The Greens oppose the CPRS not because it is too weak, but because it will point Australia in the wrong direction with little prospect of turning it around in the timeframe within which emissions must peak, says Senator Christine Milne.
Consumer advocate goes eye to eye with ophthalmologists
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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. |
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10 Comments
Great piece Carol.
Thanx for this. Minister Roxon’s line is fairly simple: the reduced Medicare payment is catching up with changes in technology and technique which make the procedure quicker and thus cheaper. I have heard nothing from the ophthalmologists or anyone ele to doubt it Roxon’s line so I thought the story on the 7:30 Report was pretty obviously a self interested campaign by the ophthalmologists. I don’t know how many others will be convinced by them.
Wow Carol, someone who can spend up to 16 years of their life training to become an ophthalmologist can earn up to $1million a year. Perhaps you may want to read Bernard Keane’s piece in yesterdays Crikey about the top public sector earners, the head of Australia Post earns 3 times that. I know whose time i think is worth more. Let me give you the tip, it isn’t the Oz Post CEO.
What used to take 3-4 hours now can be done in about 12 minutes. The post op care is minimal and I don’t think you will find many other specialists standing up and supporting this group. They have not done themselves any favours with their peers by only being able to perform 4 cataracts in a public hospital session and then trotting off to do 3 to 4 times as many in private sessions.
This is easy. You have a finite resource and relatively unlimited demand = big gap fees.
It is the most sensible way the doctors can allocate their time.
Solution: Graduate more doctors.
Sean, my problem with this argument (hey look how long it takes to become a doctor and see how much people in the corporate world make) that is always trundled out by doctors seeking more money for their services is that the practice of medicine is supposed to be about more than making lots of money. I understand doctors want to fund a certain lifestyle, pay for their kids private schooling etc, but if that’s all your interested in than don’t become a doctor. One of the real problems modern medicine has, as evidenced by the current public funding debate in the US and the identity of the opponents, is that because of the ability of it’s practitioners to enjoy a comfortable lifestyle unaffected by prevailing economic conditions it attracts students who’s primary motivation (apart from the fact that they got the marks to do medicine) is their own personal long term financial welfare.
Being a doctor is supposed to be a vocation about helping people not merely a way to buy a harbour front home.
This is a terrific piece. About 18 years ago I worked in an ophthalmologist practice - they were raking in money even then, charging well above the scheduled fee, even for pensioners. If was not unusual for a daily income to be up around $10,000 if numerous surgical fees were paid on the day. The wage they were paying their young, excusively female receptionists at the time was about $11,500pa. Yes, we were being paid in a year what they earnt in a day. So a $1m salary does not surprise me.
Someone might like to remind them that The Fred Hollows Foundation does the procedure for a lot less cost.
There are good doctors out there. My spouse is a surgeon who spends hours doing complicated surgery on sick patients with days and weeks of follow up for the price of a couple of cataracts. But it isn’t about that as Jos points out. Yes we have a comfortable life now, but we certainly had lean years, darker than most of you would realise.
It is a wonderful profession, and my spouse is very satisfied and does a good job. My spouses ‘previous secretary worked for an Ophthalmologist like Jenny did. Every day he would scream that he wanted the days billing figures. She said he once threw his lunch back at her because it had mayo on it.
Overpaid prima donnas who give the good guys a bad name. Don’t cry for them, they will be just fine.
Lots of great anecdotes.
The minimum cost to run a one doctor general ophthalmic practice, as determined by government review, more than 10 years ago was $250,000.
What does the bottom 10% of ophthalmologists earn? What is the average earnings?
Ophthalmologist earning the top incomes have been working very hard for many years to get their practices to that level.
A general ophthalmologist does about 50 consultations for each cataract operation.
The number of operations done in public hospitals is limited by the system because the more done the more it costs.
Teaching also slows it down.
Michael Wooldridge, when he was minister for health, decided that more doctors working meant more cost to medicare.
Sure, let’s train so many that each can do 2 a week at $300 each.
Me, I want the Dr who does 20 a week for $1,000 each, sticking the instuments in my eye.
Well at least we can count Rodger!!
The surgeon doing 20 cataracts a week according to you also sees 1000 patients in that week to get that operating number of 20!! So 1000 104’s or 106’s will make them over $60,000 a week if they bulk bill, and that’s just the consulting!! Your argument just doesn’t make sense.
No one doubts the cost of running a practise or the training involved, I run my spouses practise, so my comments are more than anecdotal. Few solo ophthalmologists exist, as you point out it is too expensive.
The health dollar is like a pie to be divided up. For too long ophthalmologists have happily taken a good bite of this pie.
Like I said- don’t worry, doubt any of them will starve.