A damning new report has exposed the extent of Australia’s specialist healthcare crisis, revealing that chronic shortages and high fees are forcing patients to delay or skip essential health services, including ophthalmology.

The Grattan Institute report, Special treatment: Improving Australians’ access to specialist care,1 has proposed solutions that include reducing the role of specialist medical colleges in training registrars, expediting more specialists from overseas, and demanding that specialists who charge excessive fees repay Medicare rebates. However, the Australian Society of Ophthalmology (ASO) argues the findings present a “one-sided picture” that misses the real issues driving the crisis.

ADDRESSING THE IMBALANCE

The Grattan Institute report found that 1.9 million Australians miss out on specialist care annually, with ophthalmology identified as one of the most persistently under-supplied specialties. Ophthalmologist numbers increased by just 19% in the decade to 2023, despite growing demand.

“High costs and long waits mean one in five Australians who need specialist care delay or skip getting it,” the report stated. People in wealthy communities receive about 25% more services than those in poorer areas, despite being healthier overall.

The report blamed inadequate training numbers and stated: “Governments, universities, medical colleges, and health services all make decisions on how many and what types of specialists are trained in Australia… with very limited system-wide data on workforce supply, workforce demand, training activity, or training capacity.”

It said trainee numbers “have been determined by the priorities of specialist colleges and the immediate service needs of public hospitals”, rather than community requirements.

In 2024, 154 people applied to the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Vocational Training Program, with just 30–35 governmentfunded training positions available.

ASO CHALLENGES FINDINGS

ASO Chief Executive Officer Katrina Ronne strongly contested the report’s conclusions, warning the report oversimplifies complex systemic issues.

Australia has roughly one ophthalmologist for every 24,181 sets of eyes, but only one in 10 positions are held in the public sector. Ms Ronne said this raises questions about why more public health funding isn’t directed toward ophthalmology when nine in 10 Australians are being forced to rely on private care.

“Specialists are trained in public hospitals and not inside medical colleges,” Ms Ronne explained. “If public hospitals are not delivering enough surgery or outpatient clinics, then we cannot train more specialists.”

The ASO also pointed to the Medicare rebate freeze as a critical issue. The rebate has not been indexed to inflation or average wages since 1980. Meanwhile, specialist fees are driven by realworld overheads including wages, insurance, and increasingly expensive medical equipment.

OVERSEAS RECRUITMENT CONTROVERSY

In 2024, Australia introduced expedited pathways to Australia for some specialists from countries with similar health systems like the UK, Canada, and New Zealand. Ophthalmology is expected to be announced in coming months.

The Grattan Institute report recommended the number of specialities eligible for expedited pathways be expanded as a priority. Additionally, the report suggested that rather than the specialist medical colleges making decisions on the comparability of overseas specialists, this task should be assigned to the Australian Medical Council (AMC).

However, the ASO has argued that for ophthalmology, this approach could compound rather than solve existing problems.

While many ophthalmologists train overseas and transition to Australian practice after meeting RANZCO training and education requirements, this new policy “removes the equivalency standards assessment from medical colleges, placing it instead with the AMC with limited college consultation”, Ms Ronne told mivision.

“The expedited pathway takes a one-sizefits-all approach to workforce across all of medicine, assuming an overall shortage of practitioners.”

She said, for ophthalmology, the fundamental issue lies not in the total number of ophthalmologists, but in their distribution, with regional areas significantly under-serviced.

She said fast-tracked specialists from overseas would be “free to practice where they like”, representing a departure from previous approaches that tried to direct overseas-trained doctors to areas of greatest need.

NEW FRAMEWORK FOR RURAL TRAINING

As mivision went to print, the Council of Presidents of Medical Colleges (CPMC), working in conjunction with the National Rural Health Commissioner, announced “groundbreaking” changes in training selection to address the chronic shortage of specialist doctors in rural and remote communities. Under the new framework, medical colleges will recognise and reward rural experience when selecting new specialist trainees.

“We know that doctors who come from rural areas or have trained in rural settings are far more likely to return and practise in these communities,” said Associate Professor Sanjay Jeganathan, Chair of CPMC.

Reference available at mivision.com.au.