Doctors divided over fairest pay model
5th Sep 2011 Mark O’Brien all articles by this author
A
DEBATE in the MJA over whether doctors should be “hawking their wares
among the populace for a fee” or taking a “social service” approach via a
salary has divided general practice experts on the best model of pay
for GPs.
Obstetrician Dr Brian Peat argued in the MJA that it would be “simple to change the current balance” in Australia by rolling back “the more outrageous subsidies” like the private health insurance rebate and the safety net, and directing the savings into more salaried positions.
AMA Victoria past president Dr Douglas Travis argued against the salaried model, saying with fee for service “as a patient, you pay for what you get, and, as a doctor, you get paid for what you do”.
University of Western Australia professor of general practice Alistair Vickery said elements of both models were valid in certain situations.
“We need a hybrid system that rewards teaching and research by salary or funded payment and we need a system of flexible packages for chronic disease,” he said.
University of Queensland senior lecturer Dr Andrew Gunn said fee for service payments distorted clinical care.
“Bad doctors who game the system cause problems whether they are paid fee for service or salary, but at least under a salary they do very little, unlike fee for service when they do a lot,” he said.
“I’m convinced self-interest underlies the affection of many doctors for fee for service payments. I’m happy to debate the point that greed makes the world go around, but at least let’s call a spade a spade.”
Menzies Centre for Health Policy director Dr Bob Wells said the episodic nature of most general practice consultations meant fee for service worked well.
MJA 2011; 195:256-57
Obstetrician Dr Brian Peat argued in the MJA that it would be “simple to change the current balance” in Australia by rolling back “the more outrageous subsidies” like the private health insurance rebate and the safety net, and directing the savings into more salaried positions.
AMA Victoria past president Dr Douglas Travis argued against the salaried model, saying with fee for service “as a patient, you pay for what you get, and, as a doctor, you get paid for what you do”.
University of Western Australia professor of general practice Alistair Vickery said elements of both models were valid in certain situations.
“We need a hybrid system that rewards teaching and research by salary or funded payment and we need a system of flexible packages for chronic disease,” he said.
University of Queensland senior lecturer Dr Andrew Gunn said fee for service payments distorted clinical care.
“Bad doctors who game the system cause problems whether they are paid fee for service or salary, but at least under a salary they do very little, unlike fee for service when they do a lot,” he said.
“I’m convinced self-interest underlies the affection of many doctors for fee for service payments. I’m happy to debate the point that greed makes the world go around, but at least let’s call a spade a spade.”
Menzies Centre for Health Policy director Dr Bob Wells said the episodic nature of most general practice consultations meant fee for service worked well.
MJA 2011; 195:256-57
