Here’s a hint: it’s not general practice.
With GP bulk billing rates under more scrutiny than ever, it may be surprising to learn that the GP cohort is among the top bulk-billers in medicine.
Doctors working in pain medicine charged the highest average gap for a consult physician attendance last financial year, seizing the crown from neurology, while internal medicine took out the title of lowest bulk-billing rate for the second year running.
The new data comes from the Commonwealth’s embattled Medical Costs Finder site; while legendarily underused by individual practitioners, it also draws from Medicare to display the average gap fee and bulk-billing rate of individual specialties across certain procedures and consult types.
This updates on the first day of each financial year.
At the same time, the Australian Taxation Office has released its annual list of top 10 occupations by average taxable income.
Doctors make up four of the top five earners, with surgeons coming out on top with an average income of $472,475.
Anaesthetists came in second at $447,193, with internal medicine specialists in fourth place at $342,457 and psychiatrists coming in at number five on $342,457 per year.
Other medical practitioners as a group came in at number six, earning roughly $259,802 per year.
According to the new Medical Costs Finder data, which reflects the 2023 to 2024 financial year, general practitioners bulk-billed 69% of patients for a Level B (item 23) and charged an average of $44 out-of-pocket.
Of the 20 consultant physician specialties included on the website, just four bulk-billed more than 69% of patients for an item 110, which covers an initial professional attendance following a referral.
These top bulk-billers were clinical genetics at 91%, nuclear medicine at 81%, rehab medicine at 80% and oncology at 75%.
At just 18% of patients bulk-billed, internal medicine took the dubious title of lowest-bulk-biller for item 110.
Rounding out the bottom three were intensive care on 20% of patient bulk-billed and rheumatology, where just 24% of patients were bulk-billed.
In terms of cash, the consultant specialty with the highest average fee for an item 110 was pain medicine at $375, or an out-of-pocket payment of $232 for the patient.
Neurology had an average fee of $365, or an out-of-pocket payment of $222, and immunology and allergy had an average fee of $350, or an out-of-pocket payment of $207.
Rehab medicine, geriatrics, general medicine and nephrology had the lowest average fees, with all four specialties sitting at $260, or an out-of-pocket payment of $117.
Haematology and oncology both sat around the middle of the pile, charging $284 and $290 respectively.
There is no minimum time requirement for an item 110, and in the 2023-2024 financial year it was rebated at $143.
Among the more procedural non-GP specialities – e.g. dermatology, ophthalmology and surgery – the item for an initial consult is 104, which was rebated at $81 in the 2023 financial year.
Of the 18 specialties included on Medical Costs Finder under this banner, the only one to bulk-bill more than 69% of patients for an item 104 was radiation oncology at 73%.
Diagnostic radiology was the second highest bulk-biller for item 104, at 69%.
The lowest bulk-billing procedural specialties were urology and sport and exercise medicine, which were tied at 7%, and dermatology at 8%.
As well as being the second-lowest bulk-biller, dermatology was the most expensive of the procedural specialties. The average fee for an item 104 was $280, or $199 out-of-pocket for the patient.
It was followed by the lowest bulk-biller, sport and exercise medicine, where the average fee was $270, or $189 out-of-pocket.
The third highest charging specialty in this group was obstetrics and gynaecology at $255, or $174 out-of-pocket.
The lowest chargers, meanwhile, were intensive care and diagnostic radiology, which both charged close to the schedule fee of $81, resulting in negligible out-of-pocket cost for patients.
Dental surgery was the next-lowest, with an average fee of $180, or $99 out-of-pocket.
The Medical Costs Finder is likely to stay in the news during the second half of this year, thanks to an election pledge from Labor to alter the site to analyse data and display the average fee for each specific doctor in the country.
This will cost an extra $7 million; the site has already received more than $24 million in federal funding.