Looming Physician Surpluses? Drs. Peter Walker & Michael Guerriere suggest conditional billing numbers – Everything old is new again

In their Longwoods publication today, Drs. Peter Walker and Michael Guerriere talk about looming physician surpluses? In the context of managing healthcare costs in Ontario they suggest that:

“There is also a serious physician distribution problem across the province, with oversupply in some locales and specialties, and significant shortages in others.

Today, newly qualified physicians receive an OHIP billing number automatically. A rookie doctor bills the same rates as a world renowned expert in an academic medical centre. Both of these policies need to be reconsidered. Perhaps new physicians should practice in areas of the province where there is a demonstrated need for their services and should receive conditional billing numbers. Differential pay based on demonstrated quality and experience would also allow the government to control cost increases while rewarding quality at the same time.”

I have argued all the way back to 1998 when I was still a medical student (having finished my graduate training in Health Policy and Bioethics under Dr. Bernard Dickens) that:

Before the government can adopt a regulatory policyof toying with restricting physician-billing numbers in over-serviced urban area or based on age, it must fully assess the ethical implications of restricting a physician’s ability to practice of medicine.

In 1998, I published the following in the University of Toronto Medical Journal (Moving Doctors north 1998 Kaplan): “Even though a constitutional right to practice one’s profession does not exist, an examination of government attempts to restrict physician billing numbers in urban areas has indicated a basis for such a moral right, at least a limited one. Employment is an essential vehicle through which society allows a person to become a constructive member of that community, and one who contributes to the overall good. While not constitutionally protected, the government must have good reasons for disregarding this moral claim.  As Dr. J. Armstrong, then-President of the Canadian Medical Association (1996), put it: “The fiscal health of the nation should not be cured by detrimental changes to the health of Canadians.” According to Raisa Deber, the key problem in Canada is not the current or past fiscal austerity. The economy of Canada has been steadily collapsing since the 1960s; every year, the total GDP per capita has declined. Thus, even though health expenditures have increased, the GDP has decreased. While this ratio (health $/GDP), has become larger, closer examination of the data indicated that Canada spends less money per capita than Japan on health care. Yet, Deber (1996) asserts that, “If we don’t change soon we won’t be able to sustain our system.” The issue now is appropriateness; what are the appropriate measures that government and the medical community take in order to make the healthcare system more efficient. ‘Band-Aid’ solutions to fee-for-service medicine are inappropriate when the system has ‘cuts that needs stitches’ and ‘ limbs that need amputation’. We need to look for other forms of health care delivery; capitation, integrated system delivery or other managed care models need to be examined for their appropriateness.” It think it is time for me to revise this piece of scholarly work for 2011 (13 years later) and have it submitted for rapid publication!