Referred medical specialist attendances

Medical specialists generally see patients after receiving a medical referral from a primary health care practitioner or another specialist. They provide diagnostic and treatment services in a specific area of medicine, usually focused on a particular disease or body system. This differs from other practitioners, such as specialists in General practice, allied health and other primary care services, who typically do not require a referral.

Specialities that patients are commonly referred to include cardiology, dermatology, gynaecology, neurology, obstetrics, oncology, paediatrics and rheumatology. All specialists complete advanced training and must be registered with the Australian Health Practitioner Regulation Agency to be able to practise in Australia. The Medicare Benefits Schedule (MBS) data includes claims for more than 40 medical specialities.

This page presents analysis of referred medical specialist attendances (denoted as specialist attendances or consultations hereafter) subsidised by the MBS from 2014–15 to 2024–25, based on the financial year in which the service was provided. It does not report:

• surgical operations
• obstetric care, including antenatal and post-natal attendances
• services provided by specialists without a valid referral.

Services not covered by the MBS include those:

• provided to public patients in public hospitals
• covered by the Department of Veterans' Affairs
• covered by third party insurers or workers' compensation arrangements.

How many Medicare-subsidised specialist attendances were provided?

In 2024–25, 35.6 million specialist attendances were subsidised by Medicare across a range of settings (Figure 1). These services were provided to 8.9 million patients (33% of the population). This was an increase from 28.8 million attendances provided to 7.4 million patients in 2014–15. However, the proportion of the population who had an attendance with a specialist only increased slightly over this period, from 31% to 33%.

The number of specialist consultations per 100 people increased from 123 to 131 consultations between 2014–15 and 2024–25. After adjusting for differences in the age structure of the population, the rate remained stable at 115 consultations per 100 people over the 10-year period to 2024–25.

Most attendances in 2024–25, 26.8 million services (75%), occurred in non-hospital settings, such as private consulting rooms and private outpatient clinics (Table 1). These services were provided to 8.6 million patients.

Table 1: Medicare-subsidised specialist attendances^a by setting, 2024–25^b

1. Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes. Specialist attendances do not include surgical operations or obstetric care, including antenatal and post-natal attendances. These obstetric attendances are in broad service group of obstetrics in standard Medicare statistics reporting. Note, obstetric attendances provided by obstetricians were included in this report in Australia’s health 2024.
2. Services provided to public inpatients or outpatients are not included in the table.
3. This is the number of unique patients, with patients being only counted once in the total, even if they have had services across different settings.
4. The proportion of people receiving a service is calculated by dividing the total patients by the Australian Estimated Resident Population as at 30 June 2024.
5. Services provided in hospital settings are those involving hospital treatment or hospital substitute treatment (for example, treatment at home). Most attendances provided to patients in emergency departments of private hospitals do not require hospital treatment and would be classified as non-hospital attendances.

Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health, Disability and Ageing; National, state and territory population, ABS 2025a.

Medical specialities

In 2024–25, one-third of the population (33%) had at least one Medicare-subsidised specialist consultation, a slight increase of 2 percentage points compared to 2014–15.

The specialities most commonly accessed (based on the proportion of the population receiving at least one service) in 2024–25 were:

• anaesthetics: 7.1%
• cardiology: 5.3%
• ophthalmology: 4.7%
• general surgery: 3.7%
• dermatology: 3.7% (Figure 2).

Across all specialities, patients received an average of 4.0 specialist attendances each in 2024–25. Patients may have seen multiple types of specialists during the year. The specialities with the highest average number of repeat services (where patients accessed the same type of speciality more than once) were: 

• rehabilitation medicine: 6.6 services per patient
• medical oncology: 4.6 services per patient
• infectious diseases: 4.2 services per patient.

In 2024–25, the specialities with the largest number of Medicare-subsidised consultations were:

• cardiology: 3.0 million
• anaesthetics: 2.6 million
• psychiatry: 2.6 million
• ophthalmology: 2.1 million
• general surgery: 1.9 million
• general medicine: 1.8 million
• dermatology: 1.7 million
• medical oncology: 1.7 million.

Together, these 8 specialities accounted for nearly half of all specialist consultations subsidised by Medicare (49%).

Figure 2: Top 10 specialities by various measures, 2020–21 to 2024–25

Patient characteristics

Older people received more Medicare-subsidised specialist consultations than younger people. In 2024–25, almost 2 in 3 people aged 65 and over (64%) had at least one specialist consultation. This compares with 28% of people aged 16–64 and 20% of children aged 15 and under who had at least one consultation (Figure 3).

Figure 3: Specialist attendances by demographic group, 2014–15 to 2024–25   

Across all ages, a higher proportion of females (35%) had at least one specialist consultation compared with males (30%).

