Fund hospitals instead of physicians
Re Better pay for doctors won’t cure what ails the system: Cohn, June 26 The following is grounded in my decade and a half experience as the head of human resources for three Ontario hospitals: North York General, Kingston General and St. Joseph’s Health Centre.
Our compensation system for physicians dates back to the days when virtually all doctor-provided services were provided in non-institutional settings. The rich were generally treated at home, whereas “public” hospitals, called such because they served the public but were in fact privately held, not-for-profit, charitable institutions, were mostly for the indigent poor. In this environment, doctors from the local community, as self-employed, fully independent contractors, would be invited in to provide medical services, generally for a modest fee negotiated between the physician and the hospital, later charged to the patient’s medical insurer. The legacy of this is that nurses and support workers are considered hospital employees, whereas doctors are still considered contractors.
The introduction of single-payer socialized medicine in Canada both institutionalized this anomaly and made it much worse. Hospitals lost what little financial leverage they had over their in-house medical staff, and currently receive no government funding to pay their physicians, or not pay in the case of unnecessary or financially wasteful procedures. Physicians, who in Ontario bill OHIP for their services, are essentially a law unto themselves, virtually impervious to managerial control and discipline, even in egregious cases of personal misconduct.
It is inherently untenable that, in our ossified health-care sys- tem, “physicians inevitably play the role of gatekeeper: ordering tests, writing prescriptions, booking followup visits, referring patients to other specialists.” The solution is a simple one. Take all medical services provided inside hospitals, as well as in other institutions whose operating budgets are now funded by the Ministry of Health and LongTerm Care, and transfer the funding envelope for those services to the institutions using them. This would allow hospitals to take control of and become more financially accountable for the activities that occur within their walls, as well as allowing them to break the physician stranglehold on in-house medical services by pioneering more innovative and less costly means to deliver services: more salaried workers, physician assistants and advanced practice nurses, for example.
Finally, in no other industry and in no other corporate environment does the hired help get to dictate to management how to run their business. Edward Ozog, Brantford, Ont.