Tuesday, April 17, 2007

Turning doctors into civil servants

Al, once again, has some interesting thoughts on the decline of the family doctor. This time he zeros in on the stagnating effect of the rigid, bureaucratic fee structure.

With the advent of “Universal Medicare”, Alberta physicians were put in the position of negotiating (through the Alberta Medical Association) a fee schedule that the government agreed to honor. For the most part, these negotiations were a farce, akin to a rank amateur hockey player squaring off against Gretzky in his prime. As a result, the settlements were less than inflation the majority of the time. Fortunately, physicians in the early years had the capability of “balance” billing. Unfortunately, this was soon taken away from them by the federal government and the provinces.

At this point I felt the medical profession was no longer a profession. With no ability to address changing environments in their businesses and the government “paying the piper”, physicians soon began to lose their professionalism, and, as the only means of controlling their incomes, began choosing what they would and would not do, depending on time involved, remuneration per item of service, etc. When the government declared they were taking a more business-like approach to healthcare, the physicians responded by taking a more business-like approach to their practices.

So where are we at now? Most doctors limit a visit to one complaint by the patient. Additional complaints need additional appointments. Many family docs have taken up lucrative sidelines outside of the healthcare system (eg. botox injections, hair transplants, etc). A strong trend towards walk-in clinic work and away from continuing patient care and management exists, and the number of young medical graduates choosing family medicine is continually on the decline.

I find it amazing that politicians and unions talk about health care reform in bureaucrat-speak and rarely talk about the nuts and bolts of actually delivering health services. People like Al, and not Roy Romanow, should be consulted more often.

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