Bariatric surgery - widely recognised as the most effective, long-term, and safe treatment for severe obesity - is under threat in Australia, as skyrocketing indemnity insurance premiums and growing malpractice claims drive surgeons out of the field.
A new study by Flinders University, the University of Notre Dame Australia and the Australian and New Zealand Metabolic and Obesity Surgical Society (ANZMOSS) warns that bariatric surgery, a critical tool in combating the country's obesity crisis, could soon become unsustainable to provide.
Professor Lilian Kow, a leading general surgeon and recipient of the Medal of the Order of Australia (OAM) for her service to bariatric and obesity medicine, says the situation is dire.
"Obesity is one of the most urgent global health challenges of the 21st century," say Professor Kow from the College of Medicine and Public Health.
"A third of Australian adults - more than 6 million people - live with obesity, yet it's still underdiagnosed, undertreated, and too often misunderstood as a lifestyle issue rather than a complex disease."
Despite its proven cost-effectiveness and role in preventing obesity-related conditions like type 2 diabetes and heart disease, bariatric surgery in Australia is almost entirely delivered through the private sector - and that's where the crisis lies.
"Surgeons must carry professional indemnity insurance (PII) to practice, but recent years have seen insurance costs spiral out of control.
"According to our survey of 115 surgeons, PII premiums rose by 35 per cent in the past year alone, with average costs nearing $70,000 annually. Some surgeons reported premiums as high as $500,000.
"The financial burden is forcing many to reconsider their future in bariatric surgery," says Professor Kow.
"And rural surgeons are hit even harder - facing steeper increases despite operating in regions where need is greatest."
More than 40% of surveyed surgeons have faced at least one malpractice claim during their careers, but just 2% of those claims proceeded to trial - fuelling concerns that Australia's 'no win, no fee' legal framework may be encouraging excessive or opportunistic litigation.
"Surgeons are being penalised by rising premiums often driven by broader trends, not their own clinical records," says Professor Kow.
"We risk losing highly skilled professionals, particularly in rural areas, where obesity is more prevalent, and specialist care is already scarce."
Co-author, Notre Dame researcher and bariatric surgeon Associate Professor Nick Williams says, "Obesity disproportionately affects lower socio-economic groups, regional and remote communities and Indigenous populations.
"These are the patients with the greatest need for access to obesity care, and if surgeries are not available publicly then we at least need them to be available as cost effectively and as widely as possible in the private sector," says Associate Professor Williams.
Experts and advocates are calling for urgent reform to stabilise insurance costs and protect patient access to these vital procedures.
Without intervention, they warn, clinic closures and workforce shortages could leave thousands without life-changing - and life-saving - care.
"As things stand, we're watching a vital healthcare service unravel," Professor Kow concludes.
"If we don't act, patients with severe obesity will be the ones who pay the price."
The article, 'Professional indemnity insurance rates for metabolic bariatric surgeons in Australia: survey results' by Jacob Chisholm, Lilian Kow, Adam Skidmore and Nicholas Williams was published in ANZ Journal of Surgery. DOI: 10.1111/ans.70087
