Starting a private anaesthetic practice —
the setup sequence, from a FANZCA who's done it.
Provider numbers, indemnity, hospital credentialing, billing software, health-fund agreements, business structure. The order matters. The administrative side is where new specialists either build a smooth-running practice or spend the first two years cleaning up avoidable problems.
The clinical side is the easy part. This guide handles the rest.
Three pathways into private practice.
Going private isn't a single decision — it's a sequence of smaller ones. Most FANZCAs ease in through one of three pathways. Mixed practice is the most common starting point. Don't underestimate the ramp — building a steady private list typically takes one to two years.
Pure private
Rights of practice at one or more private hospitals, with no public commitment. Higher earning ceiling, no fallback income while you build referrals.
Mixed practice
A part-time public appointment (often VMO or staff specialist) alongside private sessions. Stable income while you build a private list and surgeon relationships.
Locum-to-private
Building referrals through locum work before committing to fixed sessional rights. Maximum flexibility, slower establishment.
Twelve steps from fellowship to your first private list.
Several of these run in parallel, but the dependencies matter — provider numbers gate billing, indemnity gates credentialing, and credentialing gates your first list. A realistic timeline from "decided to go private" to "billing your first list cleanly" is three to four months if everything runs on time. Six months is more typical.
- 01
AHPRA specialist registration
You should already have this on FANZCA completion. Confirm it's current and the specialty endorsement is correct.
- 02
ANZCA CPD enrolment
You need to be enrolled in an accredited CPD home and meeting annual requirements from your first year of practice.
- 03
Medical indemnity tailored to private work
Public-only cover is not enough. Get quotes from Avant, MIPS and MIGA based on your expected case mix and hours. All three offer reduced first-year premiums for new specialists.
- 04
Provider numbers
Apply via Services Australia's HPOS portal. A separate provider number is needed for each location you bill from. For straightforward fellowship-holders the online process is often very quick — sometimes issued within the same session. Paper applications take up to 28 days, longer during the December–April peak.
- 05
Business structure decision
Sole trader, service trust, or company. Talk to a healthcare-specialist accountant before you bill a single case — restructuring later is messy and triggers avoidable tax events.
- 06
Hospital credentialing
Apply at each private hospital where you intend to work. Allow several weeks to a few months per hospital — each has its own forms, references, and committee schedule, and timeframes vary widely. This is usually the slowest single step in the sequence.
- 07
Practice management software
The two anaesthetic-specific platforms used by most Australian anaesthetists are Anaesthetic Private Practice (APP) and MediTrust. Both are purpose-built for anaesthesia billing — units, time, modifiers, IFC — and integrate with Eclipse for online claiming.
- 08
Health fund agreements
Register with Medibank, BUPA, HCF, NIB and HBF, plus the AHSA Access Gap Cover (AGC) scheme which covers 20+ smaller and member-owned funds (Australian Unity, GMHBA, Defence Health, Police Health, Teachers Health and others). Each has its own gap arrangements.
- 09
Billing model decisions
Decide your default approach — no-gap, known-gap, or AMA fees — and how you'll handle WorkCover, TAC, DVA and ADF cases. (Detail below.)
- 10
Patient payment infrastructure
BPAY, credit card processing, and on-the-spot claiming where relevant. Your practice management software handles most of this once configured.
- 11
Billing process — in-house or outsourced
Decide before your first list. Switching after six months of accumulated unpaid invoices is painful. Most established anaesthetists outsource for the same reasons most surgeons do.
- 12
Insurance beyond indemnity
Income protection, life, TPD. As a private specialist your income protection is critical, and underwriting is easier and cheaper while you're younger and healthier.
anaesthetic invoices billed for Australian anaesthetists — and counting.
Fast Tracking has been doing this since 2018. Whatever stage you're at, the path is well-trodden.
The four decisions that shape the next decade.
Some of the twelve steps above are paperwork. These four are not. Get them right and the rest follows easily; get them wrong and you'll be unwinding the consequences for years.
Business Structure
Most private anaesthetists operate through a service trust or service company arrangement rather than as a sole trader, primarily for asset protection and income flexibility. The right structure depends on your existing assets, family situation, expected income, and whether you intend to bring on associates.
Use a healthcare-specialist accountant — generalist accountants miss medicine-specific issues like the personal services income (PSI) rules, service trust arrangements, and the GST treatment of medical income.
GST and Tax
Most clinical anaesthetic services are GST-free under the medical services provisions of the GST Act, which means you generally don't register for GST on clinical income. Non-clinical income — medico-legal reports, expert witness work, teaching honoraria — may be treated differently.
Set up a separate business bank account from day one. Never run personal expenses through it.
Medical Indemnity
The three major Australian providers — Avant, MIPS and MIGA — all cover anaesthetists. Premiums vary based on hours, case mix (obstetrics and paediatrics push premiums up), claims history, and location. Get quotes from all three before you commit.
