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It’s time to talk frankly about the implications of the way doctors are paid

To meet society’s growing demand for health care and social services that respond effectively to users’ needs, many changes have been introduced across Canada in recent years to the system that provides care. Some of these have been refinements, while others were significant overhauls, especially in Quebec. To varying degrees, improvement has resulted. However, significant and long-lasting progress will be difficult to achieve, if a particularly thorny issue is not addressed head-on: the outdated and sometimes incoherent way in which physicians are compensated for their services.

  • As I point out in an article that will appear in the healthcare policy journal Health Care Papers, we have expended too much effort in tweaking a system that still puts doctors at the centre, while leaving patients at the margins. Consider the following:
  • It is possible for the same service to be reimbursed differently, depending on which specialist is billing for it.
  • Certain specialists receive a financial incentive simply for showing up on time to perform a procedure.
  • Government policies in Quebec try to ensure that medical care is available in all regions. However, these measures are based on two false assumptions: that a patient will seek medical care only in the region where he or she lives, and that older physicians will retire, making room for younger doctors.

Meanwhile, nurses and other allied healthcare professionals have become more capable in meeting the needs of patients, increasingly doing things that only doctors used to do. And all of this is happening at a time of enormous change in the field of medicine itself, as digital technology alters the way treatment is delivered, and as patients with longer lifespans need more intensive care in their later years.

I know it will not be easy to devise a more rational scheme of compensation, with doctors held more accountable for costs and outcomes. Nevertheless, it is essential that we recognize the unintended (and negative) consequences of physicians’ traditional roles and the outdated structures within which they have become organized. Unless we deal with the incongruities and contradictions in the way physicians are compensated, our healthcare system will not be able to consistently deliver the superior care to which patients are entitled.

Lawrence

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