Bioethics Blog Posts Tagged students

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Fee-for-service: an ethical conflict

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Source: Impact Ethics: Making a Difference in Bioethics.

Excerpt:

Andrew Mitchell suggests that innovative institutional changes are needed to sustain universal healthcare in Canada.

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When Canadian provinces instituted universal healthcare, doctors were reluctant to become salaried employees, so a system of fee-for-service was developed. This payment model creates incentives for physicians to focus on quantity instead of quality of care and turns patients into bits of piecework. Indeed, most of us have experienced the whirlwind consultation with a doctor eager to get to the next patient.

Fees for specialist services are greater than those for family doctors. This encourages physicians-in-training to specialize and reduces the supply of family doctors. On average, doctors in Canada earn over $250,000 annually. Specialists often make twice this amount. Some specialists earn more than a million dollars a year. These kinds of salaries encourage individuals to enter medicine for reasons of high income and status, rather than a true desire to serve those who are sick.

Healthcare services are expensive and so they are rationed by provincial governments that restrict both the numbers of doctors and specialists, and the availability of operating rooms and diagnostic equipment. In this way, governments create an artificial, administered market for healthcare characterized by a scarcity of healthcare providers and high costs. This rationing often results in wait times for treatment, with some patients waiting for more than a year in pain and distress.

Physician associations have bargained with provincial governments and received benefits for doctors that usually would be considered employee benefits.

Read more at impactethics.ca
The views, opinions and positions expressed by these authors / blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

The Knick by Gregory Clark

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Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

Excerpt:

“The More Things Change, The More They Stay The Same”

When I first watched The Knick two years ago, it seemed like a show about the past and the rapid pace of medical discoveries in the early days of modern medicine, before antibiotics, when patients were still brought into the hospital on an ambulance pulled by horses. When I watched the fictional Dr. Thackery using electricity for the first time in his operating room, I couldn’t help but sit back smugly and marvel at how far we have come since those early days of modern medicine.

Now, re-watching the first season of The Knick as a first year medical student in NYC, I’ve found myself focusing more on the similarities between medicine at the turn of the 20th century and today than the differences. Part of my excitement is particular to being in NYC. I get a thrill when I recognize street names, or when they mention the hospitals where I am slowly learning how to be a doctor. In a deeper way though, I no longer see the characters in The Knick as distant, historical figures. The problems that they confront are many of the problems we face in our medical culture today: the pervasiveness of racism; the stigma surrounding mental health issues; birth control rights for women; doctors becoming addicted to their own drugs; and even how to pay for the treatment of uninsured patients.

Now when I watch The Knick, I wonder how could it be possible that we are no closer to solving these problems a full century later.

Read more at medhum.med.nyu.edu
The views, opinions and positions expressed by these authors / blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.