Specialist income may never recover to pre-COVID levels, financial expert predicts


By Megan Howe

1 Sep 2020

Australian specialists’ income has fallen dramatically as a result of the COVID-19 pandemic and while there are now signs of recovery, earnings may never return to pre-COVID-19 levels, medical billing experts suggest.

Ms Margaret Faux, founder and CEO of Synapse medical administration company, says about 90% of her clients are specialists and their income took a big hit as the COVID-19 pandemic reached Australia.

While March billings were as usual, there was a 20-25% drop in specialists’ overall income, including Medicare billings and gap fees in April and May, she says.

The halt to elective surgery in many jurisdictions, combined with patients’ reluctance to undergo procedures or seek consults due to fears about COVID-19, had a huge impact on most specialists’ patient loads, with surgeons and anaesthetists hit hardest.

“I’ve never heard this in my life before, but we had some anaesthetists say: ‘I have no work’,” she tells the limbic.

A report released last month found that four in five Australian specialists experienced a fall in monthly income in May compared to before the pandemic and that half were relying on the Federal Government JobKeeper scheme to support practice staff.

Ms Faux says some specialists were able to switch to telehealth consults, but procedural specialists including some gastroenterologists and procedural cardiologists were unable to do so and were significantly affected.

Exceptions included oncologists and haematologists who didn’t appear to experience a big drop in patient volume, she said. Rehabilitation medicine specialists and geriatricians who already had well-established telehealth systems were also not as badly affected.

“We saw some signs of recovery in June, but we’re not seeing pre-COVID levels yet,” Ms Faux said, noting that specialists in lockdown areas of Victoria were again seeing a drop in patient volume.

Regional variations

Medical Billing Experts Managing Director Loryn Einstein said intensivists, surgeons, anaesthetists and proceduralist specialists had experienced the biggest falls in income due to reduced theatre time due to COVID-19 restrictions.

“Everyone has been hit, but it has really varied hospital, by hospital and state by state,” she said, noting that Western Australia had been the least affected.

”We have had a number of specialists close their offices and send staff to work remotely, and a few have had staff reductions.”

Billing appeared to have returned almost to normal in July and August for most specialists outside Victoria, Mrs Einstein said, but the long-term outlook remained uncertain.

“Doctors need to prepare long term for intermittent theatre constraints. There is no guarantee there won’t be further impacts.”

MBS data shows almost 2.79 million specialist attendance services were claimed in February 2020, 2.73m in March, then claims fell to a low of 2.27m in April, before rising to 2.54m in May and 2.84 m in June.

MBS claims for miscellaneous diagnostic procedures and investigations across most specialities also experienced a sudden, big drop off in April, started to rise again in May and returned to close to pre-COVID-19 levels in June.

MBS data also shows that specialists embraced the new COVID-19 telehealth and phone items, with almost 540,000 services claimed from March to the end of June (not including consultant physician and psychiatrist telehealth/phone items)

No return to ‘pre-COVID’ levels

While signs were now more positive, Ms Faux suggested COVID-19 would have a long-term impact on specialists’ incomes.

“I would expect that they won’t go back to pre-COVID levels of earnings, certainly not quickly, because of the broader impact on the economy,” she said.

“With job losses and a higher unemployment rate, patients don’t have pre-COVID levels of earning, so they are not in a position to pay large gaps. Some may put off seeing a specialist or they might shop around harder to try to find specialists who are using no-gap schemes,” she suggested.

The falling rate of private health insurance membership could also impact specialists’ incomes, Ms Faux said.

Private health insurance hospital membership fell from 44.3% in June 2019 to 43.6% in June 2020 according to the latest data from the Australian Prudential Regulation Authority.

Ms Faux’s advice to specialists was to ensure they were set up to provide services via  telehealth where possible.

“Getting systems that support telehealth is part of the future of medicine – it is not going to go away.”

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