And a veterans'psychiatry expert,Dr Andrew Khoo,said the imbalance was acting as a disincentive for specialists to treat veterans with battlefield issues such as post-traumatic stress disorder (PTSD).
There is a concern that veterans are not getting the medical support they need under the current DVA arrangement.Glenn Campbell
The issue has been highlighted ahead of Remembrance Day on Wednesday by a former Australian Army captain Sarah Watson who returned from a tour of Iraq in 2007 with PTSD.
During the time in the army,Watson says she came under Iraqi fire,experienced harassment by members of her own battalion and was subjected to the attentions of a stalker and abuse from a female colleague. She has now left the force.
In the budget last month,the federal government announced $94.3 million for a ‘‘one-off fee increase’’ for psychiatrists,allied mental health professionals,social workers and community nurses and 10 specialised psychiatric training positions a year.
Ms Watson says some of these funds should be used to address the specialists'remuneration imbalance.
Sarah Watson wants to raise awareness about the prevalence of mental illness in veterans.Alex Ellinghausen
"A lot of psychiatrists and medical professionals want to take veterans but they are not getting the same amount they could for treating a private client,''Ms Watson said.
"That's completely criminal as far as I am concerned. We should be paying the market rate."
Her concerns are supported by Dr Khoo who is the chair of the Military,Veterans’ and Emergency Services Personnel Mental Health Network at the Royal Australian and New Zealand College of Psychiatrists.
A consultant psychiatrist and director at Toowong Private Hospital in Brisbane,he has been been treating veterans for 20 years. He said there has been a long-time discrepancy between what a psychiatrist or psychologist can claim from the DVA versus what they can charge a civilian. Dr Khoo said specialists were reluctant to charge veterans the gap.
"Per half hour a psychiatrist would make $290 paid partly by Medicare and out of the patient's pocket,"he said."But from seeing a veteran they will make $188 paid by the DVA.
"Most of these patients can't work. There is a fairly significant disincentive for psychiatrists as well as other specialists to see veterans. All psychiatrists I know in Queensland and other surgeons,they are all busy. If you look at your waiting list and you have got a gap and you have got a veteran there and a non-veteran there and you have got bills to pay,there is a disincentive for many specialists to see veterans.
"Many specialists across all fields of medicine decide that they are not even going to see veterans,so they don't even have to make that choice.
"For me,my frustration is not that I don't get paid as much,because if I was worried about that I wouldn't have been seeing veterans for the last 20 years. My issue is that it is very hard to get veterans into other psychiatrists.
"We have the DVA saying[to the veteran] you have got this gold card,you can go and see the doctor of your choice. That's really not realistic,that's not what is happening. The DVA will say this is the rate we pay and we won't pay you any more and that has been the case for many,many years.''
Dr Khoo said he had been lobbying the government for change for many years.
"They[veterans] need better access to appropriately experienced and trained psychiatrists as what happens is that the only psychiatrists that have space and are able to see patients sooner may be more junior psychiatrists who are building a practice,''he said.''They will take veterans on but they don't necessarily have the training in the management of post-trauma syndrome.
"The only way they will address this is to pay market rate for the services that veterans are trying to access. This whole access to treatment issue is a chronic problem and something we need to address."
A DVA spokesperson said the mental health and wellbeing of veterans and their families was its top priority and that it had listened to the sector's concerns about the DVA’s provider fees when it allocated $94 million in the budget last month.
Fee items for all health providers,including mental health providers,will also continue to be indexed annually,the spokesperson said.
''Healthcare providers in private practice are free to choose how to run their business,including whether or not to provide treatment under DVA arrangements. DVA continues to monitor trends in access to services,''the spokesperson said.
DVA records show the number of psychiatrists treating DVA clients has increased between 2012–13 and 2019-2020,from 1111 to 1495 providers.