Extreme specialist fees hit 2.2m Australians as psychiatrists lead the pack

More than 2.2 million Australians were hit with an extreme specialist fee last year, and the club is growing fast. A Grattan Institute report published Sunday defines extreme as a fee at least triple the official Medicare schedule fee. Roughly 250,000 extra patients join that group every year, and psychiatrists and paediatricians rank among the most likely to charge it.

Specialists can't pin the blame on stingy rebates or the cost of doing business, the thinktank found. Medicare rebates fell by $9 in real terms between 2012 and 2025, while specialists lifted patient fees by an average of $37 over the same stretch, clawing back the lost subsidy more than four times over. Average specialist fees climbed 4% above inflation in 2025 alone.

The top 5% of psychiatrists charge a median out-of-pocket fee of $669 for a first consultation, the report says. High-cost paediatricians sit at $362, high-cost cardiologists at $265.11. Those are 104%, 212% and 203% above what their peers charge. Entry prices are climbing too: a first dermatology consultation rose by $28, now at $217.80, between 2023 and 2025, while psychiatry jumped by $90 to reach $351. Fewer than a quarter of initial consultations were bulk-billed in 2025, and in urology, dermatology, ear-nose-and-throat and psychiatry, fewer than 10% were.

Grattan wants the government to yank the subsidy from the worst offenders. Any specialist whose yearly fees average more than three times the Medicare schedule fee would have to repay every rebate claimed that year, while patients keep theirs. That would catch roughly 6% of specialists, about 2,000 doctors, but more than 60% of private dermatologists and a quarter of obstetrician-gynaecologists.

Lead author Peter Breadon, a health economist, said price transparency matters but won't be enough to fix a market that refuses to police itself. Legislation passed in September lets the government publish every specialist's fees on the Medical Costs Finder website, starting in 2027; since the site launched in 2019, only about 100 of 6,300 eligible specialists have volunteered their numbers. Breadon said specialists lack competition because there are too few of them, public waits are long, and patients have little way to judge care quality. Other recommendations include $500 million a year from federal and state governments to expand public hospital outpatient clinics, GP advice lines to skip referrals altogether, and binding training quotas on medical colleges.

The Consumers Health Forum's chief executive, Dr Elizabeth Deveny, said Australians are increasingly rationing their own care or skipping follow-ups because the gap costs more than a week of groceries, and paying becomes the only move when the alternative is a two-year public waitlist. Federal health minister Mark Butler told Guardian Australia that all options are on the table to rein in climbing specialist fees, and a specialist affordability working group is already advising on reforms. Royal Australasian College of Physicians president-elect Dr Julian Kelly said the peak body backs regulation to tackle extreme charging, calling it unacceptable.