For NSW Child Psychiatrists Whose Work Can Reach More Patients and Families
NSW has the country's longest child psychiatry waitlists. For specialist psychiatrists in the state — whether you are considering what comes next after a difficult stretch in public, or working through where your training goes furthest — this page is written for you.
What follows is practical: what the transition to private child and adolescent practice actually involves, and what a practice built around reaching more of the patients and families who need specialist care can look like for the clinicians doing the work.
The patients and their families behind the waitlists
Where your specialist training goes furthest
NSW has the country's deepest unmet need for child and adolescent psychiatry. Families wait 12 months or longer for assessment. Paediatricians and GPs carry cases that would more appropriately sit with a specialist. Patients who need a psychiatrist often do not see one until the situation is well past where it could have been.
If you have completed FRANZCP training, spent years in public psychiatry, or built your own practice, your specialist training is directly what the state needs more of. The question worth asking is not whether to stay in public or go private — it is where your expertise can reach the most of the patients and families who need it, while remaining sustainable for you.
That is the question this page is really about. What follows covers the practical transition to private child and adolescent practice and what a practice designed around both reach and sustainability can look like.
What a subspecialty-aware C&A practice looks like
Three things we build the infrastructure around
Protected clinical time
Administrative load, Medicare billing, referral intake, scheduling, patient correspondence and report coordination are handled end-to-end by your admin support. Your hours go to clinical work. This is the single biggest difference most clinicians report against generalist platforms.
Clinician-set caseload
You choose your days, hours, and weekly caseload volume. You set which presentations you see and which you do not. There are no minimum consult quotas. Several of our clinicians work 1–2 days per week alongside academic or hospital roles; others work a full private week. Both patterns are genuinely sustainable here.
C&A-native infrastructure
Child and adolescent psychiatry is not adult work with smaller patients. Referral intake, assessment workflows, consent processes, report templates, and peer community are built specifically around developmental framing, family systems, school and paediatrician liaison, and under-18 medication considerations.
The practical transition from public to private
Four things to sort out, and the order to sort them
1. Professional indemnity insurance
AVANT and MDA National are the two options most psychiatrists use. Both cover telehealth private practice. Transitioning from public indemnity is usually straightforward; allow 1–2 weeks.
2. ABN and business setup
You will need an Australian Business Number to invoice for private services. Sole trader is the simplest structure for most psychiatrists starting private practice; speak to your accountant about whether a company or trust structure is worthwhile given your income expectations. ABN registration is free and takes a few days.
3. Medicare provider number
Your existing specialist registration travels with you. You apply for a Medicare provider number linked to your practice billing location. Relevant MBS items for private C&A practice include item 291 (new patient psychiatric assessment), 296/297/299 (new patient telehealth), time-tiered review items 304/306/308, and their video (91827–91831) and phone (91837–91839) telehealth equivalents. If you billed these items in public practice, the knowledge transfers directly.
4. Onboarding
With us, onboarding takes 1–2 weeks once the above are in place: credential verification, platform training, introduction to your admin support, peer community introduction, and setting your initial availability. You then control when you see your first patient.
Questions NSW psychiatrists ask us
Direct answers, no sales language
Four things need to be in place before you can see patients privately: an ABN, professional indemnity insurance (AVANT and MDA National are the common options for psychiatrists), continuing AHPRA specialist registration, and a Medicare provider number linked to your billing location. Most psychiatrists complete this in 2–6 weeks. We guide clinicians through each step during onboarding — most of the admin friction is one-off, not ongoing. Your MBS billing knowledge from public practice transfers directly: items 291 (new patient assessment), 296/297/299 (new patient telehealth), and time-tiered review items 304/306/308 plus their telehealth equivalents (91827–91831 video, 91837–91839 phone) cover the vast majority of C&A work.
What changes is how much of your week reaches the clinical work. Public system constraints — throughput pressure, risk-management load, the administrative scaffolding of big institutions — compete with direct clinical time. Private practice organised around the same competition (volume-driven billings, thin admin support, isolation from peers) reproduces it in a different form. Private practice organised around protecting clinical time, clinician-set caseload, structured peer consultation and C&A-specific workflows tends to return most of your hours to the work itself. At Lionheart, administrative and billing load is handled end-to-end, caseload is fully clinician-set, and peer consultation is a structured part of the week rather than something that happens when people happen to bump into each other. Most of our clinicians describe the first few months as the clinical work starting to feel recognisable again.
Three NSW-specific points. First, NSW public psychiatrist remuneration has lagged other states significantly (per RANZCP data, 28–52% behind QLD, SA and WA), so financial calibration may be different to what colleagues elsewhere describe. Second, NSW has the largest C&A referral backlog in the country — there is genuine unmet clinical need you can address via telehealth without relocating. Third, if you left a NSW Health role in 2024–25, the transition is not unusual right now; many colleagues are working through the same decision, and peer conversations about what comes next are worth seeking out.
Yes, and better than most generalist platforms will let you. Lionheart is built specifically around child and adolescent psychiatry rather than adult-psych retrofitted for younger patients. That means referral intake, assessment workflows, report templates, consent processes and peer community are C&A-native. Clinicians with neurodevelopmental, ADHD, autism-assessment, or perinatal/infant interests can orient their caseload toward that work rather than being pushed into generic adult-style consulting. We do not currently see acute presentations (active suicidality, psychosis, acute eating disorders) — these remain appropriately with public and hospital services.
No. Caseload is entirely clinician-controlled; we do not set minimum consult counts. Several of our clinicians work 1–2 days per week alongside academic, hospital or family commitments and maintain that long-term. The business model is compatible with lower-volume, higher-quality practice because we are fee-for-service rather than salaried — you are paid for the work you do, and the right volume for you is the volume that keeps practice sustainable.
Yes, with the right infrastructure and case selection. Stable C&A presentations — ADHD assessment and management, anxiety and mood disorders, autism assessment, OCD, trauma-related presentations — have a substantial evidence base for effective telehealth delivery. The RANZCP Professional Practice Guideline on Telehealth in Psychiatry covers appropriate use. Acute and high-risk presentations are not suitable and we do not accept them. We provide platform training, clinical supervision during onboarding, and peer consultation for complex cases. Most clinicians report the adjustment takes 4–6 weeks.
Yes. Many of our clinicians hold university academic positions, part-time hospital roles, or continue supervising trainees alongside private work with us. The contractor model is designed to complement rather than replace other professional activities. Some clinicians use private work as the sustainable clinical component of a mixed portfolio.
Have a conversation, not an interview
If any of this resonates, the next step is an informal conversation with our clinical director — not a formal application. Share your CV and what you are looking for, and we will talk about whether this is the right fit.