07/04/2026
🧪 Screening children early is one of the most ethical things we can do. So why can't most of us afford to do it?
Screeners are fast. Twenty to thirty minutes per child. Whole cohorts. Whole schools. The logic is compelling — cast a wide net early, catch what would otherwise go unnoticed, intervene before small difficulties become significant ones.
The logic is sound. The economics are not🤑 .
Most small private practitioners will tell you the same thing. Screening barely covers wages. Often it doesn't. Planning, consent, travel, scoring, reporting, referral coordination, parent communication — the true cost is rarely reflected in the final bill. All of it is essential. All of it is absorbed.
We absorbed it because that's what you do. You stay late. You do the work because it matters, because you have an obligation, and because you can💁🏻♀️ .
But something has shifted.
Practitioners are leaving the field in significant numbers — and when you ask them why, the picture is uncomfortable. The largest study of Australian health practitioners to date found the top reasons included mental burnout, feeling undervalued and unrecognised, and a loss of professional fulfilment. Pay sits inside that cluster — not always named directly, but inseparable from the feeling that the work costs more than the system is willing to acknowledge. We built a profession on goodwill, and it's only considered normal because it's a workforce made up of mostly women. For a long time, that held. It doesn't anymore.
Most of us didn't question it. You do the work because that's what you do. You don't expect thanks, you don't keep score — it's just the water you swim in🐠 .
What changed wasn't a crisis of conscience. It was the NDIS. A structural shake-up that — whatever its intentions — forced small practices to look at the bottom line in ways they never had to before. And once you start looking, it forces some uncomfortable but genuinely empowering💪🏻 questions.
Because when there are only so many of you to go around, you start to prioritise. You look at what you've built, what you bring, and you feel proud of it. And then you feel ready — to charge for it, to defend it, to answer the sticky questions that come with that. Who is most urgent. Who can wait. That prioritisation — quiet, daily, mostly undiscussed — is one of the most ethically loaded decisions in the practice. It just doesn't look like one from the outside.
This is not a workforce problem. It is an ethical problem wearing a workforce problem's clothes.
The ethical obligations of screening — accuracy, informed consent, honest communication, follow-through, data stewardship, equity — are real and non-negotiable. But they cannot be met by practitioners working in financial survival mode. Ethical practice requires viable practice. The profession has not been honest enough about that connection.
There are solutions emerging. Practitioners — not systems, not policy bodies, not tech companies — are building the infrastructure that makes ethical, sustainable screening possible in small practice settings. That work deserves recognition, investment, and collaboration.
— More soon.
