DOCTORS & LODGES

Dominion, Volume 9, Issue 2830, 22 July 1916, Page 3

DOCTORS & LODGES

THE MEDICAL DISPUTE THE CASE FOR THE FRIENDLY SOCIETIES AN OFFICIAL STATEMENT The lledical Committee of the United Friendly Societies of Wellington has issued tiro following reply to the doctors' statement contained in Thk Dominion of .Inly 12:— The doctors, in the opening remarks of their statement, refer to tlio low rate paid by friendly societies to doctors perlorming lodge work. 11l order to make the position quite clear to the public it will be necessary again to detail tho systoui that has been in voguo in the past respecting the payment made to doctors by friendly societies. The doctors receive 15s. per annum for every member, whether sick or healthy, that is to say, a doctor may be paid lor, say, iifty members, yet "he may only have to attend ten. The medical benetits are limited. A lodge doctor is not bound to attend i; lodge member at his own home if such member is physically able to attend the doctor's consultingrooms. All medicines, also all operations, and aceouchements, and the administration of anacstnetics are paid tor by tlie member privately, so that in audition to the 15s. per annum paid by the lodges, the doctors receive many pounds irom members as private patients. Tiio " Friendly Societies' Committee deny that they Ijaye tried to create diversions under a iuass of irriiavance, but say that the Jiritisli; lledica! Association has boen'at great pains to avoid the main issue, and to delude the public into a belief that the question is merely one of whether 'members should contribute 3Jd. 'or ad. per week. This tno committee absolutely deny, and consider it remarkable that it has taken' the doctors, . according to their own' admission, a quarter of a century to come to the conclusion that thoy were being sweated, and that the time to resign was after the war had been raging for over u year, and consequently doctors were, scarce. Lodges Recite the Facts, The doctors resigned their x>ositions, but all desired reappointment under an agreement which tney presented to the lodges demanding 21s. per member, instead of 155., and requiring other payments and conditions. These were considered by the lodges in conference with Vuo doctors, who were asked to accept iSs; per member per annum. This they definitely declined in. writing, stating thai they would not accept less than tho amount stated in their agreement. . The lodges declined to accede to tho demands, and a deadlock resulted, and tho attitude of the doctors to the Wellington societies is shown by the advertisement reprinted below: WARNING NOTICE. ."Medical practitioners aro hereby warned against outering into cou- . tracts with tho Wellington Friendly Societies without'having first communicated with tho becretary of Wellington Division of the British ' lledical Association. "(Sgd.) <J. F. PATTIE, "Hon. Sec., "Wellington Division, 8.A1.A." Notwithstanding this \rarnii)£; one doctor from the South Island entorod into an agreement with the committee, but, on account of the representations of tho British Medical Association, threw up tho appointment after one week's service. In referring to this matter when the doctors interviewed the Hin'sler of Public Health, Dr. Collins stated: "Regarding a doctor that did accept service with tho lodges, tho fact is that ho left of his own accord after, one week's experience of the, situation." In reply to this tho committee hereunder publish tho doctor's own written statements on tho subject, and leavo the public to draw their own conclusions.

"Dear Mr. lvelly,—ln confirmation . of my verbal communication this morning, 1 mil sorry to say I am ..unable to continue m tho position of . medical oflicer lo the institute, on account of tho representations of the Aledical Association. 1 will continue, till to-morrow night, bo as to lessen Uie inconvenience of your members, •which 1 regret is thus caused. "If I stay iu .Wellington I shall be pleaded, ol course, -to' treat patients . privately (.pending 'tho possible settlenieut ol an agreement with tho association). This I understand, members of tho association are, and liavo been doing. "1 have to thank you, personally, and mcmb'ors of , the conimitteo for your kind consideration—Yours '■faithfully, "listened) E. W. SMYTH, M.8." The house for this particular doctor was leased by tho doctor himself, and as he did not comply with the iinancial conditions of tho lease a claim was made agaiust him by the agents, which lie relerred to the Wellington branch or the U.M.A., as the following correspondence UISUIOtiCS: — "i have luid to forego the appointment I came to Wellington to take, as it was banned by the Medical Association, so must let the matter of " taking tno house slide in tho meantime. I only made up my mind at the last minute to come south last night, so was unable to see you. I regret to say, and the sooner I re- • turned to my practice the belter, as 1 was 'one ol the. unemployed' in Wellington. I regret our business relations have not been more satisfac-. tory.—Tours faithfully, "(Signed) K. W. SMYTH, M.8." "Dear Sirs,—!, am in receipt of your letter of March -0. I have also a letter from Messrs. Meek and Von llaast, solicitors, and have replied to them. Both letters I am 6eiuiing to the Medical Association, Wellington, as I understand they are seeing tho matter through for nie. 1 regret, that my position is due.to circumstances wholly beyond my control.—-Yours l'aitlmilly, "(Signed) E. W. SMYTH, M.B. • Dr. Collins also stated that Mr. Burke had stated that the doctors were attemptin" lo boycott friendly Societies, and the doctor said that that statement was totally untrue.. In answer to this the committee publish an extract of ono ot tho complaints madu from Friendly Society members: — "i might state here the kind of treatment I received from Dr. , whom I first went to. He examined my leg for a time, and wrote out a prescription which he hesitated about giving me. .Finally he gave it to mo ami asked aie if .1 expectcd him to book it. 1 told him I wished ho would, but lie said 1 don't know you.' 'Well,' I said, 'you- will get paid.' That didn't satisly him, so I said tho lodgo would seo that he was paid. Ho started raving when 1 mentioned the lodge, and took the prescription out of my hand and toro it up before me, and threw it on the lloor in a rage, and said, 'Now go lo your lodge doctor.' and hastily opened the door and as good as ordered me out. Ot' course .1 was in a weak state at the time, or I would have chosen my own time to leave, and not until after I had told him what I thought of him. As I said before, I was in a weak, state,

