When medical consulting is the norm, consultants who do the work often find themselves getting charged extra to cover costs.
It’s a growing trend that has been widely condemned as unethical by academics, regulators and consumer groups.
The rise of consultancy fees has been largely ignored by the industry, which has a vested interest in keeping consultants as low-cost as possible.
But it’s increasingly happening as the consulting industry seeks to diversify its business model to attract new clients and keep costs low.
This year alone, consultancy fees in the US soared from $6.4bn to $9.2bn, according to consulting company consulting firm Consulting Engineers.
Some consultants are now charging $50,000 per hour or more for the services they provide.
“The industry is shifting, as people are finding that they can do a lot more work without having to pay for the consultant fees,” said Dr John Buss, director of the Centre for Medical Ethics at the University of NSW, where he specialises in ethics.
“But the problem is that we have an existing system where we pay a fee to the consultant who has no obligation to the client to perform their work.”
That’s where consulting firms, such as consultancy firm McKinsey & Co, have sprung into action.
McKinsey is now charging a $2,500 per hour fee to doctors, which is more than the annual fee consultants are typically paid.
“Our clients are increasingly looking for cheaper, more effective and ethical work for their patients,” McKinsey CEO Mark McKinsey told Al Jazeera.
McKinseys’ fee structure means consultants are earning about 30 percent less than they would be, but the firm is offering free consulting services to anyone with an annual salary of $100,000 or less.
In a statement, McKinsey said its fees are “comprised of a one-time charge for a consultation and an annual fee to cover all necessary professional expenses”.
“The fees are paid by a small number of our clients, who are eligible to participate in a competitive marketplace of services that includes consulting and other services.”
McKinsey’s fee structure is “an important part of a health system that is increasingly focused on reducing health care costs”, McKinsey chief financial officer Ian Coyle said in a statement.
“We have been doing more than 1,000 hours of consulting and have had great success with our services.”
Consulting firms are becoming increasingly aware of the potential impact that fee structures could have on their business.
In May, consultancy firm Medtronic, which operates more than 100 healthcare centres in Australia, began charging $500 for each consultation it provides, up from $50.
In the US, the firm has been charging $10,000 for each hour of work.
The Australian Medical Association (AMA), which represents medical professionals, has also taken a stand against consulting fees.
“I think it’s fair to say the AMA has been extremely vocal in opposition to consulting fees,” AMA general secretary David Sheppard said in an emailed statement.
Medtrop, which provides consulting services for the Royal Melbourne Hospital, is the latest medical consulting firm to join the fray.
MedTrop CEO, Dr Jonathan Dey, told Aljazeera that it charges consultants a “single fee, for a single consultation”.
“I would say that it’s probably the least ethical way to approach a medical issue,” he said.
“Consultants are paid to get their work done, but there’s also a fee that comes out of that work.
It can be an unnecessary burden.”
Medtrup’s fee scheme has been criticised by experts.
“This is clearly a way for consultants to charge a very, very high rate for their work and to keep the fee as low as possible,” said Robert Fenton, a professor of ethics at the Australian National University.
“It’s a very unethical way to run a business.”
Fenton said he did not see how consulting fees could be justified as a way to “avoid some of the costs of medical care”.
“If it’s really about lowering costs, why not let people do their own work and use the expertise they’ve gained?”
Dr Dey added: “If you want to charge fees that are in line with the costs you’re facing and you can pay them for those things, why should consultants have to pay extra?”
In an email to Al Jazeera, Medtrol’s CEO, Michael Schmitz, said that Medtrois “completes a very high percentage of all the consultations we do”.
“Our consulting fee structure allows us to manage costs, to manage the number of consultations and to manage workloads.”
He added that Medtran’s fees are less than the fee for an equivalent job performed by a “typical doctor”.
“When you’re doing a consultation, you’re paying a consultant for an amount of time that is not your primary care patient, but is your primary physician,” he explained.
“And you’re also paying for