Financial Planning for Oncologists in Australia

Oncologists - whether medical, radiation, or haematological - carry significant professional costs that are all deductible against clinical income. The subspecialty affects the cost profile significantly.

• AHPRA Medical Board specialist registration: ~$900–$1,000/yr for specialist registration in Medical Oncology, Radiation Oncology, or Haematology - fully deductible
• COSA/MOGA membership: Clinical Oncology Society of Australia (COSA) and Medical Oncology Group of Australia (MOGA) - annual membership ~$400–$800/yr; COSA Annual Scientific Meeting, national and international oncology conferences (ASCO, ESMO for medical oncologists) - registration, travel, accommodation deductible where CPD purpose dominates
• RANZCR (radiation oncologists): Royal Australian and New Zealand College of Radiologists - annual fellowship contribution; radiation oncologists may have additional imaging and planning system CPD costs
• MDO premiums: Avant, MDA National - medical oncology premiums typically $3,000–$8,000/yr; radiation oncology $3,000–$8,000/yr; haematological oncologists performing procedures (bone marrow biopsies, intrathecal chemotherapy) may pay higher; all premiums fully deductible
• Clinical trial costs: Oncologists participating in or running clinical trials may have research-related costs (IEC fees, data management, research nurse coordination costs) - deductible if directly related to income-earning activity; grant-funded research costs are typically not deductible against personal income
• Oncology software and registries: Chemotherapy prescribing software (MOSAIQ, ARIA), oncology-specific EMR subscriptions, and cancer registry contributions may be deductible where they support the clinical income-earning activity

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Medical oncologists and radiation oncologists have distinctly different billing structures, which creates different PSI analyses and income-splitting opportunities.

• Medical oncology billing: Primarily consultation MBS items (110/116/132) plus a significant component of PBS chemotherapy prescriptions; the chemotherapy drug itself is funded by the Pharmaceutical Benefits Scheme (PBS) and paid to the dispensing pharmacy (not the oncologist); the oncologist bills for the consultation and administration supervision, not the drug cost
• Chemotherapy drug authority (CDA) income: Some oncologists work in private oncology day units that charge patients or health funds for chemotherapy administration - a professional administration fee; this administration component may be income of the day unit entity (business income, not PSI) if the day unit employs nursing and pharmacy staff who materially administer the treatment
• Radiation oncology billing: Highly procedure-dependent - MBS items for radiation treatment planning (IMRT, VMAT, stereotactic), simulation, dosimetry, and treatment delivery; the radiation oncologist is the responsible physician; some items are billed by the practice entity that owns the linac machine and employs radiation therapists
• Radiation therapy facility income: Where a radiation oncologist has an ownership interest in a radiation therapy facility (linear accelerator, treatment planning system), the facility fee income is business income of the entity - not PSI; the oncologist's personal consultation and planning fees remain PSI
• Haematological oncology: Haematologists who are also oncologists have dual billings - both consultative haematology items and oncology treatment supervision; bone marrow biopsy and trephine items are procedural; all billing is typically under the individual's provider number - generally PSI unless in a genuine group practice structure
• PBS prescribing restrictions: Oncologists must hold specific PBS authority prescribing approval for oncology drugs; this is tied to the individual's AHPRA registration and Medicare provider number - not transferable to a company or trust entity

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The PSI analysis for oncologists is particularly nuanced because of the interplay between individual professional billing and the significant investment in treatment infrastructure (day units, radiation facilities) that may generate genuine business income.

• Solo medical oncologist = PSI: A solo medical oncologist billing consultations and chemotherapy administration supervision under their own provider number - income is PSI regardless of whether a company or trust is used
• Group oncology practice: Multiple oncologists with shared oncology nursing staff, pharmacy input, and administrative infrastructure - the oncology nurses and pharmacists make a real contribution to patient care; the income from the day unit entity may not be PSI; each oncologist's personal consultation fees remain PSI
• Radiation oncology facility: Where radiation therapists plan and deliver treatments (under the responsible radiation oncologist's oversight), the treatment component income may be business income of the facility entity; the radiation oncologist's consultation and planning fees are PSI
• Day unit ownership model: Many private medical oncology day units are operated by a company in which the oncologist has equity; the day unit charges a facility/administration fee; the oncologist also bills a consultation fee; the facility fee income distributes to the company shareholders as business income
• 80% single-payer rule: If 80%+ of an oncologist's income comes from one entity (one hospital group, one cancer centre), the results test is automatically failed - all income from that source is attributed to the individual; public hospital employees are typically salaried employees (not PSI at risk)
• Research income: Investigator fees from pharmaceutical company clinical trials are generally assessable income of the oncologist conducting the research; where the hospital holds the trial contract and pays the oncologist, it may be employment income; where paid to the oncologist directly, it is likely PSI or business income depending on the research activity structure

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Oncologists are consistently high-income earners - typically $300,000–$600,000+ - with training histories that create carry-forward opportunities. Division 293 is virtually universal.

