Some Australians are languishing on waiting lists for longer than six years to see crucial specialists including neurosurgeons, ear, nose and throat surgeons, and immunologists in parts of the country, as a prominent doctor warns people could die while waiting for care.
The ABC has analysed public specialist outpatient waiting times across Australia, with the figures revealing some Australians are waiting longer than two years for urgent appointments with brain surgeons, despite the recommended time frame of 30 days.
The data only tells part of the story, as there is no comprehensive information available revealing the true extent of waiting times for public and private specialists in Australia.
Known as the ‘hidden’ wait list, specialist outpatient waiting times only detail the lengthy waits for an initial specialist appointment in the public system – not the period of time from that appointment to subsequent ones or elective surgery.
They reveal that in Victoria, some people are waiting more than eight years to see ear, nose and throat surgeons, and longer than seven years to see immunologists and dermatologists.
In Tasmania, some are waiting longer than six years to see neurosurgeons, while in parts of South Australia, doctors like gastroenterologists and ophthalmologists come with lists as long as five years.
Professor Graeme Stewart, from the Westmead Institute for Medical Research, described the figures as “unconscionable”.
“The word heartbreaking comes up after 50 years as a doctor to think that we’ve got to this stage,” he said.
“For some problems, you can wait quite a period of time.
“For other problems, the difference between being seen promptly or waiting a long time is a difference between life and death, and we’re seeing that constantly being played out.
“This is not what Australians were told their health system was going to be.”
Below you can look at wait times in your state, noting the figures are not directly comparable across jurisdictions as they are measured differently.
The data compares actual wait times to the recommended wait times of 30 days for urgent (category 1) conditions, 90 days for semi-urgent (category 2) conditions and 365 days for non-urgent (category 3) conditions.
New South Wales, the Australian Capital Territory, the Northern Territory and Western Australia do not currently publish this data.
Victoria
Below are the routine first appointment waiting times statewide between October-December 2022 at the 90th percentile, which is the time it takes to see 90 per cent of patients. We have selected the top-10 longest waits at the 90th percentile.
| Specialty | Overall state wait time | Health service with longest wait |
|---|---|---|
| Hepatobiliary and pancreas | 1005.2 days or 2.75yrs | Melbourne Health 1005.8 days or 2.76yrs |
| Ear, nose and throat surgery | 819 days or 2.24yrs | Austin Health 3270.2 days or 8.96yrs |
| Orthopaedics | 769.10 days or 2.11yrs | Mercy Health 2070.8 days or 5.67yrs |
| Plastic surgery | 741.70 days or 2.03yrs | Northern Health 1334 days or 3.65yrs |
| Ophthalmology | 631 days or 1.73yrs | Austin Health 1378.4 days or 3.78yrs |
| Dermatology | 616 days or 1.69yrs | Austin Health 2622 days or 7.18yrs |
| Immunology | 534 days or 1.46yrs | Austin Health 2793 days or 7.65yrs |
| Urology | 470.90 days or 1.29yrs | Bendigo Health 1573.10 days or 4.3yrs |
| Rheumatology | 467.7 days or 1.28yrs | St Vincent’s 1739.6 days or 4.77yrs |
| Gynaecology | 454 days or 1.24yrs | Western Health 1068 days or 2.92yrs |
A spokesperson for the Victorian government said in a statement that timely outpatient appointments were central to patients’ long-term care needs and recovery.
“Even in the face of record demand driven by COVID, staff furloughing and deferred care – the most urgent patients always received care within the clinically recommended time,” they said.
“Our $12 billion Pandemic Repair Plan is all about training and recruiting more staff, upgrading and building new hospitals and delivering more planned surgery – all of which will move patients through the system quicker, including outpatient services.
“We know there are shortages across Australia both in the public and private system, which us why we’re working with health services to improve their triage and referral processes, investing in training more specialists and boosting appointment numbers.”
Tasmania
Below are the indicative 75th percentile waiting times in days across the Southern, North West and Northern Regions as at 28 February 2023. The 75th percentile is the time it takes to see 75 per cent of patients. We have selected the 10 specialties with the longest waits based on the non-urgent category.
| Specialty | Urgent condition wait time | Semi-Urgent condition wait time | Non-urgent condition wait time |
|---|---|---|---|
| Neurosurgery (Southern Region) | 898 days or 2.46yrs | 1741 days or 4.77yrs | 2546 days or 6.98yrs |
| Gastroenterology (Northern Region) | 385 days | 1820 days or 4.99yrs | 2163 days or 5.93yrs |
| Orthotic prosthetic services (Southern Region) | 251 days | 1118 days or 3.06yrs | 1929 days or 5.28yrs |
| Respiratory (Northern Region) | 157 days | 1386 days or 3.8yrs | 1784 days or 4.89yrs |
| Urology (Northern Region) | 37 days | 1191 days or 3.26yrs | 1694 days or 4.64yrs |
| Neurology (Northern Region) | 378 days | 1091 days or 2.99yrs | 1596 days or 4.37yrs |
| Ear, nose and throat Clinic (Northern Region) | 41 days | 441 days or 1.21yrs | 1565 days or 4.29yrs |
| Colorectal (Northern Region) | 80 days | 920 days or 2.52yrs | 1519 days or 4.16yrs |
| Vascular (Northern Region) | 77 days | 744 days or 2.04yrs | 1511 days or 4.14yrs |
| Plastic Clinic (Northern Region) | 16 days | 581 days or 1.59yrs | 1478 days or 4.05yrs |
A spokesperson from the Tasmanian Health Department said the department acknowledged the impact difficulties recruiting specialists in Tasmania had on outpatient waiting times.
