STATE DOCTORS.

Dominion, Volume 7, Issue 2000, 6 March 1914, Page 3

STATE DOCTORS.

MEDICAL Mm AS SALARIED OfFICIALS. position in mum. \ "A'oiv that, the . Inanrauce Act has been in full.opei'atieii for nearly a yoar, tho attention of the public is gradually being drawn to tho fact that its passage baa constituted a revohrtion in tJi* conditions of medical praetict;,'-' writes-the London "Morning L'ost." "Already for 14,000,000 members of tlw public' ttio days or ordinary private metrical prattico have gono for cvor. There arc abundant indications that it is only H question of time when ones party or another will extent! the operation of the act so as to bring within its ssopo tile dependents e-f thqsa who a«s already compulsorily insured. AVheM this has been-done, some 40.000,000 of the 45,000,000 oF Great Britain will have bren excluded for ever from, ordinary private practice, It is fairly evident tliat tho present panel system is an. attempt to combine tho advantages of tho contract system with sorao of those ot private. practice. Tho compulsory levy made; on tho insured person, and' liis release from any res.pMis.ibi.lity for bills for ordinary .mfldjeai attendance, ai'o commonplace features of A cb'iitt-aeS practice on tho one hand, On tho other the recognition <jf fho principle of the freo choice of. jnedioal attendant, in «o lar as/ it has ha-ai - granted, incorporates one of tlie most attractive 'feature-3 of private , practice, and was iiidud&d. in the act because it was felt that it would bo possible by no other moans to reconcile the public and the roedieal profession .to the j)«r raothocls of practice. Over large areas of the country insured persons have practically tlie same choice t'hsit they enjoyed before, and the outstanding feature, of tho present panel system is the comparatively frce-choico that is at present assured.-'' ,

"Since the report of the Poor' Law Commission tho question' of a : Stato medical serviec has repeatedly bei?n brought .before the .notice of the '-public. Professor Banjamin Moore ,tdvocated it with conspicuous ability this year in tbo rooms of the Jledical Society, aitd.when the British Medical Association met at Brighton a meeting of State Medical Service Association was held, in .connection, with it. Since '. tjwa o medical paper has been established, the 'Medical World,* wliioh lias.aißoiig ite objects, the advtf&aev of the organisation of the medical prolossioni by the State. The exponents of this ideal have showa that.it is. possible to present it in ji very favourable- light iotlaafulblic, and. indeed,',to the' members of the medical nrofession; but a'pflii! ; t,ttot slwul-cl be borne in mind, bot-li by the yiitblie atid the medical- p.r-ofessitti, ■is tiitii no ona has yet shown that -,a service, of this kind is compatible with .anything liK;i> free choice. If oiicc a wliolq-tirac inedinal service were sk£ up on a. salaried basis the' Govejftment, or those- responsible for its organisation, VfbaH have to consider primarily, the population • and the number of doctors whdeo'uid servo it. It is hot coneeivaiile. that they could' allow the- more popular doctor lo_ iin> dertake more than his hit sfo.Vo of tho work. Such a.. praeticJo weuld coiiflifit with all civil s.ervioo ideas,' atid Inevitably so. Their duty .would bo to a&» cato the patients; «'f a. ecrtaj-n flistrkt to the doctor of doetors that district. It is this questimi of ehoiee of doctor that i's.&e qi:Hx.o?.the.-ffhplft business. Ifc is uiinoee.ssary at this sta«t* to examine the view tafceii of it b.y acs' demic.debaters.. The point that at the present moment, as a Matter of practical politics, concerns the.eoitiitry is vfhatlwr the medical'profession as a v« - iioVo,. alid tho public prefer a systeiu like the panel system with its : ■ eampafatively fk-o choice -of doctor to a whole-time .system in which there could be no smeh fi'co choice. The public has got within the next few years to takc'Ono sHs or t!i« other, insisting eifcf on tho panel system and a, measiiro of free chflice or a civil service systraM and no freo ehqko.. Tho-matter is one- on .which both tlie medical profession and tke puWie taw a right'to express an opinion, and on which it is a matter of civic dutv. for them to speak oitL 'ft'hilo tile views of the profession -will have carefully- to be considered, tlte responsibility for the ultimate decision- Keg with tho pubMi?., "In coming to a eoiielusioa c.i tii& niatter, it has'to bo remetnbereil that doctoring is' somefcMng' v-ery miiob mdya than a question -of s&jentific attainment, Tlie ideal physician is not only a luaii possessed of technical skill; ho nwst bo a, nian who can inspire Ilia patients with confifcrtoß, ,to whom tho patient will bo wlllisg to tell eveiything. It by.no means, follows that the indoctor will ht>. able to niato this appeal uiiiversally, for is dealing with different t-J-pra of patient fliffercnt types of phisician arc required. Jt is a significant fact that the medical advocates of the.proposal arc for tho most part specialists and pnot'essars; in other words, men wh-6se interest in matters affecting general praetke is essentially. Tlib general practitioners, despite , tlio tact tliai the advocates can offer them fixed fours, a regular income, a regular , jtolkkj. , , a pension, and general security of position, are almost Unanimously- opposed to tho scheme. There itfust surely be some, reason for the rejection of a proposal that has so much in it of material ad' vantage, and it may be submitted that the reason is that thaso- in, daily , con.tact with their realise that tho personal element is of vastly greater importanco than the afiadegi.ite deiaert arc willing to admit.. The , opinion'of tho profession as a , whole fe that il'i-o eJement of competition that enters into the panel system and into- private p-rae-* tive is good'for the profession, and therefore good for the public.

"It.is only unwillingly that the abler members of tho profession have accepted service under tho let, even tliougli in many cases it }ias proved consider* ably to their financial advantage to bo under it. Many haye preferred the freedom and independence' of . private , Practice, and tho- unpopularity of tho Insurance Act among .dootffrs has been almost entirely due to the, way in which the freedom of tile pvofcssiou has bewi interfered with. Uttder a State iireuical Eorvice this freedom—-esccpt passilily in the case of tho vexy weal'thy —would ?so entirely done , a*ay with. There are lew signs. at present that the wedieal -profession would lie willing , to-sacrifico its present ideals for the ideab and -material advantages that are'lrting lwld out under a Stato service, 'flje fsct remains, , however, that iio prefession can perniaucntly resist tlto 4cnla.ada of too public. If the public serronsly ffish to receive their medical attendance at the hands of salaried. -civii_ servants there can be no doubt that private pfflctice will bo replaced, by civil .sofvice."