely because they can no longer reconcile the financial realities of practice with imposed limits. Others will compress the way they work, shorter consults, higher throughput, less capacity for complexity.
None of that is malicious. It’s just what happens when you constrain one part of a system without adjusting the rest of it.
And for patients, the outcome isn’t always what was intended. Access doesn’t neatly improve. It shifts. It becomes more uneven. Those who can afford to navigate outside the system continue to do so. Those who can’t are left with fewer options and longer waits.
All of this is happening while the one intervention that would genuinely relieve pressure, which is rebuilding and properly funding public outpatient services, remains largely absent from the policy focus. Because that is the harder conversation. It requires long-term commitment, workforce planning, infrastructure, and a willingness to acknowledge that parts of the system have been allowed to quietly erode over time.
It’s not something that produces immediate political returns.
But it is the thing that would actually change the underlying problem. That’s the tension that sits at the heart of this. On the surface, this is about affordability, and that is a legitimate concern. Underneath, it risks becoming a way of avoiding a much more confronting discussion about how we fund healthcare, where responsibility sits, and what has been deprioritised over time.
Doctors didn’t create the gaps patients are now navigating. They responded to them. They built services where none existed, absorbed demand where the public system couldn’t, and continued to deliver care in an environment that has become progressively more complex and constrained. Now, at a moment where that strain is most visible, they are being repositioned as the source of the problem. That is why this doesn’t sit right.
Because if we are serious about fixing affordability, we have to be equally serious about where the problem actually begin and that requires a level of honesty that goes well beyond capping a fee.
Just for reference I have attached the ATO "get the data" - Interesting that CEOs and politicians are not listed on the average taxable income list. With a base salary of $234,000. Ministers: Receive a 57.5% bump, taking their salary to around $376,850 before electorate allowances. Opposition Leader: Peter Dutton receives an added loading, making his salary roughly $442,650. Prime Minister: Anthony Albanese receives a 160% salary bonus, making his total base salary $622,110. People, this is not their taxable income, it is their BASE. Then add in the perks, travel allowances, accommodation, family travel allowences...... now you know where our tax dollars go, and its not the surgeons, physicians or psychiatrists.
