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Stop exploiting us – consumers tell ophthalmologists

“Patients will suffer if the Government does this.” It’s a time-honoured line that the powerful players in the health and medical industry are quick to trot out when their interests are threatened. Sometimes they’re right – that patients’ or the broader community’s interests are at stake. But often the real agenda is much more about defending the interests of someone else.

The Australian Society of Ophthalmologists has set up this campaign – with the appalling name Grandma’s not happy – “to inform the public about the consequences of the Cataract Rebate cut planned for November 2009”.
Their PR/media campaign has been successful in drawing coverage largely supportive of their goals. One notable exception was Adam Cresswell’s piece in The Australian, in which the redoubtable Peter Brooks  – a longstanding advocate of health workforce reform – accused the specialists of conducting “blackmail”.
But Carol Bennett, executive director of the Consumers Health Forum of Australia, has had enough. And it looks from her piece below that last night’s  7.30 Report was the final straw. She wrote this piece for Crikey today, but I thought it worth sharing with Croakey readers who may not have seen the bulletin.

She writes:

“Ophthalmologists again are demonstrating what most people involved in health policy have known for decades: no Health Minister should ever dare stand between a medical specialist and their hard-earned Medicare entitlement.

What is particularly disappointing about the latest campaign from ophthalmologists (here and here) is the way they are using marginalised health consumers as cannon fodder in a public campaign to maintain their substantial tax payer-funded incomes.

The ophthalmologist’s story last night on the 7.30 Report adopted the following script: Take a struggling, older truck driver with limited employment options and limited income. Tell him he is going blind. Tell him the government has cut the rebate for the eye surgery he needs so now it will cost him hundreds of dollars to save his sight. He doesn’t have a spare few hundred dollars. Watch him struggle to hold back tears, this salt-of-the-earth Aussie battler now facing blindness because of the callous and ignorant actions of this government. But all is not lost. An ophthalmologist mounts the white horse of compassion and offers to do the operation for free! Wow, these ophthalmologists are wonderful people, and this government doesn’t seem to understand or care if some older people to go blind!

In my view, exploiting a vulnerable health consumer is unethical behaviour for a professional group campaigning to maintain their high incomes.

Perhaps just as annoying is the lack of factual information about this campaign. No one mentions that the ophthalmologist who performs the miracle cataract surgery will receive a minimum $300 rebate and that the operation will take less than 30 minutes.

And that is not all that goes unsaid.

Make no mistake; this is a campaign about the level of tax-payer contributions to the income of ophthalmologists. It is only reasonable then that their incomes be on the table as part of the discussion. Like most people in the health sector, I want to know why ophthalmologists cannot afford to charge only the new scheduled fee of $300 for cataract surgery? Why do they have to charge above this fee? Is their economic viability now under threat? Does this mean their average income would drop below the level of our PM? Each time an ophthalmologist talks publicly in this campaign, I would like them to be honest about their income, from Medicare and private fees.

As I understand it, the top 10% of ophthalmologists make well over $1 million a year in Medicare rebates alone, more than twice the income of our Prime Minister. Even these high rebates have not prevented ophthalmologists charging substantial gap fees to health consumers, making their services less accessible while increasing their income.

One of the real barriers to health reform is skyrocketing Medicare payments. No government can afford to let costs continue to spiral upwards without seeking to impose some limitation on the amount paid for each procedure. There are very real inequities in the incomes that medical specialists with similar levels of training derive from Medicare for their work.

Governments need to be supported in imposing some measure of work value on Medicare, despite the self-interested campaigns from groups such as pathology companies, obstetricians and ophthalmologists.

Perhaps, more importantly, the media and others need to acknowledge that many of these campaigns against Medicare reform represent exploitative, self-interested attempts to maintain a very substantial tax-payer supported income.”

Comments 6

  1. Croakey says:

    Jon Hunt sent in this comment: It is a fact of life that some doctors see their work as a business. Cataracts, well, there isn’t much to it. Anyone can be trained to do them, they take only a few minutes so you can do one after another after another. Ca-ching. Ca-ching. Ca-ching.

