Corporate Medicine

I read on smh.com.au the sorry story of a GP who signed up with one of the corporate medical mammoths and later got chewed up by the same monster. It sent a tingle up my spine to think I nearly went the same way 10 years ago.

In 2001, 2-3 weeks after I opened the door of my GP practice in Avoca Street Randwick, a highly ranked representative of a medical corporate appeared. He sat in my waiting room for about 30 mins, counting my clients like sheep - well, I saw only 10-15 patients per day at that time. Then he came in to see me and told me to either sign up with his business or get out of town. He told me I would not survive here.

"We buy you out, or you join us. We don't want this practice to be here."

He offerred to pay off my debts, all of them (Yay!).
The condition was I would have to work for his boss for 5 years (Boo!).
He would look after all my income issues (Yay!).
I just had to work HARD - including odd shifts in odd places (Boo!).
After 5 years, I would be able to leave (Yay!).
However, I ought not to open a practice within 5km radius from any of his centers (Boo!).

The temptations were there. The only problem was I hated the way the guy spoke to me. He and I are both doctors. There usually exists a fraternity mutual respect between decent doctors. This guy got nothing. He was one big fat business bully!

I politely showed Dr Bully the door and promised when my business collapsed, I would consider calling for his help. He looked at my empty waiting room, threw a wry smile and said he'd get my call in one month.

Ten years on, I am still struggling to make ends meet. I don't like the car I drive, an old Honda - no Mercesdes, not even a BMW. I don't like the butterfly in my stomach every time I read the loan statements.

But I like the way I work - as my own boss.

I can spend 1 minute to give a script or 1 hour to calm down a distressed newly widowed man. No receptionists can knock on my door to hurry me up. I do home visits. I joke and laugh with my colleagues and staff. I walk out to a quick lunch even when there are people waiting for me - I can't help them if I am too hungry to think.

It is sad that medicine is going down this corporate path. It is a big machine that mows down all health funds, for little results. But it makes big bucks. Simple. You go there, your GP sees you then almost immediately refers you to the Xray specialist in the next room who also belongs to the corporate. You take the report to your GP. He refers you to the physiotherapist who also belongs to the corporate. Tching! Tching! Tching! ... within less than 30 minutes, the mower chomps down 3-4 transactions from Medicare and other health funds. And you, the corporate's valued client, bounce like a beach ball between the rooms in that beautiful corporate building. Whether you get better is not the issue. Your job is just to keep bouncing.

Sure the contract says the doctors can have autonomy. They supposedly can do what they like. But if they follow the herd and refer as often as and as many as they can to pathologists, radiologists, psychologists, whateverologists of the corporate, then the corporate will let them work in more agreeable environment - longer holidays, perhaps.

I just now read the article about the late Dr Bill Marchione. I knew Bill well, he graduated in my year. That was just terrible the way he ended his life. We doctors should never be sucked into a cut-throat business like this.

In the current climate of Ms Nicola Roxon's "health care reforms", my business might collapse. But I'd rather go to CentreLink than work for CentreStink.

And to Edmund, Primum non nocere!