“The demand for neurosurgical services in Tasmania has been increasing, whilst also being a particularly challenging area for recruitment with a limited number of neurosurgeons available. Unfortunately, this can result in extended wait times for these patients,” they said.
“We understand the effect long waits can have on patients’ lives and we work collaboratively with patients and general practitioners to ensure patients are appropriately prioritised according to their level of clinical urgency and can access an outpatient appointment as soon as possible.
“To address these challenges, we are transforming the way outpatient services are delivered in Tasmania to better meet the needs of our community, improve waiting times and reduce waiting lists to sustainable levels.”
South Australia
The below shows the maximum waiting times for routine (category 2) and non-urgent (category 3) who have not been given an appointment date as at 31 December 2022. We have selected the 10 specialties with the longest maximum waits based on both categories.
| Specialty | Hospital | Maximum waiting time |
|---|---|---|
| Opthalmology | Flinders Medical Centre The Queen Elizabeth Hospital Royal Adelaide Hospital | 60 months or 5yrs 57 months or 4.75yrs 56 months or 4.67yrs |
| Ear, nose and throat (ENT) | Lyell McEwin Hospital The Queen Elizabeth Hospital Modbury Hospital | 60 months or 5yrs 57 months or 4.75yrs 53 months or 4.42yrs |
| Plastic and reconstructive surgery | Flinders Medical Centre The Queen Elizabeth Hospital Royal Adelaide Hospital | 60 months or 5yrs 58 months or 4.83yrs 52 months or 4.33yrs |
| Gastroenterology | Flinders Medical Centre Lyell McEwin Hospital The Queen Elizabeth Hospital | 60 months or 5yrs 54 months or 4.5yrs 50 months or 4.17yrs |
| General surgery | Flinders Medical Centre The Queen Elizabeth Hospital Lyell McEwin Hospital | 60 months or 5yrs 44 months or 3.67yrs 34 months or 2.83yrs |
| Urology | Flinders Medical Centre The Queen Elizabeth Hospital Lyell McEwin Hospital | 59 months or 4.92yrs 52 months or 4.33yrs 51 months or 4.25yrs |
| Neurology | Royal Adelaide Hospital The Queen Elizabeth Hospital Flinders Medical Centre | 58 months or 4.83yrs 57 months or 4.75yrs 46 months or 3.83yrs |
| Orthopaedics | The Queen Elizabeth Hospital Lyell McEwin Hospital Flinders Medical Centre | 58 months or 4.83yrs 55 months or 4.58yrs 47 months or 3.92yrs |
| Endocrinology | Royal Adelaide Hospital Flinders Medical Centre The Queen Elizabeth Hospital | 58 months or 4.83yrs 47 months or 3.92yrs 35 months or 2.92yrs |
| Vascular surgery | Flinders Medical Centre Royal Adelaide Hospital Lyell McEwin Hospital and Modbury Hospital | 58 months or 4.83yrs 27 months or 2.25yrs 16 months or 1.34yrs |
SA Health said the latest report showed South Australians were being seen faster for outpatient appointments at public hospitals.
“The specialist outpatient waiting time quarterly report shows a total of 65 speciality outpatient services at South Australian metropolitan hospitals have reduced overall maximum waiting times to between two weeks to 33 months, compared with the last quarterly report,” it said.
“All hospitals have met the initial goal of having no patient wait more than five years for an appointment by 31 December, 2022.”
“We’re working as a system to continue to improve and make sure all South Australians can access the healthcare they need in a timely manner,” SA chief medical officer Dr Michael Cusack said.
“There have been significant inroads made, particularly over the last 12 months.”
Queensland
Below are the 90th percentile waiting times for patients in days across total categories for October-December 2022. We have selected the 10 specialties with the longest waits at the 90th percentile across all categories.
| Specialty | Wait time |
|---|---|
| Ear, nose and throat | 725 days |
| Ophthalmology | 507 days |
| Surgical other | 489 days |
| Pain management | 487 days |
| Paediatric surgery | 455 days |
| Rheumatology | 431 days |
| Neurology | 420 days |
| Paediatric medicine | 384 days |
| Orthopaedic | 363 days |
| Vascular surgery | 350 days |
In a statement, Queensland Health’s director-general Shaun Drummond said the state’s health system was facing increased pressure, driven by a growing and ageing population, the increasing burden of chronic conditions, workforce challenges, lack of access to GPs and declining health cover.
“The significant international workforce shortage, particularly of key medical specialists, continues to be the greatest obstacle to the delivery of sustainable health services across the nation,” he said.
