The sum did not cover the assistant surgeon fees, the anaesthetist, the operating theatre, hospital stay or pathology tests. The total out-of-pocket cost to the patient would have been at least $22,000. A redacted copy of a surgical fee quote for a robotic radical prostatectomy. Leading doctors groups including the AMA have denounced doctors who charge patients egregious out-of-pocket fees. The Urological Society Australia and New Zealand has also condemned specialist "price gouging". But the $18,000 quote invokes the AMA and the representative body for urological surgeons to justify the eye-watering price. “This fee is derived from the Australian and New Zealand Association of Urological Surgeons and the AMA and the particular difficulty or expertise required for the operation,” the document reads.

USANZ president Adjunct Professor Peter Heathcote was “not happy” to see the ANZAUS appear on the “excessive” bill. “Let me make it very, very clear: the ANZAUS and USANZ have no role whatsoever in setting fees,” Dr Heathcote said. “This is entirely unsatisfactory." Adjunct Professor Peter Heathcote, president of the Urological Society of Australia and New Zealand He said the USANZ board was investigating the matter and would discuss what action to take.

The USANZ can cancel a specialist's membership if they have brought the organisation into disrepute, Dr Heathcote said. Exorbitant specialist fees have come under immense scrutiny in recent days. ABC Four Corners exposed the extent of the practices and galvanised unanimous condemnation from other peak specialist groups. Loading “This is causing us enormous reputational damage," Dr Heathcote said adding 95 per cent of members charge no-gap or known gap fees. “There is absolutely no evidence that paying higher fees will get you better outcomes."

President of the AMA Dr Tony Bartone said $18,000 was “several orders of magnitude about what we recommend for that procedure”. “We would label this as egregious and we would not be pleased to see this level of misrepresentation [or] the suggestion that the fee is in line with the AMA,” Dr Bartone said. The AMA were investigating the matter but Dr Bartone drew the line at naming and shaming specialists who charged egregiously. “More importantly, there needs to be much better literacy and understanding among patients ... to be able to have informed financial consent,” he said. President of the AMA, Dr Tony Bartone. Credit:Darrian Traynor

Urological Surgeon in Sydney Dr Henry Woo said the public outrage was an indictment on the entire medical profession. “We brought this on ourselves,” Dr Woo said. “It may only be a minority of doctors engaging in these toxic billing practices, but our inaction makes us complicit to toxic billing." A federal government ministerial sub-committee chair by Chief Medical Officer Dr Brendan Murphy is investigating on out of pocket medical costs. Public hospital alternative

The prostate cancer patient agreed to speak to Fairfax Media on the condition that he and the surgeon not be identified. The 64-year-old did not accept the $18,000 quote. He opted to undergo a robotic prostatectomy at a public hospital at no charge. Loading “I went from being out of pocket something like $25,000 to paying next to nothing,” he said. His biggest fear using the public system was that he would be shunted to the back of a long wait list.

But within five weeks of his initial consultation he underwent the surgery at the Peter MacCallum Centre, Melbourne. “I would have paid the price premium … it’s my life we’re talking about,” he said. “But after meeting with [the treating team], I was confident in their skills and capabilities, and comfortable to go down that pathway." “My message to others is reach out to the public system, because it can look after you and do a very good job at little cost with little wait time.”

The patient's surgeon Dr Declan Murphy tweeted a redacted image of the $18,000 bill, writing "I see lots of 'economic migrants' fleeing to Victoria to avoid extortionate fees elsewhere". "[T]empted to reveal surgeon," he tweeted. Several Sydney public hospitals (RPA, Nepean and Liverpool) also have robotic surgery programs. Cancer Council CEO Professor Sanchia Aranda said there was a tendency among some surgeons to suggest that private patients would be treated faster, Professor Aranda said. Chief executive of Cancer Council Australia Professor Sanchia Aranda said it was a myth cancer patients received better care in the private system.

“A sense of urgency is created and patients get seduced into that system and told that public hospital treatment isn’t available in a timely way.” But was a myth that cancer care is better in private hospital, or that the public system had lengthy wait times once a patient was diagnosed. “Once you have a cancer diagnosis, you would be the urgent category in almost all instances, which would take you to the front of the queue [of the public wait lists]. Loading “In most cases you wouldn’t wait longer than a couple of weeks, which won’t make a difference to your outcome.”