DOCTORS’ SALARIES Reform Of Payment System Urged

Press, Volume CVIII, Issue 31681, 17 May 1968, Page 20

DOCTORS’ SALARIES Reform Of Payment System Urged

(New Zealand Press Association! WELLINGTON, May 16. A radical departure from the present system of paying doctors’ salaries was suggested to the Royal Commission on salary and wage-fixing in the State services today.

Instead of the present annual salary system the State should pay hospital doctors a fee for every service performed.

This was advocated by the secretary of the New Zealand Medical Association (Dr E. Geiringer). Dr Geiringer said the present system of salaries paid by the State through hospital boards had proved inappropriate and had resulted in bad medical care. Medical education and research also were hampered by the present “obsolete” system. New Zealand had been deprived of what every other country had found necessary for the healthy development of academic medicine —that is. independent university hospitals ruled by autonomous boards determining their own conditions of employment. “The predictable result of this meddling by the State in matters which are outside their competence has been that the Dunedin medical school, which was an international asset before the Government started to interfere, has now become one of the worst medical schools in the Commonwealth,” said Dr Geiringer. Extra Patients The salary system enabled hospital boards to save money by understaffing. Dr Geiringer claimed. Doctors were forced to skimp services to individual cases. Under a fee-for-service system an employer could not save money by squeezing extra patients into the time unit and a trend would therefore be created for the employment of sufficient numbers of doctors to provide a proper standard of care. The salary system distorted the interplay of demand and supply. It not only lowered

standards of care for hospital patients, but it also inhibited the increase of specialist hospital posts. The hospital specialist who has been induced to give skimpy service to an excessive number of patients for insufficient pay in the public hospital must raise his private fees in order to extract a living from a diminishing number of private patients. Waiting Lists Dr Geiringer said that there was naturally a resistance among many specialists to pull their weight to the full extent in the public hospital and thus impoverish themselves. This was a contributory cause to the length of hospital waiting lists. The State should not attempt in any way to lay down criteria for the fixing of wages or of conditions of work in academic institutions, said Dr Geiringer in his submissions, conclusions and recommendations. The wage and staff structure of medical academic institutions should be a matter for their own determination and experimentation within the limits of a total budget Doctors providing medical care for individual patients could never be part of a State service, said Dr Geiringer. New Conditions Their services are rendered to individual citizens to whom their undivided responsiblity must lie. All those practising doctors

should be paid by fee for service and their conditions of employment should be readjusted to establish clearly their direct responsibility to the patient. As part of the new arrangement the relationship of master and servant between hospital board and doctors should be done away with. Junior medical hospital staff should be paid by salary at a rate below parity and the right to proper training should be safeguarded as an essential condition of work.

Dr Geiringer said the medical profession should be represented on the committees which determine methods and rates of pay and conditions of work of doctors. Postal Ballot But instead of representation by the Medical Association of New Zealand he wanted representatives to be chosen by secret postal ballot amongst all doctors on the New Zealand register. Approximately one-third of the 3000 doctors working in New Zealand received State salaries and the remainder were in private practice. Dr Geiringer told the Royal Commission,__ Genera] practitioners in the private sector received a State fee for each medical service (about half their total earnings) and many held parttime hospital appointments for which they received a State salary. Private specialists received the same State fee as was paid to general practitioners, but it was not a significant part of their total earnings. Most specialists also held appointments in public hospitals for which they are paid a salary by the State.