Mock: Should physicians be paid fee for service or salaried?

[Guest sassy101]

Curious what others think.....

 

Should physicians be paid fee-for-service or salaried?

[Guest shrimp]

I think physicians should be paid by fee for service with a maximum number of visits per day. Do you think so?

[Guest bj]

Hi guys,

 

I must disagree. I think fee-for-service has had its chance to shine and has failed. There are drawbacks to other methods (salary or capitation) but they far outweigh the money-grubbing impression that one gets of fee-for-service physicians. The College/CMA have taken major critiques for "protecting" their income by keeping the numbers of physicians low. . .and each physician necessarily has an economic motive for trying to see as many patients as possible within the same time period. I am not saying that quality of care necessarily goes down, but it theoretically would. I personally support some combination of all three depending on the specialty and the setting. I would love to work on a capitation (fee per case) or salary basis at a community health centre. I could take longer for some patients and not feel rushed. Idealistic, perhaps, but that's my opinion.

 

BJ

[Guest phantom8]

I think that this would be a pretty tough question in an interview setting, given how strongly some physicians feel about this issue! Personally, the drawback I see with capitation (especially in a family medicine practice) is that people will only want to accept "easy patients who will only make 1 or 2 visits a year" and turn away the more complicated patients that will require far more visits. Sounds mean but it already does happen -- and I imagine it would get a lot worse with capitation!!!

[Guest shrimp]

maybe I got the definition wrong.:\

 

What's the difference between fee for service and fee per case? I used to think that, for family physician, it's the same! Please kindly tell me the difference.

[Guest Koggetsu]

I think that fees-per-case means that for the same patient, no matter how many times they see the doctor regarding the same problem, u only get paid once.

 

fee-for-service, I think means that u get paid everytime the patient sees u.

 

BTW: Is the current system based on fee-for-service and then capped right??

[Guest Ian Wong]

It's perhaps easiest to break down physician payments into:

 

1) Fee-for-service

2) Capitation

3) Salaried

 

These three seem to be the most prevalent in Canada, with fee-for-service being by far the most common. I've never heard of capitation being described as fee-by-case before; I think fee-by-case is just another way of describing fee-for-service. With that said, maybe someone could do a search on Google.com and post up some of the links and information that they find out on the above three systems.

 

Ian

UBC, Med 4

[Guest aneliz]

While there may be 'money grubbing' at the extreme of fee for service...there is also little incentive to 'hustle' and be efficient in a salaried environment...As an example: all of the pediatricians at UWO are on an 'alternative funding scheme' (ie salary) and the number of patients they see has dropped...to the point where one of my classmates did an elective with one of them and they saw TWO patients in FOUR hours....not a terribly efficent use of time....and would never happened in a fee for service environment...because you sure wouldn't make very much at that speed! But, with a salary you get the same amount of money if you see fifty patients or five in an afternoon...so why should you be constantly running for no extra reward?

[Guest sassy101]

I posted this mock and have gotten exactly what I expected. I have considered every one of the views that you all have posted here! I really don't know what is the best.....I think that all ways have a potential to be abused so to speak ( for all the reasons you have posted here ). I guess overall I feel the same as bj....perhaps it should depend on the setting or specialty etc. I really found this a difficult question and am relived to see others find it difficult too. I'll try to search goggle as Ian suggested and post what I find.