A common question that gets asked at my practice is “Do I need a referral to see an Orthopaedic Surgeon?”  (or other specialist).

I will provide an answer and explanation below:

The answer is “Strictly speaking NO, but it is strongly advised”.  Let me explain:

Whereas anyone legally can chose to see a specialist WITHOUT a referral, the Australian healthcare system is based on a model of primary care by a patient’s own doctor (i.e GP) and referral to a specialist when indicated. By design, government contribution to the cost of the specialist’s care (i.e via a medicare rebate) is therefore deliberately restricted to situations where the patient does have a medical referral to the specialist.  This is to ensure that resources are utilised appropriately.

Take the example of a patient who may have “pink eye” or other common minor eye irritation. A patient could, theoretically go straight to see an Ophthalmologist (eye specialist) but common eye conditions can be very well managed by a general practitioner.  The GP will have a long term relationship with the patient, understand their wholistic medical history, know their medications and allergies and be able to prescribe the most appropriate eye care for that patient.

Therefore the government understandably discourages unnecessary review of common conditions by an eye specialist and restricts government funding to situations where the GP actively requests specialist input.

The situation is slightly more complicated in Orthopaedics where primary care of musculoskeletal conditions is often administered by allied health practitioners – such as physiotherapists, osteopaths and chiropractors and exercise physiologists.

These allied health practitioners can often make enormous impact on symptoms of arthritis through conservative treatment such as exercise, activity modification and weight loss but periodically will identify patients who have plateaued with conservative treatment and then my suggest that the patient see an Orthopaedic Surgeon.

While allied health practitioners can advise that the patient see a surgeon and recommend a particular surgeon, allied health practitioners currently unfortunately cannot write a “medical referral”  The patient therefore does need to go back to their GP for a medicare referral to allow them to access a medicare rebate for the surgeon’s consultation and subsequent care (eg surgery).

In my experience, most GPs are more than happy to accept allied health recommendations to refer the patient to a specific surgeon and/or provide a patient with a referral to a specific surgeon if a patient requests (e.g the patient may have a preference due to knowing of a friend or family member who underwent a similar procedure with good result).

However, in some situations the GP may exercise their experience and suggest that the patient be referred elsewhere. While the GP often will know best, and the patient should generally heed their GP’s advice, many patients and allied health practitioners do not realise that a specialist referral is NOT limited to the specialist named on the referral.

For example, if the patient received a GP referral to Dr X but wanted to see Dr Y for a second opinion or wished only to see Dr Y, the GP referral addressed to Dr X is perfectly valid if presented to Dr Y instead and the patient will receive full medicare benefits if they redirected their care to Dr Y.

So therefore in a nutshell:

• Overseas patients do NOT “need” a referral (they can’t get a medicare rebate) but a referral letter that outlines their complaint and medical history is still very useful.
• Local patients strictly speaking do not absolutely “need” a referral if wanting to see a specialist “privately” (no medicare rebate) but my rooms will strongly encourage the patient to obtain a referral. While the medicare rebate on a consultation is not large, the medicare rebate on surgery can be a significant amount of money and so patient are strongly encouraged to have a valid referral.
• Physiotherapists, Osteopaths, Chiropractors and other allied health can recommend to a patient that they see me a surgeon but such recommendations do not constitute a “referral” for medicare rebate purposes and a medical (doctor) referral is still required.