A debate in the Medical Journal of Australia has addressed the merits – for both patients and doctors - of salaried positions compared to fee-for-service medicine.
Melbourne urologist Dr Douglas Travis claimed that fee-for-service remuneration encouraged productivity, was more transparent and provided better accountability for all parties.
He noted that fee-for-service was a different issue to public vs private practice, or whether patients had to pay an out-of-pocket contribution.
“While many salaried doctors do work excessive hours to cope with ever-expanding workloads, it is the human condition to watch the clock and not put in the maximum effort when you are paid by the hour,” Dr Travis said.
Although fee-for-service might risk compromising quality as doctors tried to do more in less time, “Doctors have been and can be trusted to provide quality work,” he said. Quality improvement activities could be incorporated into fee-for-service remuneration, and CME was mandatory regardless of how doctors were paid.
Salaried Adelaide obstetrician Dr Brian Peat argued that fee-for-service systems increased the number of tests and procedures performed and led to higher administrative costs.
“Salaried doctors have no conflict of interest in the doctor-patient relationship, which engenders a patient’s trust and reduces the anxiety for the practitioner,” Dr Peat said.
“They are in a better position to consider all aspects of the patient’s health, and to appropriately delegate tasks knowing they will not be out of pocket.
“This is particularly an issue as we see more lifestyle-related, chronic illness that does not fit the short-consultation model.”
Rolling back some of the “outrageous subsidies” to private practice, including the 30% health insurance rebate and safety net, would help shift the economic balance back towards salaried practice, he said.
Medical Journal of Australia 2011; doi: 10.5694/mja11.10898
http://www.mja.com.au/public/issues/195_05_050911/pea10898_fm.html
http://www.mja.com.au/public/issues/195_05_050911/tra10878_fm.html