Navigating the Business of Ophthalmology

Foundations for a successful practice was presented by Jarrod Bramble, Managing Partner of the accounting and financial firm, Cutcher and Neale. Mr Bramble discussed types of practice structures, including trusts, companies, and self-managed super funds. Discussion centred around how best to share profit between owners in a way that could be considered to be fair, as well as what service fees are typical for ophthalmology practices. Lastly, he said it is important to have a succession plan, and to maximise your super contributions.

In the Dr Andrew Stewart Lecture titled ‘Are private doctors going out of fashion?’, Associate Professor Julian Rait OAM – ASO member and Vice President of the Australian Medical Association (AMA) – described the evolution and current challenges facing Australia’s private medical sector. He traced the origins of Australia’s healthcare system, from the proposed National Health Insurance Scheme of the 1930s to the eventual establishment of Medibank (now Medicare) in 1972, highlighting growing tensions between the government and the medical profession over time.

The session on medical real estate discussed aspects of strategic site selection, ownership, and leasing. It is important to perform market research when planning the location as well as determining the type of building that best suits your needs. It may be advantageous to initially lease as it is cheaper, and easier to move if expansion is required. Building ownership can also occur through a selfmanaged superannuation fund. This can be a good investment due to limited availability of suitable sites and is a reliable source of income due to its essential nature.

Nicole Brown, Partner at Cutcher and Neale, outlined the seven pillars for building wealth: cashflow, income and tax minimisation, estate planning, key performance indicators, superannuation, insurance, and cloud systems. Ms Brown shared some practical strategies for reducing tax, including end-offinancial-year planning and key deductions relevant to medical professionals, such as negative gearing, bucket companies, and super contributions. She concluded by outlining the financial attributes commonly seen in a successful, financially secure medical professional.

The session on payroll compliance was presented by George Sotiris from HR in Health. Wages are known to be the biggest expense in medical practices and therefore it is important to ensure they are handled correctly. It is vital to know what each staff contract says with regards to the award rate level of pay and associated conditions. Overtime can also be costly and unpredictable, therefore ‘true’ overtime and the approval process should be clearly defined. Importantly, as of 1 July 2025, minimum award wages and super guarantees have increased.

Dr Jamie Chew, co-founder of iScribe, provided a live demonstration of an Australian artificial intelligence (AI) scribe tool in action by simulating a patient consultation with the help of Expo co-Convenor Dr Louise Robinson. The software effectively summarised, in realtime, each aspect of the medical history, examination findings, and counselling points, and generated reports and patient-friendly summaries. Dr Chew highlighted the time-saving benefits and the opportunity to enhance quality of care, trust, and communication with patients and colleagues. He emphasised that AI scribes are administrative aids and their potential lies in improving documentation efficiency. However, “clinicians must remain mindful that they are responsible for verifying the accuracy and finalising records”, he said.

Matthew Montgomery, Case Manager for MDA National – a medico-legal advisory company – outlined key medicolegal risks associated with AI use in medicine, particularly AI scribe software that uses both generative and predictive AI. He highlighted concerns around patient consent, privacy, security of data storage, and data ownership, noting legal variations across various jurisdictions within Australia. It was concluded that although AI tools can assist clinical practice, they do not replace the doctor’s legal obligations.

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) provided an update on key issues, including optometrists’ increasing scope of practice, new more rigid continuing professional development requirements, issues around ongoing medication, and equipment shortages. Most of the discussion, however, was based around a proposed specialist international medical graduate pathway. The new pathway would bypass the current system where RANZCO assesses applicants. Instead, the Australian Medical Council (AMC) would accredit applicants if trained in a country with comparable training.

The Australian and New Zealand Eye Foundation (ANZEF) provided an update of its current activities. The ANZEF provides grants of up to AU$50,000 for projects to assist organisations or professionals working in eye-related fields. These grants can be used for health promotional activities, education, research, and improving access to care, particularly for those in Indigenous communities but also South Pacific Islands. One project aims to increase the number of Indigenous ophthalmologists. ANZEF is helping to cover the cost of the RANZCO training programme application, as well as providing scholarships of $30,000 towards training costs.

The Expo concluded with discussion about what success looks like by two ophthalmologists at opposite ends of their working careers. Dr Darryl Gregor and Dr Matthew Cranstoun (both from Queensland) noted the challenges of working in private practice as ophthalmologists do not receive training in business management. Thus, it is important to find mentors in business to help shape a successful practice. Important take away points were: remember to have a good worklife balance, find things you enjoy outside of medicine, have things to look forward to, learn how to deal with setbacks, and be innovative.