Seeing a specialist

Medical specialists are doctors who have completed advanced education and training in a specific area of medicine. You usually need a letter of referral from your general practitioner (GP) to make an appointment to see a specialist.

In Australia, general practice is considered an area of medical specialty. This article focuses on other types of medical specialists, besides GPs.

Referrals for a specialist

Your GP may send you to see a specialist if they think specific expertise is necessary to diagnose or treat you. Your doctor can help you find a specialist.

Specialists will report back to your GP, who may stay as your main contact and who coordinates your healthcare with input from specialists and other healthcare professionals as needed.

Once your doctor has given you a letter of referral, you can make an appointment to see a specialist at a specialist clinic within a public hospital or at a private clinic or hospital.

Fees vary and depend on whether the specialist:

• works within the public or private healthcare system
• bulk-bills under the Commonwealth Government’s Medical Benefits Scheme (MBS)
• requires a gap payment
• requires full payment with or without reimbursement via private health cover.

You will need a referral letter from your GP to be eligible for Medicare rebates.

Some specialists offer a payment plan.

To get the most out of your visit, be honest and open with your specialist. Ask questions about your diagnosis, treatment and medication. If you do not understand something, ask the specialist to explain it further.

Types of specialists

Specialists are found in all fields of medicine. The most common specialist roles include:

• anaesthetist – administers anaesthesia and monitors patients during surgery, and treats chronic pain syndromes
• cardiologist – treats heart conditions
• dermatologist – treats skin conditions, including some skin cancers
• endocrinologist – treats conditions of the endocrine system, which is a group of organs in the body that make hormones
• gastroenterologist – treats digestive disorders
• gynaecologist – treats conditions of the female reproductive system and genital tract
• haematologist – treats conditions of the blood and blood-forming tissues
• neurologist – treats conditions of the nervous system
• neurosurgeon – performs surgery on the brain and nervous system
• obstetrician – treats women during pregnancy and childbirth
• oncologist – treats cancer and other tumours
• ophthalmologist – treats eye injuries and conditions
• orthopaedic surgeon – treats injuries and conditions of the musculoskeletal system
• otolaryngologist – treats conditions of the ear, nose, throat and neck
• paediatrician – treats infants, toddlers, children and teenagers
• plastic surgeon – restores, reconstructs, corrects or changes the shape and appearance of facial and body features
• psychiatrist – treats people with mental and emotional health issues
• radiologist - uses medical imaging technologies to diagnose and treat injury and disease
• respiratory physician – treats conditions and diseases of the lungs
• rheumatologist – treats rheumatic conditions characterised by inflammation, muscles soreness or joint pain
• urologist – diagnoses and treats the urinary tract and the male reproductive system.

Accessing a specialist

If your doctor thinks you should see a specialist, they will write you a referral letter, which needs to be presented to the specialist either before or at your first appointment.

Specialists are usually based at hospitals or private clinics. Each hospital or specialist clinic has its own process for assessing urgency, accepting referral letters and making appointments. Ask your clinic for more information on how your referral will be handled.

Finding and choosing the right specialist

Your doctor will be able to help you find a specialist to address your health issue. You may be offered a choice of several specialists you could see. You could also ask for a recommendation from trusted sources such as friends and family.

To decide who to choose, consider the specialist’s:

• qualifications and experience
• location
• availability
• cost.

If you choose to see a specialist as a private patient, you may need to pay the specialist’s fees and you will not always be able to claim reimbursement from Medicare. If you have private health cover, it may reimburse you for some or all of the fees.

Specialist fees

Fees can vary and depend on whether you access a specialist in a bulk-billing public hospital or at a private clinic or hospital.

The fee structure of individual specialists may also impact on the cost, as does your eligibility for reimbursement or bulk-billing, or access to private health cover. Ask your doctor and specialist how much it will cost upfront and if there are likely to be any further costs.

When considering costs, you may want to ask if the specialist:

• works within the public or private healthcare system
• bulk-bills via the Medical Benefits Scheme (MBS)
• requires gap payments
• has a payment plan
• accepts your private health cover.

Medical Benefits Scheme (MBS)

The MBS allows specialists to provide services within public hospitals to both public and private patients. If you access a specialist as a public patient, the hospital may bulk-bill the specialist’s services through Medicare, which makes them free to public patients.

