A damning new report has exposed the extent of Australia’s specialist healthcare crisis, revealing that chronic shortages and high fees are forcing patients to delay or skip essential health services, including ophthalmology.
The Grattan Institute report proposed solutions to the crisis, which include reducing the role of specialist medical colleges in training registrars, expediting more specialists from overseas, and demanding that specialists who charge excessive fees repay Medicare rebates. However, the Australian Society of Ophthalmology (ASO) has hit back, arguing the findings present a “one-sided picture” that misses the real issues driving the crisis.
Addressing the Imbalance
The Grattan Institute report, Special treatment: Improving Australians’ access to specialist care, found that 1.9 million Australians miss out on specialist care annually, with ophthalmology identified as one of the most persistently under-supplied specialties. The number of ophthalmologists increased by just 19% in the decade to 2023, despite growing demand.
“High costs and long waits mean one in five Australians who need specialist care delay or skip getting it,” the report stated. People in wealthy communities receive about 25% more services than those in poorer areas, despite being healthier overall.
The report blamed inadequate training numbers, and stated that “Governments, universities, medical colleges, and health services all make decisions on how many and what types of specialists are trained in Australia… with very limited system-wide data on workforce supply, workforce demand, training activity, or training capacity”.
It said trainee numbers “have been determined by the priorities of specialist colleges and the immediate service needs of public hospitals” rather than community requirements.
In 2024, 154 people applied to the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Vocational Training Program, with just 30–35 government-funded training positions available.
The ASO welcomes the release of the Grattan Institute report but warns it paints a one-sided picture of the challenges posed to ophthalmology in Australia
ASO Challenges Findings
The ASO has strongly contested the report’s conclusions, warning it oversimplifies complex systemic issues.
“The ASO welcomes the release of the Grattan Institute report but warns it paints a one-sided picture of the challenges posed to ophthalmology in Australia,” said ASO Chief Executive Officer Katrina Ronne.
Australia has roughly one ophthalmologist for every 24,181 sets of eyes, but only one in 10 positions are held in the public sector. She said this raises questions about why more public health funding isn’t directed toward ophthalmology when nine in 10 Australians are being forced to rely on private care.
“Specialists are trained in public hospitals and not inside medical colleges,” Ms Ronne explained. “If public hospitals are not delivering enough surgery or outpatient clinics, then we cannot train more specialists.”
The ASO also pointed to the Medicare rebate freeze as a critical issue. The rebate has not been indexed to inflation or average wages since 1980. Meanwhile, specialist fees are driven by real-world overheads including wages, insurance, electricity, leasing, IT expenses, and increasingly expensive medical equipment.
Overseas Recruitment Controversy
In late 2024, Australia introduced expedited pathways to Australia for some specialists from countries with similar health systems like the UK, Canada, and New Zealand. Ophthalmology is expected to be announced in the coming months.
The Grattan Institute report recommended the number of specialities eligible for expedited pathways be expanded as a priority. Additionally, the report suggested that rather than the specialist medical colleges making final decisions on the comparability of overseas specialists, this task should be assigned to the Australian Medical Council (AMC), which has a stated purpose “to ensure that the standards of education, training and assessment of the medical profession promote and protect the health of the Australian community”.
However, the ASO has argued that for ophthalmology, this approach could compound rather than solve existing problems.
While many of the country’s ophthalmologists train overseas and transition to Australian practice after meeting the training and education requirements established by the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), this new policy “removes the equivalency standards assessment from medical colleges, placing it instead with the AMC with limited college consultation”, Ms Ronne told mivision.
Additionally, Ms Ronne said “The expedited pathway takes a one-size-fits-all approach to workforce across all of medicine, assuming an overall shortage of practitioners”. In the case of ophthalmology, she said the fundamental issue lies not in the total number of ophthalmologists, but in their distribution across Australia: regional areas are significantly under-serviced.
Ms Ronne further stated the concern is that fast-tracked specialists from overseas won’t be restricted or bonded to regional areas where they’re most needed. “They’ll be free to practise where they like.”
This represents a significant departure from previous approaches that attempted to direct overseas-trained doctors to areas of greatest need through various distribution mechanisms.
“This could exacerbate metropolitan concentration while leaving rural areas under-served,” Ms Ronne said.
Alternative Solutions Proposed
Rather than fast-tracking overseas recruitment, the ASO advocates for more sustainable solutions focussing on better funding for regional training positions and improved support for existing practitioners.
The ASO has called for meetings with state, territory, and federal health ministers to address the complexities prohibiting accessibility and affordability of ophthalmology services.
As the debate continues, all parties agree that urgent action is needed to ensure all Australians can access essential eye care. However, the path forward remains contentious, with fundamental disagreements about whether the solution lies in recruiting more overseas specialists or addressing the systemic issues that have created the shortage in the first place.
“Sight matters to Australians,” Ms Ronne concluded. “It should matter to our governments too.”
Further reading: Ophthalmology Workforce Crisis Debated
