Jane McCredie: Are Medicare rebates skewing the system?

“You don’t see geriatricians driving around in Porsches,” a member of that profession once said to me.

He had a point.

Findings from the largest ever survey of Australian doctors’ earnings, covered by InSight two weeks ago, put geriatricians near the bottom of the list.

The outright winners are diagnostic radiologists, followed by orthopaedic surgeons, while GPs, psychiatrists and paediatricians cluster towards the end of the list.

GPs’ average personal income is $178,000, while specialists across the board average $317,000.

Of course, there are lots of reasons why members of one specialty might earn more than those in another – length and complexity of training, supply and demand, and the level of copayments patients are prepared to pay, to name a few.

But the bedrock underlying our medical fees system is that unwieldy beast, Medicare, and the rebates it establishes for particular services as provided by particular groups of doctors.

This strange mish-mash of empirical evidence, politically motivated decisions and historical accident has more impact on the make-up of our medical workforce than any incentive program designed by government or a professional body.

You can’t blame a debt-burdened new medical graduate for thinking the specialist sports car might be a better bet than the general practice station wagon.

But you have to wonder about some of the rarely questioned assumptions that underlie the schedule.

Why, for example, does procedural work tend to be valued more highly than other services?

And do we really want to perpetuate a system that may be discouraging young doctors from going into fields such as general practice, geriatrics and paediatrics?

Genuine reform of the Medicare schedule would be a courageous endeavour. It’s hard to imagine any of the current crop of lacklustre politicians having the guts to do it.

There’d be winners and losers. And you could expect the losers to make a lot of noise about it.

Just look at the furious response of ophthalmologists when the government last year reduced the Medicare rebate for cataract surgery, claiming new technology had made the procedure simpler and quicker.

I’m not making any judgement about the rights or wrongs of that particular decision, but you can imagine the uproar if a government tried to fiddle with hundreds of item numbers across every specialty in the country.

Still, maybe it would be worth it.

Shouldn’t the publicly funded remuneration for medical services be just as evidence-based as the medicine it provides?

Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne's The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor magazine. Her book, The sex factory, on the science of sex and gender will be published by UNSW Press later this year.