Beyond “Cheaper Up the Road”: What It Costs to Deliver Safe Private Women’s Care.

This week, Health Minister Mark Butler has announced that he is introducing legislation to mandate disclosure of specialists’ out-of-pocket fees, arguing that specialists declined to publish voluntarily and patients should be able to compare costs between clinicians.

Transparency that helps patients make informed choices is a legitimate policy objective. But if the policy conversation stops at “which specialist is cheaper up the road”, it will miss the more important question: why fees vary so widely in the first place and what it actually costs to deliver safe, compliant, high-availability women’s health care in private practice.

Private obstetricians and gynaecologists are often portrayed as amongst the most financially motivated doctors in the system. When private obstetrics and gynaecology are discussed publicly, the conversation jumps quickly to money. Fees, billing and perceived income dominate the narrative, while the economic reality of delivering care is rarely examined. It is a narrative that sounds intuitive, but one that rarely survives contact with the numbers.

The Minister’s remarks are a clear signal that out-of-pocket costs have become politically and socially intolerable for many households. They also reflect a genuine consumer frustration: patients frequently cannot obtain comparable, reliable information about likely gaps before committing to private care.

NASOG supports transparency that strengthens informed financial consent. However, meaningful transparency must be more than a price list. Without context, fee comparisons risk reducing complex, high-liability, 24/7 services to a simple retail transaction, when the underlying cost base and service inclusions can be fundamentally different between clinicians and practice types.

That reality came into sharper focus recently when NASOG was asked by AMA Queensland to participate in a detailed economic analysis of what it actually costs to run a private obstetrics and gynaecology practice. The exercise was not about defending income. It was about understanding viability. And it forced a much more honest examination of how this work is structured, funded and sustained.

The pathway into obstetrics and gynaecology alone challenges the idea of easy financial reward. Most specialists complete around 14 to 16 years of training from high school graduation to independent practice. While many GP colleagues enter the workforce earlier, build practices and begin accumulating financial security, O&G trainees remain in hospital systems for years longer. These are years of delayed earning, rotating rosters, night shifts and geographic instability that often extends well beyond what is acknowledged when incomes are compared later in career.

By the time a specialist enters private practice, there has already been a substantial opportunity cost. Delayed superannuation accumulation, deferred property ownership, postponed savings and prolonged financial uncertainty are not abstract concepts. They shape life decisions, family planning and long-term security in ways that are rarely visible from the outside.

Training, however, is only the beginning. Obstetrics in particular places sustained demands on personal and family life. On-call responsibilities, interrupted nights, missed events and unpredictability are not temporary phases that end with fellowship. For many private obstetricians, they are structural features of the job. Partners and children carry that load alongside the clinician, often quietly and without recognition.

Running a private practice adds another layer of complexity. Private obstetrics and gynaecology is not simply clinical work delivered in consulting rooms. It is a small business operating in a highly regulated environment. Practices are responsible for staff wages, payroll tax, superannuation, professional indemnity, accreditation, rent, IT systems and clinical consumables.

Capital costs are significant and ongoing. Ultrasound machines, for example, must be replaced approximately every five years to meet NATA accreditation requirements. These are six-figure investments that do not increase revenue, but are essential for compliance, quality and patient safety.

NASOG’s own detailed survey of the profession last year made this visible in concrete terms. For private obstetrics, average annual running costs per obstetrician, including indemnity, approach half a million dollars per year. These are baseline costs before a clinician pays themselves, contributes to superannuation or accounts for the substantial unpaid time spent on administration and governance.

What remains less well understood are the cost structures across gynaecology and its subspecialties. Procedural gynaecology, fertility care, advanced laparoscopy, oncology and ultrasound-heavy practices each carry different staffing, capital and compliance burdens. NASOG is now working to develop a clearer, evidence-based picture of these variations, because workforce planning without cost transparency is largely guesswork.

This is where the Minister’s proposed disclosure regime must be handled carefully.

Publishing “average gaps” may help consumers, but it can also mislead if it is not paired with basic contextual information: what is included in a quoted fee (and what is not), whether the clinician provides true 24/7 continuity and emergency availability, what level of practice infrastructure is required to meet accreditation and safety standards and what proportion of the gap reflects the widening mismatch between modern practice costs and rebates. The risk, otherwise, is that the policy response treats symptoms (visible gaps) while leaving the structural drivers (cost base and funding settings) untouched.

To gain a better understanding of these costs and inform our advocacy, NASOG has begun connecting more deliberately with state and national associations, subspecialty groups and peak bodies. Looking ahead at 2026, as a speciality, our focus must shift toward whether Medicare and health insurance rebates genuinely support women’s access to care. When funding structures lag behind reality, it is patients who experience the consequences first, through longer waits, higher costs and fewer choices.

Most private obstetricians and gynaecologists are not motivated primarily by maximising income. Many could earn comparable or greater incomes with fewer hours, lower risk and less emotional load in other areas of medicine. They remain in this work because of continuity of care, professional responsibility and commitment to women’s health.

If Australians want private women’s healthcare to remain viable and accessible, we need to move beyond simplistic narratives about money and look honestly at what it actually costs to deliver care safely and sustainably. Transparency can help, but only if it is paired with a serious policy conversation about the funding and regulatory settings that shape those fees.

Without that, we risk designing public and private systems that are misaligned with reality and founded on perception rather than evidence. And then being surprised when access, affordability and capacity continue to deteriorate.