The following letter was written to the Medical Chairman of a metropolitan corporate medical practice which had bought-out my bulk-billing solo rural private practice several years previously.
(Under Medicare, the government funded payment scheme, a standard fee was set for each medical procedure. Bulk-billing involved charging the government for 85% of that fee, with no charge to the patient.)
I continued to work as a salaried consultant for the company for several years after the sale of the practice, before resigning and returning to the Public Hospital sector.
There was no reply to, or change in practice policy as a result of this letter.
The sentiments expressed in this letter are, sadly, still relevant.
***********
Dear George,
I have been instructed by the General Manager's secretary to write to you to request your consideration of review of recent fee increases at this practice.
Whilst I am aware of the economic rationale for the significant incremental increase in gap payments for private patients at our rooms, I must bring to your notice the unfavourable reaction from patients and referring doctors to this change.
There is a perception in the community that the increases reflect a lack of sensitivity to the financial difficulties faced by the majority of families in our community, the per capita income of several centres in our referral base being amongst the lowest in New South Wales.
The $70.00 gap payment for some procedures at our surgery may make essential purchases (food, school requirements for the kids) discretionary for some families for the week during which that expense occurs.
There is a perception in the community that the decision to introduce this major fee increase is influenced by the monopolistic nature of our practice in this area, forcing a choice for our patients between (what they see as) a major outlay for an essential medical procedure, or no procedure at all.
There is a perception in the community that we should see our unopposed position as a responsibility to the community, rather than an economic opportunity.
This fee increase has occurred in unfortunate juxtaposition with a deterioration in the service provided by this practice.
This is related to what has become permanent under-staffing since the takeover, resulting in unacceptable waiting times for appointments.
The direct result of the company's unwillingness to provide adequate technical staffing is anger and resentment amongst our patients, frustration amongst out referring doctors and low staff morale.
I feel very strongly that the goodwill built up in the medical and general community over the last nineteen years is under serious threat, and that this fragile commodity is in danger of dissipating
completely.
We may be able to survive with reduced service to our patients, but not at increased cost.
And not without me.
Yours sincerely
Dr Benjamin Clibrig.
P.S. Oh, and fuck you, George, you smear of bird shit of the countenance of the noble profession of Medicine, and fuck all your fucking friends.
Ben.
Whilst I am aware of the economic rationale for the significant incremental increase in gap payments for private patients at our rooms, I must bring to your notice the unfavourable reaction from patients and referring doctors to this change.
There is a perception in the community that the increases reflect a lack of sensitivity to the financial difficulties faced by the majority of families in our community, the per capita income of several centres in our referral base being amongst the lowest in New South Wales.
The $70.00 gap payment for some procedures at our surgery may make essential purchases (food, school requirements for the kids) discretionary for some families for the week during which that expense occurs.
There is a perception in the community that the decision to introduce this major fee increase is influenced by the monopolistic nature of our practice in this area, forcing a choice for our patients between (what they see as) a major outlay for an essential medical procedure, or no procedure at all.
There is a perception in the community that we should see our unopposed position as a responsibility to the community, rather than an economic opportunity.
This fee increase has occurred in unfortunate juxtaposition with a deterioration in the service provided by this practice.
This is related to what has become permanent under-staffing since the takeover, resulting in unacceptable waiting times for appointments.
The direct result of the company's unwillingness to provide adequate technical staffing is anger and resentment amongst our patients, frustration amongst out referring doctors and low staff morale.
I feel very strongly that the goodwill built up in the medical and general community over the last nineteen years is under serious threat, and that this fragile commodity is in danger of dissipating
completely.
We may be able to survive with reduced service to our patients, but not at increased cost.
And not without me.
Yours sincerely
Dr Benjamin Clibrig.
P.S. Oh, and fuck you, George, you smear of bird shit of the countenance of the noble profession of Medicine, and fuck all your fucking friends.
Ben.
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