Let’s have a look at who earns the most in Australia.

These people?

Or these people?

The Mob

Without doubt, the Al Calpone mob in Chicago provided a lot of necessary and essential services:

1. Prostitution The world’s oldest profession.
2. Bootlegging of Alcohol.  Humans since time immemorial have always sought mind altering substances, to help them deal with the negatives vastitudes that had been dealt to them in their hand of life.  Alcohol is the most common. The Eighteenth Amendment to the United States Constitution, which had mandated nationwide Prohibition on alcohol on January 16, 1919.  This is the only amendment that has been repealed. The Twenty-first Amendment (Amendment XXI) to the United States Constitution repealed the Eighteenth Amendment to the United States Constitution, which had mandated nationwide Prohibition on alcohol on January 16, 1919. The Twenty-first Amendment was ratified on December 5, 1933.
3. Gambling. Australians has been known on 2 flies crawling up a pub window.  Two Up is a national Australian pastime on Anzac Day! Gambling is restricted in America, though its popularity is increasing. Laws regarding gambling are important not only for those involved with gaming operations, like casinos, bingo, or poker tournaments, but also for the average person who wants to know whether he can legally start a betting pool among his friends or at his office, has an idea for a new business model involving some form of chance, or if he can legally participate in an online poker tournament.

American gaming laws are heavily influenced by the history of gambling itself. Games of chance first came to the American colonies with the first settlers. Attitudes on gambling varied greatly from community to community, but there were no large-scale restrictions on the practice at the time. For many years, the colonies used lotteries to help raise revenues. For example, lotteries were used to establish or improve dozens of universities and hundreds of secondary schools during the 18th and early 19th centuries. In fact, a 1769 restriction on lotteries by the British crown became one of the many issues which fuelled tensions between the Colonies and England prior to the American Revolution.

As America grew, gambling spread and diversified. Lotteries continued to be used at the state and federal level, and privately owned gambling businesses slowly developed in various communities. The lower Mississippi River valley became a hotbed of gambling activity, and New Orleans became the nation's leading gambling centre. However, a backlash against gambling began to gain momentum in the mid-19th century, pushing gaming from the Mississippi River west into younger, less well regulated territories and onto the famous Mississippi River Boats.

As anti-gambling forces in the northeast continued to gain supporters, state sponsored lotteries in these locations came to an end. Similarly, the spread of railroads harmed the Mississippi River Boat industry, deeply cutting profits to these operations. The California Gold Rush caused San Francisco to become a popular gambling city, even as New Orleans began its gaming decline. Post-Civil War reconstruction efforts saw the brief return of lotteries and other forms of gaming as a means of generating revenues, but by the beginning of the 20th century it was once again almost uniformly outlawed throughout the United States.

The increasing legal pressures on gambling gradually created opportunities for illegal operations. As a result, and not surprisingly, gambling was one of the most popular illegal operations run by many organized crime syndicates. During the Prohibition Era, illegal liquor provided an additional revenue stream for mob figures, and organized crime blossomed. Towns which had already had lax attitudes about vice such as Miami, Galveston, and Hot Springs became major gambling centres attracting tourism from around the nation. The Great Depression saw the legalization of some forms of gambling such as bingo in some cities to allow churches and other groups to raise revenue, but most gambling remained illegal. Major gangsters became wealthy from casinos and speakeasies.

The stock market crash of 1929 and the Hoover Dam project led to the legalization of gambling in Nevada as a way of generating revenue for the state. Interest in development of Nevada was slow, however, given its arid climate and sparse population. However, as gaming laws again became more restrictive after World War II the desert town of Las Vegas became an attractive target for investment by crime figures such as New York's Bugsy Siegel. The town rapidly developed during the 1950's, quickly eclipsing the popularity of illegal gambling empires such as Galveston. During the 1960's, the casino industry in Nevada exploded as legitimate investors like Howard Hughes recognized the huge profit potential of such operations.

Hence the mob met the need for otherwise illegal gambling.

The mob were also into 'Loan Sharking' - providing high-interest loans for people who found it difficult to qualify for bank loans. We have the same thing in Australia. They are pay-day lenders, and small loans amounts.