Most offer trainee-to-specialist transition packages with reduced first-year premiums. Underinsuring on hours or case mix to save premium is a false economy.
Practice Management Software
Unlike most medical specialties, anaesthetists have two purpose-built platforms designed specifically for the way anaesthesia bills — units, time, modifiers, IFC, the lot. The two market leaders are Anaesthetic Private Practice (APP), developed in Brisbane in 2010 and now part of Magentus, and MediTrust, an Australian-owned Melbourne company in operation since 2005. Both are cloud-based and accessible from any device.
Generalist specialist tools like Genie/Gentu and Clinic to Cloud can be configured for anaesthetic billing, but the two platforms above are the standard because they were designed for the workflow from day one. Talk to colleagues at the hospitals you're credentialing with — most will be using one of the two, and continuity within a group is worth a lot.
Billing models — where new specialists lose the most money.
Anaesthetists almost universally use the ASA Relative Value Guide (RVG) as the structural basis for billing — it converts each procedure into units that combine with time and modifiers to produce a fee. The RVG is not itself a fee schedule; it is applied against one of four models below.
| Model | What it means | Anaesthetist fee | Patient out-of-pocket |
|---|---|---|---|
| Bulk bill | Bill Medicare schedule fee only, accept as full payment | Lowest | None |
| No-gap | Bill within the health fund's no-gap schedule | Funded fee paid in full by Medicare + fund | None |
| Known-gap | Bill above no-gap, within fund's known-gap cap | Funded portion + capped patient gap | Capped (varies by fund) |
| AMA fees | Bill the AMA list of fees in full | Highest | Largest |
A few practical notes
- No-gap is the path of least resistance with patients but pays the least. Most anaesthetists running a mixed-fund practice use no-gap as their default and known-gap or AMA fees selectively.
- Informed financial consent is mandatory. Patients must know in advance if they'll have an out-of-pocket cost. Late or vague quotes are the single biggest cause of complaints.
- WorkCover, TAC, DVA and ADF each have their own schedules and pre-approval processes. Don't assume they pay AMA fees — most don't.
- First-pass acceptance rate is the metric that matters most. Every rejected invoice costs weeks of cash flow and admin time. Our service runs at 99% first-pass acceptance because we know each fund's quirks. If you're billing in-house, build in time to learn them.
Your referral source is the surgeon.
Anaesthetists don't get referrals from GPs the way procedural specialists do. Surgeons book the anaesthetists they trust to make their list run smoothly. The reputation phase typically takes one to two years — after that, work tends to find you.
Be available, especially early
Saying yes to short-notice cases in your first year buys goodwill that pays for years.
Run their list well
Be on time, induction-ready, and don't slow turnovers. Surgeons remember who finished on schedule.
Communicate clearly
With theatre staff and recovery. Surgeons hear when you don't.
Stay reachable
A surgeon's secretary who can never get hold of you will quietly route work elsewhere.
Attend the right meetings
Your hospital's M&M, theatre committee, and any specialty-specific groups your surgeons attend.
The mistakes I see most often in new private anaesthetists.
Underbilling out of uncertainty. New specialists often default to no-gap on every case because they're worried about patient pushback, leaving significant income on the table. Learn the models, decide a default, and quote with confidence.
Slow invoicing. Invoices not lodged within a few days start ageing fast. Ninety-day-old invoices are much harder to collect than ones lodged within a week of the case.
No follow-up on unpaid invoices. Funds and Medicare reject for small reasons — wrong item, wrong modifier, missing date. If no one is chasing rejections, that revenue evaporates.
DIY everything. Doing your own billing alongside a full clinical week is feasible for the first few months but rarely sustainable. Most who try it end up either burnt out or with significant aged debt.
No business structure planning. Operating as a sole trader and restructuring later triggers tax events that could have been avoided. Make the decision before your first invoice, not after your first BAS.
Poor financial consent. Patient complaints almost always trace back to fee surprise, not the fee itself. Informed financial consent in writing, before the case, prevents the vast majority of issues.
Built for the part you shouldn't be doing yourself.
"All I have to worry about is providing the anaesthetic service (Fast Tracking does the rest of the billing, scheduling and communication with hospitals & surgeons rooms). Highly professional staff. With one short phone call any anaesthetist can easily setup their own private practice with minimal hassle and no setup costs."Dr Michael Chappell
Google review
I built Fast Tracking in 2018 for exactly the part of this list that most anaesthetists shouldn't be doing themselves: lodging invoices accurately, chasing rejections, reconciling payments across Medicare, health funds, WorkCover, TAC, DVA and patients, and producing clear monthly reporting.
Our pricing is 4.5% all-inclusive — no setup fee, no exit fee, no contract, and free migration if you're switching from another service or in-house. If you're at the planning stage, we can also help you sequence the setup so you're not blocked when your first list lands.
"Your administration reflects you. The standards your patients see before they meet you are the standards they'll attribute to you."Dr Brad Hindson, MBBS FANZCA
Founder, Fast Tracking
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