  2. idoc says:

    Sorry, had to comment on this. It seems a sad indictment on my profession (ophthalmology) that many people feel that “we’re in it for the money”.
    I didn’t spend 6 years at medical school, more than 2 years as resident house officer and 6 years as a registrar and specialist registrar to earn a million dollars a year – and I don’t.
    I’m a standard general ophthalmologist, with further training in paediatric and neuro-ophthalmology, and my income since becoming fully qualified 6 years ago (17 years after commencing medical training) is approximately $400,000 gross per annum (of which about $240,000 comes from medicare funded cataract surgery). Cataracts (and other surgery) account for less than 10% of my work, the remainder is outpatient work. A third of my week is spent teaching registrars and seeing public patients in teaching hospitals in WA, as a salaried medical officer, on a substantially reduced hourly rate compared to private practice. Ophthalmology is one of the most expensive medical specialties to run, back in 2000 an independent relative value study showed the average overhead per suburban ophthalmologist was $232,617 per annum (60% of income).
    Cataract surgery is not “pure profit”, it helps me keep the non-viable part of my ophthalmic practice afloat. If the rebate is halved, I have to find a way to make my practice profitable, do I pass on the cost to the other 90% of my patients, do I only see “profitable cataract patients”, do I fire staff? I cannot absorb the drop in my gross income and remain in practice.
    10% of ophthalmologists may earn over $1,000,000 but the average ophthalmologist does not.
    Can anyone be trained to do cataracts, perhaps – I currently help train some of the best medicos in the country (saving peoples eyesight makes ophthalmology a very sought after specialty) – and the majority of the trainees are very skillful by the end of their 5-6 years of training.
    A success rate of ~99% is something to be proud of. It seems surprisingly difficult to explain to the politicians (and some other doctors) how an operation where one simple slip or oversight can result in catastrophic visual loss is not “simple” just because it is quick.

  3. Doctor Whom says:

    Part of the problem here is the process. Cutting the Medicare rate for cataracts in half was a major political mistake in itself. It might have some unintended knockon effects – we might see more cataracts done by people like idoc but less done by others. I don’t understand why the rebate wasn’t lowered gradually and sensibly over a few years allowing Optham. time to adjust and averting them arcing up.

    One problem is that cataracts are a pretty fundamental health benefit – its relatively cheap, even fully privately, around $3,000 all up, even less in an efficient public hospital and is spectacular procedure. People come in blind and within two hours or so go back home and the next day they can see with little if any pain.

    Cataract procedures enable people to avoid nursing home admissions, live active lives, read, cook, recognise loved ones and prevent falls one of the biggest causes of A&E presentations, and by preventing falls prevent hip operations etc.

    The waiting lists for cataracts is huge anywhere in Australia – not neccessarily the same overseas.

    We could train up technicians to do them under supervision, some other countries do with success, but we haven’t made any moves to do so.

    The College, and others, have neglected to point out that the halving of the rebate, from $800 to $400, is only the payment for the actual procedure, and does not stop the fees for other professionals at the procedure or consultations prior on rooms.

    Still @$400 with 7 to 11 procedures per session = $2,800 to $4,700 a half day – it isn’t going to force opthamologists onto the street.

    idoc – without being rude – if overheads for a suburban opthamologist are so out of whack – it suggests to me that the practice model is up the proverbial and a revamped model whereby overheads are shared and amortised differently might be the go. Cut those overheads by half and you have an extra $100,000 for the same work!

  4. john2066 says:

    Typical outrageous greed from Australias most powerful and rampant trade union – the specialists. I dont think ordinary australian taxpayers understand the sheer physical scale of money the specialists make – with regular income from taxpayers in the multi millions.

    Every person reading this is paying tens of thousands of dollars a year for the surgical monopoly.

    Of course, they make sure to keep the numbers of new specialists down to keep their stratospheric incomes high. And naturally the conservative parties slobber all over them.

    And its a fact – shortages cause deaths.

    Enough is enough is enough. These specialists are bankrupting Australia’s health and we have to stand up to them once and for all.

  5. moss14 says:

    Put them all in the public system. The ophthalmologists would get the same money and would not have to buy any equipment and employ any staff – their incomes would be similar and there would be much less grief. The only people who would have the grief would be those who would have to wait years and by that time they would be blind. Why would anyone want to spend 17 years getting fully qualified to be treated like second class citizens. This government has never engaged in meaningful discussions with the profession and has never conducted anything that looks like a cost benefit analysis. They want to reduce specialists to the lowest common demoninator – it is the same old story Australians hate people being successful

  6. So what has been the progress of this issue, close to 1 year on and its stalled, no real changes to the system or the costs for treatment. It seems that the cost for surgery can range from $500 to almost $3000 for surgery on a single eye.

    This ongoing increases in costs is not going to help Medicare and some health funds don’t seem to be as clear in their disclosures about what types of eye surgery is actually covered. So a patient with private health cover may still be left out in the cold…

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Federal Budget 2020-21
Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20