2 million Australians skip specialist care each year: inquiry

Almost 2 million Australians each year either delay seeing a specialist or skip it altogether. That figure comes from Grattan Institute data tabled at a parliamentary inquiry examining what it would actually take to fix specialist access in this country.

The inquiry, chaired by Labor MP and paediatrician Mike Freelander, has been taking submissions through 2026 and closes this month. It is looking at both sides of the access problem: the people who cannot afford private specialists, and the people who cannot get onto a public waiting list in a reasonable timeframe.

What the data shows

The numbers are stark. Australians spent more than $4 billion on out-of-hospital specialist services in 2025 — up more than 75 per cent since 2019. That rise is not explained by population growth or an equivalent expansion of services. It reflects the growing gap between Medicare rebates and what specialists charge.

Grattan’s analysis found Australians pay, on average, roughly three times the Medicare schedule fee for an initial specialist appointment. The numbers by specialty:

• Psychiatrist: $670 average out-of-pocket
• Endocrinologist: $370
• Cardiologist: $369
• Paediatrician: $363

These are averages. Some specialists charge considerably more. The inquiry heard from multiple clinicians that Medicare rebates have become “almost meaningless” as a contribution to the cost of a consultation.

Public outpatient clinics provide about one-third of specialist care, and some patients in parts of Australia are waiting years for a public specialist appointment. Suzanne Luder, a pensioner who testified, waited two years on a public list while experiencing unexplained abdominal pain. She eventually paid more than $1,000 to see a private gastroenterologist and was diagnosed with gastritis and oesophagitis.

What the inquiry is considering

Three proposals are receiving the most attention.

Secondary consultations. The model that GPs and general practice advocates have been proposing for years: a formal Medicare pathway where a GP rings or writes to a specialist for advice on a patient, both are paid for their time, and the patient does not need to attend. A 2022 Queensland pilot found patients avoided a face-to-face specialist appointment in 86 per cent of cases after their GP received specialist advice. That is a significant finding for a country where specialist waitlists are a known access bottleneck.

Training targets. The government projects a shortfall of almost 7,000 specialists by 2033. Grattan’s Peter Breadon has argued those projections should become binding training targets for specialty colleges and hospitals — so that the people setting training numbers are accountable for the resulting workforce. That is a structural argument, not a quick fix.

Fee regulation. Breadon also called for rules targeting excessive fee charging. Outgoing AMA vice-president Julian Rait pushed back gently, noting that rising out-of-pocket costs reflect rising practice overheads and more complex patients — not only fee-setting decisions. The inquiry chair acknowledged that framing too: easy to characterise doctors as greedy, but the system itself has not kept rebates anywhere near pace with costs.

Both-and: who carries the structural risk

The tension here is between the system-level problem and the individual-level consequence.

The system-level problem is structural: Medicare was designed in a different era of specialist cost and volume. Rebates have not kept pace. Specialist training has not kept pace with projected demand. And there is no current mechanism that makes anyone accountable for the consequences of those gaps — not at the college level, not at the payer level, not at the state health department level.

The individual-level consequence is Suzanne Luder waiting two years in pain before spending $1,000 she may not have had. It is 2 million Australians a year making the calculation that the cost or the wait is not worth it and going without. That group is not randomly distributed. People with complex conditions — who most need specialist input — are often also those with the least economic headroom to go private and the worst capacity to endure a long waitlist. Women navigating endocrinology, rheumatology, or psychiatric referrals will find their own version of this map.

2 cents: this lands in general practice first

The 2 million people who skip specialist care do not disappear from the health system. Many of them turn up in general practice — with the same unresolved condition, months or years later, more complex, more costly to manage, and more frustrated by a system that passed them past the door to care more than once.

Secondary consultations, if properly funded and implemented, would revalue something GPs already do informally: the phone call to a colleague, the message to the specialist registrar, the letter that says “what would you do here?” That work is currently unremunerated and invisible. Making it a formal, funded pathway would change the capacity and the equity of specialist input across the country.

The inquiry is at the submission stage. If you have a view on what should change, the window is this month. The committee has already written to states and territories — the people who run the public clinics — to discuss improving access. That is a broader structural conversation than individual fee reform, and it is overdue.

Verdict: yes — 2 million Australians forgoing specialist care annually is a system-level failure with direct implications for general practice workload and patient outcomes. The secondary consultation proposal is the reform most worth watching.

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Sources cited

1. Specialist wait times and excessive fees in sights of parliamentary inquiry — ABC News, 4 November 2026
2. Grattan Institute — health system reform research