The proportion of Australians who received at least one specialist consultation varied by where people lived. The proportion of people who had at least one specialist consultation was similar for Inner regional areas and Major cities (34% and 33%, respectively). Rates decreased with increasing remoteness, with 12% of people in Very remote areas receiving at least one consultation. The lower use in Remote and very remote areas may reflect reduced availability of local specialist services, with these populations often relying more on general practitioners (GPs) to provide health care (see Medicare funding of GP services over time). 

Specialist consultation use also varied by socioeconomic status. The proportion of people receiving at least one specialist consultation increased in areas with high socioeconomic status. In the highest socioeconomic areas (quintile 5), 43% of residents had at least one specialist consultation, compared to 25% of residents living in the lowest socioeconomic areas (quintile 1). Although people living in the lowest socioeconomic areas had lower rates of Medicare-subsidised specialist consultations, they may receive specialist care though public outpatient clinics or as public inpatients, which are not subsidised through the MBS.

Over time, some demographic groups saw a small increase in the proportion of the population receiving one or more specialist consultations between 2014–15 and 2024–25. Only the highest socioeconomic areas had a larger change from 39% to 43%.  

Spending

In 2024–25, a total of $6.1 billion was spent on Medicare-subsidised specialist consultations, an increase of 36% from $4.5 billion (inflation adjusted price) compared to 2014–15. 

Total spending in 2024–25 comprised of:

• $3.3 billion in Medicare benefits paid by the Australian Government
• $2.7 billion in out-of-pocket costs paid by private patients.

Of the $2.7 billion in patient out-of-pocket costs:

• $2.2 billion was for services provided in non-hospital settings (such as specialist consulting rooms)
• $580.3 million was for services provided in-hospital or hospital-substitute settings (such as hospital in the home).

Overall spending on Medicare-subsidised specialist consultations has increased since 2014–15:

• Australian Government spending increased in real terms (adjusted for inflation), from $2.9 billion in 2014–15 to $3.3 billion in 2024–25 (Figure 4). When accounting for changes in the number of patients, spending decreased from around $397 per patient in 2014–15 and $374 per patient in 2024–25. 
• Patient out-of-pocket costs in non-hospital settings increased in real terms from $1.1 billion in 2014–15 to $2.2 billion in 2024–25. On a per patient basis, average out-of-pocket costs rose in real terms from $222 to $316 per patient (a 43% increase) and from an average of $87 to $126 on a per service basis, an increase of 45% over this period. 
• Patient out-of-pocket costs in hospital settings also increased in real terms from $448.3 million in 2014–15 to $580.3 million in 2024–25. On a per patient basis, average out-of-pocket costs also increased in real terms from $239 per patient to $272 (a 14% increase), and from $61 to $68 on a per service basis (a 10% increase) during this period. 

Over the 10 years to 2024–25, the average specialist fee per service increased in real terms by 0.9% per year (on average), rising from $156 in 2014–15 to $170 in 2024–25. During this period, the proportion of specialist fees covered by Medicare for specialist attendances decreased from 65% to 55%. This reflects a faster growth in specialist fees (36%) compared with the growth in Medicare benefits (14%).

Figure 4: Spending on specialist attendances, constant prices, 2014–15 to 2024–25

Top 10 specialities

In 2024–25, spending on specialist consultations was concentrated among a small number of specialities, although the ‘top 10 specialities’ differed across spending measures (refer to Figure 2):

• Specialist fees charged: The top 10 specialities, ranked by total fees charged, made up 61% ($3.7 billion) of all specialist fees.
• Australian Government spending: The 10 specialities with the highest government spending accounted for 59% ($2.0 billion) of all spending.
• Patient out‑of‑pocket costs: The top 10 specialities accounted for 66% ($1.8 billion) of total out‑of‑pocket costs paid by patients.

In non-hospital settings, 37% (9.8 million services) of Medicare-subsidised specialist consultations were bulk-billed in 2024–25, meaning that patients incurred no out-of-pocket costs. For those patients who did pay out-of-pocket costs (79% of patients or 6.8 million people), the average annual cost was $316 per patient, or an average of $126 per service for those who had at least one out-of-pocket cost.

In hospital settings, 2.5% (223,000 services) of Medicare-subsidised specialist consultations were bulk-billed in 2024–25. For those patients who incurred out-of-pocket costs (92% of patients or 2.1 million people), the average annual cost was $272 per patient, or an average of $68 per service for those who incurred at least one out-of-pocket cost.

How many specialist attendances were delivered via telehealth?