Private health cover

If you have private health cover, you can choose to be treated as a public or private patient. Once you decide, however, you cannot swap. Private patients can choose their own specialist and can also decide whether to attend a public or a private hospital or clinic to visit their specialist.

Private patients are not usually subject to long waiting lists and can choose the time that best suits them for their appointment or procedure.

Gap payments

Some specialists require a gap payment (or co-payment). Sometimes, you will have to pay part of a specialist’s fee direct to the specialist, while the remainder is bulk-billed via the MBS. This is common if you visit the specialist at their private clinic within a public hospital.

Payment plans

Some specialists operate payment plans where the full fee can be paid off over a long period, with smaller part payments billed at regular intervals.

Patient travel and accommodation assistance schemes

The Victorian Patient Transport Assistance Scheme (VPTAS) may provide financial help if you are living in rural and regional Victoria and need to travel long distances to access specialist services.

Please refer to the VPTAS website to check your eligibility and apply for assistance.

Preparing for your specialist visit

To prepare for a visit to see a specialist, think about:

• collecting your health history, including any relevant test results
• writing down a list of your symptoms, if you have any
• noting any relevant lifestyle activities your specialist should know about
• writing down any other treatments you are receiving, including medication
• having your referral letter, any test results, Medicare or other benefits cards and health insurance details ready.

If you require an interpreter or have other special needs, such as wheelchair access, a specialist of the same gender, or having experience with special needs patients, let their office staff know when you book your appointment.

During the specialist visit

Once you are with your specialist, be honest and try to have an open discussion. The information you give about yourself, your concerns and your situation is important. Your specialist is trained to listen.

Discuss your health with your specialist

Things that you should mention to your specialist include:

• symptoms – what they are and how long you’ve been having them, concerns or things that you think are unusual about your health
• any recent medical appointments or other treatments
• all the medication you have recently taken or are currently taking – this includes over-the-counter medication, vitamins, medicinal herbs and other nutritional
• supplements
• your treatment preferences.

Your specialist can explain:

• your diagnosis
• your test results
• any treatments or procedures they suggest
• options that are available to you, such as treatments other than surgery
• how each treatment will help you
• the risks or side effects of each treatment
• how much time you have before you have to make a decision.

You might find it helpful to take notes during your visit so you can review them later.

If you believe the advice or suggested treatment is not right for you and your situation, you should tell your specialist your reasons

Ask your specialist questions

Make a list of any questions you may have and put the most important ones at the top. A list will help you remember the questions you want to ask, particularly if you are feeling stressed about your diagnosis.

Examples of questions you may want to ask your specialist:

• What is my diagnosis?
• What treatment do you recommend for me and why?
• What experience have you had with this treatment or procedure?
• How effective is this treatment?
• Are there any side effects or risks for the treatment? If so, what are they?
• How soon can I have this treatment and will your office contact me if another patient cancels?
• What are the risks of not having the treatment and what other treatment options do I have?
• What should I do if I need to delay or cancel the treatment?
• How long am I likely to be in hospital and how long should it take me to recover?
• What sort of care will I need at home after the surgery?
• Is there anything I should stop or avoid doing?
• Is there anything I can do to help myself?

After your specialist visit

After your appointment with your specialist:

• follow up on test results – find out who you need to phone and when your results will be ready
• make any other appointments you have been told you need
• make sure you know how to take your medication or treatment – if you cannot remember, ask your pharmacist (they may ring your doctor to check)
• call your specialist’s office, clinic or hospital if you have more questions about your situation or the medication you have to take.

Remember to speak with your referring doctor about the specialist visit. Your specialist should have reported back to your doctor about your results, diagnosis or treatment. Your referring doctor may have further information for you and, if necessary, be able to help you with the next step of your treatment.

Getting a second opinion

It is fine to see another specialist to get a second opinion if you are not sure about a diagnosis or a treatment your specialist suggests. This may involve getting another referral to a different specialist from your doctor.

If you decide to seek a second opinion, it is important that you do it as soon as possible. If you delay getting this second opinion and your condition changes, you may receive conflicting advice.

Where to get help

• Your GP (doctor)
• Medicare, Services Australia