Ophthalmology has an under-supply problem, requires more training capacity and features a significant proportion of practitioners charging patients high or extreme fees, according to a new Grattan Institute report.
The independent research organisation – that provides public policy recommendations in Australia – released its report ‘Special treatment: Improving Australians’ access to specialist care’ on Sunday 15 June 2025 that found patients who need to see an ophthalmologist often face “a painful dilemma”.
That is, “pay out-of-pocket, sometimes double or triple the Medicare schedule fee, or join the queue for an appointment in the public sector”.
Cost and access to ophthalmology services featured numerous times in the 99-page document, that also included findings for other specialities like cardiology, paediatrics, and obstetrics and gynaecology.
It identified ophthalmology as a persistently under-supplied specialty in Australia, alongside psychiatry and dermatology. The number of ophthalmologists grew by around 19% during the past decade, significantly below the average growth for other medical specialties.
There are also far more applicants for ophthalmology training than there are training places – and the current specialist training system is heavily influenced by hospital workforce needs and specialist colleges.
“The issues start in the training system. Decisions on what type of specialists to train, and where, are made without an overall plan or assessment of the community’s health needs,” Ms Elizabeth Baldwin, senior associate in Grattan Institute’s Health Program told Insight.
“Specialties such as ophthalmology have been growing slower than average, despite being identified as under-supplied by the Department of Health.”
The authors noted the selection criteria often emphasise “narrow academic metrics”.
“Some individual colleges have made efforts to develop innovative training models, but they can be stymied by lack of funding, public hospitals’ immediate service needs, or excessive and inconsistent accreditation requirements.”
Although RANZCO did not comment directly on this report, it has previously stated ophthalmology doesn’t have a supply issue, but rather a maldistribution problem.
The Grattan report also noted many trainees also lack support at work, particularly on rural rotations and in new jobs, and bullying and discrimination are common.
“Trainees often work long and unpredictable hours, while studying for high-stakes exams, increasing the risk of stress and burnout. These factors contribute to high rates of attrition and failure in some fields, such as surgery and ophthalmology,” the report said.
Public vs. private
According to the report, the vast majority – about 80% – of ophthalmology appointments happen in the private sector.
“There are big gaps in access to care across the country. Public clinics don’t do enough to fill those gaps,” Baldwin said.
“The areas getting the least private ophthalmology care get about 25 fewer private appointments, per 1,000 people, than average. Those least-served areas only get an extra six public appointments. That leaves a big overall gap. These problems have been brewing for decades. Governments have left the system running on autopilot.”
The median out-of-pocket costs for initial ophthalmology consultations was around $100 in 2023, which placed ophthalmology 17th out of 34 specialties.
But about 6% of initial ophthalmology consultations were charged at more than triple the Medicare schedule fee, and 42% were charged at two to three times the Medicare schedule fee.
It was revealed around 7% of ophthalmologists charge “extreme fees” – more than triple the schedule fee on average across the whole year. Among extreme-fee-charging ophthalmologists, the average out-of-pocket cost per consultation was approximately $215.
However, this was much lower than specialities like psychiatry that was in excess of $650 and endocrinology and cardiology that were both $350.
“Specialists can run a profitable business and earn a high income without charging extreme fees. Medical specialties are the highest-earning occupations in Australia: nine of the top 10 occupations by income are medical specialties,” the report said, noting ophthalmology was at the top of that list.
A way forward
The report recommends a five-point national plan so Australians can get the specialist healthcare they need.
For ophthalmology, the Grattan report authors said that governments should set up a workforce planning body to ensure Australia is training enough ophthalmologists and other doctors, where they are needed.
“Governments should also increase the funding available for training. The federal government should double the funding available for flexible training approaches, led by colleges, that expand the number of training positions available,” Baldwin said.
“Training standards should be more consistent and transparent. Some work is under way to do this, and the effects of these changes should be reviewed in three years to ensure they have made training more consistent and responsive to community needs.”
Baldwin said it was also imperative that governments increased funding for teaching, training, and research that is tied to state governments delivering training places that align with forecasts of future community needs.
“State governments should develop strategies to create training capacity in public hospitals, for example, by reducing hospitals’ reliance on registrars for service delivery,” she said.
“To fill gaps in access and address maldistribution, governments should measure each community’s need and access to specialist services. They should make targeted investments in public services in the areas that are in the bottom quarter of the country for access to ophthalmology services, and other specialty types.
“These additional services could come in the form of new public clinics, expanded virtual care, or by helping existing clinics deliver care more efficiently and see more patients.”
The five overarching recommendations for the broader medical specialty workforce are:
- Governments should expand public specialist appointments in areas that get the least care, providing one million extra services each year.
- The federal government should remove Medicare funding from specialists who charge excessive fees – and name them publicly.
- Governments should set up a system where GPs can get written advice from other specialists. This could avoid 68,000 unnecessary specialist referrals each year.
- Governments should modernise public specialist clinics across the country, spreading best practices.
- Governments must train the specialist workforce Australia needs. They should provide an extra $160 million to expand training, and the funding should be linked to targets for undersupplied specialties and rural training.
More reading
Ophthalmologists become Australia’s top earning profession; all ophthalmic incomes revealed
Workforce: attracting more ophthalmologists to the regions
RANZCO Congress 2024: Dr Kristin Bell on workforce issues