• Division 293 at $250,000: Additional 15% on CCs - total 30%; all oncologists earning above $250,000 (the overwhelming majority in private practice) pay Division 293; ATO issues assessment after lodgement - pay personally or elect super fund release
• CC cap at high income: At $400,000 income, SG = $46,000 - $16,000 over the $30,000 CC cap; excess CCs are assessable income at marginal rate less 15% offset; optimal salary to keep SG at CC cap = ~$261,000; structure additional income as dividends or distributions where possible
• Carry-forward from training: Oncology training (internal medicine + oncology advanced training) typically 7–9 years with registrar salaries significantly below $250,000; unused CC cap from 2018-19 onward is available as carry-forward if TSB was under $500,000 at 30 June of the prior year; catch-up lump sum CCs of $50,000+ possible in the first years of consultant income
• SMSF with radiation facility or consulting suite (BRP): Where an oncologist owns a consulting room or has a partial ownership in the day unit premises, SMSF purchase as BRP allows rent paid to SMSF at arm's-length market rates; LRBA 8.85% for real property; rental income at 15% in accumulation / 0% in pension
• NCC bring-forward: $360,000 in after-tax contributions (bring-forward, TSB under $1.68M, under 75) - after-tax day unit distributions or practice profits can fund NCCs; builds super balance for TBC maximisation
• Contribution splitting to spouse: Up to 85% of CCs can be split to spouse's super - particularly useful where the oncologist's spouse has a lower income and lower TSB; equalises balances for combined TBC of $3.8M in pension phase

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An oncologist's practice involves intense clinical and emotional work - burnout, moral distress, and physical health risks (radiation exposure for radiation oncologists) are occupational hazards that make personal risk insurance essential.

• Own-occupation income protection: Oncology is a defined specialty - own-occupation IP pays if you cannot perform the duties of an oncologist; a medical oncologist who develops severe depression or chronic fatigue (occupational hazards in oncology) qualifies under own-occupation even if they theoretically could do other work
• Agreed value (pre-31 March 2020): Any agreed value IP policy issued before 31 March 2020 is irreplaceable - retain without question; the fixed benefit is not subject to the APRA 70% cap reform that applies to new policies
• Radiation oncologist occupational exposure: Radiation oncologists working with radiation-producing equipment have ARPANSA-managed exposure limits; radiation exposure over a career is monitored; this is a genuine occupational health risk that should be reflected in IP underwriting - disclose all radiation work history at policy application
• Burnout and mental health: Medical oncology has high rates of compassion fatigue and burnout; most IP policies cover psychological conditions including burnout-related illness if supported by a treating psychiatrist; ensure your MDO has access to a wellness and support program
• Trauma insurance: Lump sum on diagnosis of specified serious illness - the somewhat uncomfortable reality that oncologists have access to early cancer detection and may benefit from trauma insurance that pays on cancer diagnosis (when they would most benefit from a capital sum for treatment and life adjustment)
• Life insurance and dependants: Oncologists with young families and mortgages require life insurance; the earlier in career, the greater the income replacement need; hold life insurance outside super if adult children are the intended beneficiaries (avoids 17% death benefit tax on taxable component)

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AHPRA specialist registration (Medical/Radiation Oncology/Haematology): ~$900–$1,000/yr. COSA/MOGA membership: ~$400–$800/yr. MDO premiums: $3,000–$8,000/yr. All fully deductible against professional income. PBS chemotherapy drug cost is funded by the government to pharmacies - NOT charged by the oncologist.

Chemotherapy day unit facility income: Where a private oncology day unit charges health funds or patients for chemotherapy administration (nursing, pharmacy, infusion suite), this facility fee income is income of the day unit entity - not PSI of the individual oncologist. Oncologists with equity in a day unit can legitimately receive business income (dividends or trust distributions) alongside their PSI consultation income.

Division 293 for oncologists: At $400,000 income, income + CCs = $430,000. Division 293 on full $30,000 CC = $4,500 additional tax (total 30% on CCs). ATO assessment issued post-lodgement. Can pay from personal funds or elect release from super fund. At $600,000 income with SG $46,000: excess $16,000 CCs are assessable (marginal rate 47% − 15% offset = 32% on excess = $5,120 additional tax).

Carry-forward super opportunity: Oncology training programs typically run 7–9 years (physician training 3yr + oncology advanced training 2–3yr + possible fellowship). During training, annual CC = SG only (registrar base salary ~$80,000–$130,000; SG ~$9,200–$14,950). Unused cap accumulates: from 2018-19 to 2023-24 (six years), a registrar making no additional CCs may have $40,000–$70,000 in carry-forward entitlement available in the first years of consultant practice.

LRBA and radiation therapy infrastructure: Radiation therapy linac equipment ($3M–$8M+) is too expensive for SMSF direct ownership; however, the building housing the radiation therapy facility may qualify as BRP if the oncologist/SMSF owns the premises and leases to the operating entity at arm's-length rates. LRBA for real property: 8.85% (2024–25). NALI rules require independently verified market rent annually.

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