I went to see my family doctor today. It was primarily because of a tiny sore on my earlobe about the size of a grain of rice, and because it was not healing, itching and had bled just a little, I thought it was time to have it biopsied. The doctor had a look at it and because it had persisted agreed that it ought to be biopsied. Now, when I was a general practitioner, I'd have injected a little local anesthetic and as soon as it was appropriately numb taken a punch biopsy. A punch biopsy is a instrument that is like a ball point pen with the ballpoint retracted and a sharp edge. A little twisting movement takes a core out of the lesion, The core is sent to the pathologist for identification and to determine that there are no malignant cells. The patient would have been out of the office in a quarter of an hour and would have had the pathology results in a couple of weeks. The whole procedure would have cost the health care industry about $30 in the fee for service days, but because most group practices nowadays are paid on a capitation basis per year, any procedures such as the above are unpaid. So there is no incentive for the GP to do many procedures, that are time consuming and involve possible liability risk and are unpaid, despite being within their sphere of competence. Instead,such patients are referred on to already overbooked specialists to further lengthen their long waiting list. Of course, this procedure that would have cost thirty dollars in the gp office ends up by costing much more in the specialist's. Injections into the knee and other joints in the fee for service system used to cost about twenty dollars and not only gave immediate treatment and saved the patients many months wait but saved the system much money.
The capitation system pays physicians an annual fee for each patient they have on their register. The physician gets paid the same whether he sees that patient once a year or once a week, whether he does a dozen procedures a year on a patient or none. The only way to increase income is to have as many patients as allowable on the list, spend as little time as possible with each patient and to refer any procedure that takes time no matter how competent you may be to do it yourself. It must be obvious that the temptation to 'cherry-pick' one's practice as much as possible to healthy young families is great, since patients with multiple complaints require so much more time. The administridiots have engineered a system that they thought would be cheaper than fee for service and provide as good care, thereby displaying their lack of understanding and insight.
In case you are thinking the fee for service the decreasing number of family doc on that system gets I'll give you a few examples from the fee schedule.
Minor assessment- $21.70
Intermediate assmt- $33.70
Complete Physical Examination- $77.20
Proctoscopy - $8.70
Housecall - $64
I won't go on, but if you think the health care system hasn't been getting very good value from its family docs you should compare the above with a plumber's fees!
I'd like to hear your comments, if you have any.