President’s update: specialist fees

For people experiencing mental illness, the cost of specialist care can be a significant barrier at a time when they may be particularly vulnerable. High out-of-pocket expenses can lead people to delay seeking help, disengage from treatment or go without the care they need. As psychiatrists, we must take this seriously.

We as psychiatrists do have a professional and social responsibility to charge reasonably and transparently, ensure patients understand the costs of their care and consider affordability wherever possible. We must also recognise that exceptionally high fees charged by some practitioners can undermine public trust in psychiatry as a whole. While there may be legitimate reasons for differences in fees, charges that are difficult to justify risk overshadowing the extraordinary work of colleagues across public and private practice. This is something we need to reflect on as a profession.

These are issues the College has consistently advocated on. We have repeatedly called for stronger public and community mental health services, investment in psychiatric training and a workforce capable of meeting growing demand. Governments have a fundamental responsibility to ensure affordable and timely care is available, particularly for people with severe and complex mental illness who cannot access appropriate public services.

Equally, the way specialist fees are compared and reported warrants closer examination. Psychiatric care is predominantly consultation-based, with important differences in how services are delivered and funded compared with many other specialties.

Unlike many other specialist consultation items, psychiatric Medicare consultation items are time-defined. An initial psychiatric assessment commonly takes an hour or longer, while consultations in some other specialties may appropriately be considerably shorter. Psychiatric care also involves substantial clinical work beyond the appointment, including reviewing clinical information, risk assessment, formulation, care planning, documentation and liaison with families, GPs and other services. Much of this work is not separately remunerated.

Although Grattan compares fees against specialty-specific Medicare schedule fees, these benchmarks do not necessarily reflect equivalent clinical time, complexity or the actual cost of care. Its 2025 report acknowledged limitations in Medicare fee setting and recommended an independent review. A more meaningful comparison should consider total clinical work and the different funding arrangements across specialties.

These distinctions do not justify every high fee, but neither should higher fees automatically be labelled excessive without understanding the care provided. We need a balanced and informed discussion, rather than one that risks portraying psychiatrists collectively as motivated by financial gain.

Medicare rebates have also struggled to keep pace with rising practice costs, including staffing, professional indemnity insurance and administration. While these pressures affect the sustainability of private practice, they do not explain all fee increases, particularly at the highest end.

Private psychiatrists are also providing essential care in a system where public services cannot meet the full spectrum of community need. This includes people in the ‘missing middle’, whose needs exceed what primary care alone can provide but who cannot access increasingly stretched public mental health services. For many, private psychiatry is their only accessible pathway to specialist treatment.

Access remains deeply unequal, with more advantaged communities receiving substantially more psychiatric care than those experiencing disadvantage. Where private services cannot meet community need, governments must provide adequately funded public and community-based alternatives. Regulating individual clinician fees alone will not resolve workforce shortages or the longstanding gaps in our mental health system.

Across public and private practice, psychiatrists work extraordinarily hard, often beyond funded hours, caring for people with complex needs in an under-resourced system. Their commitment deserves recognition, not generalisation based on the charging practices of some practitioners.

As a College, we have responsibilities on both fronts: to uphold ethical and transparent billing within our profession, and to continue advocating for fair Medicare funding, stronger public mental health services and sustained workforce investment. These responsibilities are complementary, not competing.

Ultimately, our shared obligation is to patients. They deserve timely, affordable and high-quality psychiatric care, regardless of their financial circumstances or postcode. Psychiatrists must play their part in making care accessible, and governments must ensure the system enables us to deliver it.

Dr Astha Tomar
President