No More. It Ends Here.
- Medical Insurance to be made more retirement friendly and part-time work friendly, with fee structures more open and publicised. . GUVNOT.COM/1/4
There are only a couple of medical defence (indemnity) organisations in Australia. I don’t want to complain about any specific organisation because they may not be any worse than their competitors. However, there are a few basic equity issues that are essential for medical practice.
Fees for each profession and each level of earnings need to be publicised annually.
IN FULL.
For example, in general practice we should be able to see a list of fees charged by indemnity providers for doctors earning: less than $50,000 PA, $50,000- $100,000 PA, $100,000-$200,000 PA, $200,000 to $350,000 PA, $350,000-$500,000 PA, and greater than $5000 PA.
If this does not happen, weird things begin to happen away from the light of day.
We should be able to see a list of modifiers that increase the cost of insurance.
Modifiers should not have more than an extra $10,000 fee upfront per claim for at-risk practitioners, more than double the annual premium for at-risk practitioners.
Premiums charged by medical indemnity organisations should be limited to 3% of gross earnings. The government can pay for the rest since they caused this mess.
Errors in billing by medical indemnity organisations should be punished. (For
example, billing annual premiums as well as monthly premiums, as well as refusing to supply the indemnity subsidy).
In general, most doctors would expect the doctor earning less than $50,000 per annum would have a premium which is 1/10 that of a doctor earning more than $500,000 per annum. This is not the case, and will be something you experience if you ever reduce your work hours- for any reason.
The method of application of medical indemnity subsidies needs to be simplified.
Methods of payment of medical indemnity must follow the rule of law. It is not an automatic right for a medical indemnity organisation to withdraw however much it wants, whenever it wants, without warning or notifying the practitioner. An invoice needs to be sent in advance to every practitioner, giving details as to amount of payment, periodicity of payment and modifiers of payment.(including the time frame for which such modifiers will be valid).
This should allow part-time doctors and retiree doctors to be enabled to keep on working without excess financial indemnity levy stress.. Current problems emerge in that doctors who are earning less than $50,000 per annum have been charged indemnity fees varying between $6000 and $15,000- though eventually it is often possible for these practitioners to obtain a part refund with continued complaint to the organisations involved , over a year or so.
Reducing working hours by definition means reduced income. It is unreasonable to expect these doctors to pay indemnity fees approaching 1/3 of their income – even if it is to be repaid eventually in a year or so if they complain loud enough.(and probably not if they don’t complain persistently and unendingly).
Rights
THE AHPRA POINT OF VIEW: on this issue
The assertion that medical indemnity insurance should be made “retirement friendly” or “part-time friendly” reflects a misunderstanding of how professional risk operates in contemporary healthcare. Risk is not linearly proportional to hours worked or income earned. A single adverse event arising from limited clinical exposure can generate harm equivalent to that arising from full-time practice. Accordingly, insurers price risk based on exposure categories, specialty profiles, and historical claims data — not on sentiment or lifestyle preferences. The regulator’s concern is not the affordability of premiums but the adequacy of protection for patients harmed by clinical error.
Calls for rigid caps on premiums, simplified subsidy mechanisms, or mandated price transparency risk distorting the indemnity market and undermining insurer viability. If indemnity providers are constrained by politically popular limits, they will either exit high-risk fields or withdraw from the market altogether. The community is ill-served by symbolic affordability reforms that reduce insurer capacity to pay claims when harm occurs. It is therefore neither appropriate nor responsible for AHPRA to intervene in pricing structures determined by actuarial assessment of professional risk.
The demand for uniform publication of fee bands by income bracket conflates income with risk. Two doctors with identical earnings can carry markedly different risk profiles depending on patient mix, scope of practice, prescribing behaviours, and complaint history. Transparency framed around income alone misleads practitioners into believing premiums are arbitrary when, in fact, they reflect risk signals derived from regulatory data. Where billing disputes arise, practitioners retain contractual remedies with insurers. This is a private commercial matter and not within the regulator’s remit.
Suggestions that the government or regulator should absorb indemnity costs misapprehend the boundary between professional accountability and public subsidy. The privilege of registration carries an obligation to bear the costs of practising in a risk-exposed environment. If certain cohorts find this economically burdensome, that may indicate a misalignment between their desired mode of practice and the risk tolerance of modern healthcare systems. Regulation cannot be softened to accommodate individual financial preferences without diluting the protections owed to patients.
Ultimately, indemnity pricing is a market signal of risk. Attempts to blunt that signal for reasons of comfort, retirement planning, or workforce convenience may provide short-term relief to practitioners, but they do so at the expense of long-term accountability. AHPRA’s role is to ensure that practitioners who remain registered are fully insured for the risks they present to the public, not to engineer affordability outcomes.
Erasmus (the old dog): Call It As I See It
Legalistic view:
Where essential professional services become functionally inaccessible due to opaque pricing practices,
serious questions arise about whether those charging structures remain consistent with fairness principles,
transparent dealing, and the policy intent of sustaining a viable workforce. A system can be “lawful” yet still
be structurally unreasonable if it predictably blocks competent practitioners from continuing at - risk work.
Human interest view:
The quiet cruelty here is that many doctors who could keep working safely — limited hours, familiar patients,
low-risk scope — stop not because they are unsafe, but because the fee shock becomes impossible to justify.
Losing an experienced clinician this way is not an abstract “market correction”; it is a human decision made at
a kitchen table, with family finances on one side and professional identity on the other.
Patient view:
Patients don’t experience “indemnity settings” as policy. They experience the abrupt loss of a doctor they trust,
longer waits, and a forced restart of care with someone new. When pricing structures push doctors out of
continuity roles, the system quietly trades relationship-based care for churn.
Legal fairness view:
When billing systems permit unilateral withdrawals, opaque recalculations, and protracted disputes over alleged
“incorrect” charges, practitioners can be effectively denied procedural fairness in a unequal financial relationship
that is essential to their ability to practise at all.
Competition policy view:
A market with only a small number of indemnity providers invites inertia and opacity. Without structural
transparency, price discovery is impossible, switching is difficult, and meaningful consumer choice becomes
largely theoretical.
Workforce sustainability view:
Disproportionate indemnity burdens on part-time and semi-retired doctors accelerate attrition at precisely the
point where mentorship, stability, and clinical judgement are most valuable. The system then pays twice:
first through loss of experience, and again through reduced access for patients.