Since 2002, telehealth items have been added to the MBS to facilitate telehealth attendances with specialists through 3 main initiatives:

• telepsychiatry program – introduced from 2002
• telehealth program – introduced from 2011
• COVID-19 temporary MBS telehealth services – introduced in 2020 as part of the Australian Government’s response to the COVID-19 pandemic, with many COVID-19 temporary items later becoming permanent.

The telepsychiatry and original telehealth programs were designed to improve patient access to specialists for people living in remote areas by supporting videoconference-based consultations. In 2022, Medicare items for specialist telehealth attendances were consolidated into a single telehealth program. As a result, many of the earlier telehealth items, some of which had specific eligibility criteria, were discontinued.

Initially, the uptake of telepsychiatry services (from 2002) was very low (Figure 5). Service volumes began to rise after the introduction of the telehealth program in 2011, and by 2015–16 over 100,000 telehealth consultations with specialists were being provided each year.

A major shift occurred in March 2020, when the COVID-19 temporary-MBS telehealth services were introduced in response to the COVID-19 pandemic. Before this point, Medicare only supported services being provided through videoconferencing (not over the telephone) and access was limited by patient location and distance from the specialist. The COVID-19 items introduced:

• new telephone consultation items
• new items supporting videoconferencing consultations with wider patient eligibility criteria.

These changes led to 2.5 million telehealth services being delivered in 2019–20, with service volume peaking at 5.9 million in 2021–22, when widespread COVID-19 lockdowns in New South Wales, Victoria and the Australian Capital Territory were introduced.   

The uptake of the new telephone attendance items was rapid. Between their introduction in March 2020 to the end of the financial year in June 2020, 1.8 million telephone attendances were provided. This was more than double the number of videoconference attendances provided in the entire 2019–20 financial year (0.7 million attendances). Telephone items were the main driver of the increase in telehealth attendances provided during the COVID-19 pandemic.

After reaching a peak of 4.3 million telephone attendances in 2021–22, the volume of telephone attendances decreased to 1.8 million in 2022–23. This decline occurred as COVID-19 lockdowns and other public health interventions ended and specialists (some of them had been providing services exclusively via telehealth during the pandemic) returned to more standard operations. In contrast, the number of videoconference attendances increased and stabilised to align more closely with the volume of telephone attendances, with between 1.8 and 2.0 million attendances delivered per year from 2022–23 to 2024–25.

Socioeconomic and remoteness areas

After adjusting for differences in age structure of the population, telehealth use for specialist attendances was highest in areas with the highest socioeconomic status and in Major cities, once Medicare telehealth items without patient eligibility criteria were introduced. In 2024–25, there were 18.7 telehealth attendances per 100 people in the highest socioeconomic areas. Telehealth attendance rates declined with decreasing socioeconomic status, with the lowest socioeconomic areas receiving 9.6 telehealth attendances per 100 people. 

When the original telehealth items were first introduced, eligibility criteria meant they were used mainly by people living in more remote areas. However, at the height of the COVID-19 pandemic in 2021–22, people living in Major cities (many of which were in lockdown) had the highest rate of telehealth specialist attendances, at 22.6 per 100 people. This number declined to 12.7 attendances per 100 people in 2022–23. Remote and Very remote areas, however, only experienced a much smaller decline in the rate of telehealth attendances, indicating telehealth has remained an important mode of accessing specialist care in remote areas. 

Since 2022–23, telehealth use has increased slightly across most areas. In Major cities, rates increased from 12.7 to 13.0 telehealth attendances per 100 people in 2024–25, and in the highest socioeconomic areas, rates increased from 17.9 to 18.7 telehealth attendances per 100 people. The lowest socioeconomic areas also saw an increase from 9.2 to 9.6 attendances per 100 people, and Very remote areas also rose from 7.2 to 7.9 attendances per 100 people between 2022–23 and 2024–25.

What were patients’ experiences of specialist attendances?

According to the 2024–25 Patient Experience Survey (ABS 2025b), among people aged 15 and over who needed to see a specialist in the previous 12 months (in both hospital and non-hospital settings):

• 18.3% delayed their appointment at least once or did not see a specialist when needed. 
  • 8.6% of these people cited cost as a reason for delaying or not seeing the specialist.
• 26.4% waited longer than they felt acceptable to get an appointment with a specialist.

A high proportion reported positive interactions with their specialists

• • 78.5% said the specialist always listened carefully
  • 78.7% said the specialist always spent enough time with them 
  • 83.4% said the specialist always showed respect. 
  • Smaller proportions of people reported that the specialists often displayed these behaviours (13.4%, 12.3%, and 10.7% respectively).

Where do I go for more information?

For more information on specialist attendances, see:

• Medicare-subsidised GP, allied health and specialist health care across local areas
• Medicare Benefits Scheme funded services: monthly data.