“We are working hard to meet growing demands while prioritising the safety and wellbeing of staff.
“We are employing an additional 9475 frontline health staff across Queensland (between 2020 and 2024), including an extra 1500 doctors over the next four years which will further help to support Queensland’s growing healthcare needs.
Few other treatment options available
For the past two years, Linsey Daly-Vincent has been waiting for an initial appointment with a public gynaecologist in Sydney.
The 37-year-old has endometriosis, an often debilitating condition where tissue similar to the lining of the uterus grows outside of the uterus.
“It’s been insanely frustrating,” she said.
“The public waiting system – it’s kind of put me on the backburner, and it’s like as if they’ve just forgotten about me.
“I’ve been in quite extreme, chronic pain to the point where I have had to take days off work, I’ve ended up in hospital twice because of it, sometimes the pain makes me throw up.”
As people such as Linsey struggle to access care, some specialists say demand for their services has never been greater.
Western Sydney paediatrician and former state Labor MP Dr Andrew McDonald said he had been forced to close his books to new patients because he simply could not see all the children who needed help.
“In the 33 years I’ve worked in Campbelltown, it’s never been as hard for a parent whose child needs to see a paediatrician,” he said.
“Thirty years ago, these children were seen. You cannot now find a paediatrician to see your child for love nor money.”
He said the children he was turning away were left with little other treatment options.
“They either don’t get care, they wait on waiting lists forever, or they fall through the cracks,” Dr McDonald said.
“And if nothing happens, the cracks will continue to widen.”
Need to reimagine healthcare
Dr Jacqueline Small, from the Royal Australasian College of Physicians (RACP), said demand for specialists was being driven by an ageing population and the increasing prevalence of chronic illnesses, meaning more people needed specialists than ever.
But training places for the next generation of doctors are limited, tied to funding and teaching capacity.
“There’s been a range of issues that have emerged, particularly through COVID, but it’s really been the tipping point for the health system with increasing demand, and difficulties in meeting the demands of people with complex health problems,” she said.
“The models of care aren’t set up to deal with these types of complexities. We need to reimagine the health system and create new models of care that are better connected.”
Dr Small also called for nationally consistent information about specialist wait times, to better understand the problem.
“One of the big concerns we have is there actually isn’t good, widely accessible data about waitlists for public outpatient clinics across Australia, but also data on what’s happening in the private health system,” Dr Small said.
“Quite a lot of healthcare in Australia is provided in the private health system and we really don’t have any grasp on what’s happening there.”
Fixing the system ‘not rocket science’
Prof. Stewart, describing the solution to specialist waiting times as “straightforward”, called on the federal government to urgently boost funding to public hospitals, so they can better resource outpatient specialist clinics, and increase training positions.
“We cannot keep calling Medicare a safety net with these big holes in it. These are huge rips in the basic fabric of Medicare, and the time has now come to fix it,” he said.
In a statement, federal health minister Mark Butler conceded long wait times were a “serious detriment” to people’s health, arguing the federal government was focused on boosting the health workforce, and was reviewing the five-year agreement on public hospital funding between the Commonwealth and states and territories.
The ABC also approached the states that publish data for comment.
They argued they were working to improve waiting lists and specialist shortages, with some pointing to significant improvements in outpatient waiting times.
In the lead-up to the 2019 election, federal Labor promised it would set up a permanent policy-making body called the Australian Health Reform Commission, flagging improved access to public specialists as an early priority.
It ultimately abandoned the policy ahead of the 2022 election, but Prof. Stewart said the body was urgently needed.
He said if nothing changed, more people would fall through the cracks.
“It will progressively get worse,” he said.
“But it’s bad enough as it is. It doesn’t have to get worse for people to take notice that we have to act now.”
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Is the problem an overall lack of Specialists, or is that it’s a lack of Specialists in the Public Arena. If so, is it because they do not get adequately recompensed for their work (IE not paid enough [just like GP’s]), or what is the Real Problem.
This is one of the reasons that I am maintaining my Private Health Insurance, so ig I need a Specialist I can get an appointment within a reasonable time, depending on the severity of my problem.
My hubby received a reply to the referral from our GP to the Orthopedic surgery clinic at Austin Health, a couple of weeks ago, 12-18 month wait for an appointment. He may not even be able to walk properly at all by then.
MMMM!Western Australia must be ON TIME THEN???
These figures are a good reason to keep paying our PRIVATE HEALTH cover!BUPA(Was going to stop to save money in this financial climate)but looks like we`ll have to save in other areas (If we can!)
I live on NSW/QLD border and when the border was closed due to COVID, even though my surgery was rated as urgent, QLD delayed it with no date given as my NSW status basically excluded me. I had Private Insurance and the Private Hospital system in QLD was happy enough to take the dollars and urgent surgery wait from start to finish was 2 weeks. My only alternative in the public health system was to travel hundreds of kms to Newcastle for urgent major surgery. So thankful I had private cover. As it turned out, what was presumed to possibly be a malignant growth was benign. I was very lucky. No matter the cost I will keep the Private cover.