Margaret McCartney: Direct patient care should be rewarded and cherishedBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k948 (Published 05 March 2018) Cite this as: BMJ 2018;360:k948
All rapid responses
Margaret McCartney makes the comment that some doctors are paid more than others and cites those running multiple surgeries whilst employing others to do "the important work".
However, without the entrepreneurship of the managing partners there would be no general practice from which the salaried GPs could do "the important work" as she puts it.
Not everyone can be a doctor and not everyone can be a successful business person. NHS General Practice needs both and it is facile to suggest that doctors who derive income from being successful in the business of General Practice are in anyway less moral than those whose income is derived from delivering face to face consultations.
This is the sickly sweet trap of 'medicine is a vocation' that promotes the view that we should give our labour for free just for the joy of it, a view endorsed by the public egged on by J.Hunt & Co.
In today's labour market for GPs, those doing the "important stuff", in this practice at least, have a higher hourly rate than those paying their wages by running the business.
If we are considering value for money, this was a cheap shot, Margaret.
Competing interests: GP Partner
Dr. McCartney addresses an important and uncomfortable topic: physician reimbursement in the UK. This subject rarely makes its way into medical journals. Perhaps, it's because "there is honour among thieves." Be aware that physician greed is more flagrant in the U.S. than it appears to be in the U.K. I looked at Medicare reimbursement in the Massachusetts county where I work and found that for cryotherapy alone one it varied by >25 times. This was just the amount paid by Medicare for this one procedure and did not include Medicare payments for other billing codes, not to mention other insurance carrier payments. Physician greed is a serious problem here that professional journals are reluctant to address. Our Center for Medicare Services makes it easy to track physician reimbursement. If any reader is interested, see ProPublica's Treatment Tracker ( https://projects.propublica.org/treatment/ ). Osler wrote, "The practice of medicine is an art not a trade, a calling not a business." Few heed his words.
I will share my data on CMS payments to dermatologists in my area of Massachusetts with any interested party.
Competing interests: No competing interests