Fee limits on small amount loans ($2000 or less)

From 1 July 2013, fees charged on small amount loans are capped (that is, limited to a maximum amount).

Credit providers can only charge you the following fees:

• A one-off establishment fee (of not more than 20% of the loan amount)
• A monthly account keeping fee (of not more than 4% of the loan amount)
• A government fee or charge
• Default fees or charges (the credit provider cannot collect more than 200% of the amount loaned if you default - that is, fail to pay back the loan)
• Enforcement expenses (if you fail to pay back the loan, these are the costs incurred by the credit provider going to court to recover the money owed under your credit contract)

Now if that doesn’t meet your definition of “Loan Sharking, these you must still believe in the tooth fairy!

ALL THE MOB DID WAS TO MEET THE NEED FOR COMMUNITY SERVICES THAT ARE NOW COMPLETELY LEGAL IN AUSTRALIA TODAY!

The Medical Specialists

Now I will be the first to admit that it’s not easy to become a medical specialist in Australia. My late father was a general surgeon, and my former wife is a well renowned ophthalmologist in Melbourne.

First you need a medical degree MB BS. Say 6 years. Then you need intern training. Australian and New Zealand medical school graduates must apply for provisional registration in order to undertake a period of approved intern training to become eligible for general registration. 
Interns are only permitted to work in accredited intern positions. They are not permitted to undertake any clinical work outside their allocated intern position.

Interns must complete the following clinical experiences in order to be eligible for general registration:

• a term of at least eight weeks that provides experience in emergency medical care
• a term of at least 10 weeks that provides experience in medicine
• a term of at least 10 weeks that provides experience in surgery, and
• a range of other approved terms to make up 12 months (minimum of 47 weeks full-time equivalent service). 

All terms must be accredited against approved accreditation standards by an authority approved by the Board. These authorities are commonly known as postgraduate medical councils.
Most doctors who which to become specialists complete 2 years as an intern

How do you become a specialist? You must become a Registrar at a Teaching Hospital.

The Multi-Billion Dollar Problem:

• Nearly all teaching hospitals are government hospitals. They are funded by State Governments.  
• These governments do not provide enough money to fund registrars. Just ask any senior nurse at a teaching hospital.
• Whenever the Specialist Colleges are blamed about the lack of specialists, they sheet the blame back to the State Governments. 
• Even as a Privately Insured Patient, it can take weeks if not months to see the specialist recommend by your trusted general practitioner.

Isn’t this telling you we have a massive shortage of medical specialists in Australia?

The next few pages set out AVERAGE INCOMES FOR HIGH EARNING PEOPLE IN Australia.

We have to remember, that unlike General Practitioners, Specialists’ overheads are a small proportion of their income.

They share consulting rooms, because most of the time, they are in the Operating Theatres.  Theatre fees are hospital fees are charged separately, and not charged to the specialist.

And the Federal Government, via Medicare, pays for the surgeon’s scheduled fees.

The numbers in the about tables are averages, and not medians.  There are a lot of part time female specialists, with young children, who bring the averages down.

And these numbers are nearly 3 years out of date!

I am also aware that the distribution of medical specialist incomes is not a traditional “bell shaped” curve, but rather shaped like the one above.

Many medical specialist earn (after costs but pre-tax) in excess of $1 million per annum.

The main solution would be for the federal government to fund many more registrar positions in state government hospitals.  This would generate more skilled specialists, and competition would drive their prices down.

The best solution would be for the Federal Government to take over all the State Health Departments.  Some staff might go, but the main benefit would be to eliminate this “Transfer Pricing” Bunfight!

SUMMARY

At least medical specialist pay their taxes, and Al Capone only went to jail for tax evasion!

Peter A Worcester BA BSc FIAA MAICD

Peter is an independent actuary of 40 years’ experience, who is passionate about:

1. Improving outcomes for Investors
2. Improving efficiency in society, thus enabling a higher standard of living for all, and
3. Pro-bono work.  He brings his varied skills to 3 pro bono medical organisations, and is seeking to add more to his workload.