and did'nt want to bo upset. ] ]ust told him i thought ho was'ut treating me fair, alui that lie would lift paid his charge for any services lie rendered to inc. . With that 1 was ushered outside. 1 had then to go lo tho dispensary, and they made 1110 up a bottlo of medicine, it was ton late'to go to any other doctor." Or. Collins said that the l.'ricndly Societies did actually boycott the four doctors who represented the executive of the Wellington Division of tho JJ.II.A. in tho dispute when electing by ballot eight doctors to attend lodge members as private patients, 'l'ho committee deny that auy boycott of tins doctors' executive exists. They admit that an approved list of eight doctors was published, but they say that this was in accordance wit'h one of their cardinal claims that the system previously existing was at fault, viz., that too many doctors wore sharing in the work, and the committee believed that if they could limit the work to eight Vit-.'s tJiov would bo able 'to prove con-

I clusivcly by the amonnts paid to tho limited number of doctors that tho Friendly Society work was worth having. As 'this list did not meet with the approval of the doctors, it. was withdrawn, and the committeo say that no other list ill the nature of a boycott exists, 'l'ho payments ■ already matlo to doctors from the pooled funds easily establishes this fact. Dr.' Collins stated that in private conversation with doctors many members epeak in disapproval of the action of tlieir representative. The committco replies that in private conversation with doctors they (tho doctorjs) speak in terms of disapproval oE the action of the B.M.A. Hloreover, on this point every lodgo member was supplied with a circular containing (he whole of the facts, yet no lodgo has withdrawn its representative. The statement that tho doctors were not aware that an oil'er of 20s. was made in writing is just quibble. The doctors mot representatives from tho friendly societies on several occasions for conference purposes. During the conferences tho doctors were asked whether they would consider first an offer of JBs., and later, whon the Hon. Mr. llussell look over the case, 2fls.

The societies say that the report of the Hon. Mr.. Kussell correctly sets forth what took place at the conference over which he presided. It was as follows:— "The Medical Association asked for an increase to 21s. per member. The lodge delegates, after a prolonged discussion at the conference, stated that they would recommend the societies to pay 20s. per member, but tho doctors demanded 215., and as neither side would give way regarding the last shilling, the conference proved abortive. The lodges were ready to accept the other clauses of the agreement proposed by the doctors, involving substantial increases of pay- ■■ nient for mileage, night calls, etc." The doctors after the conference in Loth instances absolutely refused these offers. The societies admit that these were not made in writing, but they were made at the conferences, and if iio notice was to bo taken of tho business discussed at a conference, why call a conferencer 1 In any case, the doctors replied to the Hon. Mr. Kussell, stating that tliey would not accept 205., so that'if the socie. ties did not'submit the proposals in writing to the doctors, the latter submitted through the Hon. Hr. ltussell 'their refusal iu 'writing to accept the 20s. Tho public will see from this that the societies were willing to inako many concessions aud increase the annual "payment per member- by 55., whilst the doctors would only reduce by 3s. their increased demand of 9s. per member. Taking into consideration tne average wage of i friendly society member 'we leave it to tho people to decido whether the societies or the doctors were making tho greatest concession.

The following resolutions of tho B.M.A. were conveyed to the lodges -whilst; the matter was in the hands of tho Minister, and proved tho keen desire of tho medical profession not to lose the. muchdespised lodge work with all its attendant troubles and difficulties. Resolutions Passed. "1. That the Wellington Division of the 8.11.A. cannot recede from its offer of tho reduced rate of 21s. per member per annum for a period lasting until six months after 'the declaration of peace." "2. That this division will not abido by this decision unless the offer is accepted by May 11, 1916." "3. That if the said offer of 21s. bo not accepted by that date, the divisiou will decline,lodgo work at a lower rate thau 21s. per member per annum.'" Tho committee say that tho doctors have given no definite reasons for an increase on 'tho old rate of 155., and contend that the fact that lodges . have hitherto been pestered ivith applications from medical men commencing practice in Wellington requesting appointments as lodge doctors, and they have been perfectly satisfied with the remuneration offered, but it is in this connection that friendly societies have made an error in appointing too many doctors, instead of uniting and confining the work to a limited number. They liavo in most cases acceded lo the request for appointments, so that practically every mau who applies was given ■ a position. Tho consequence is that tho work became divided,.and the "more* doctors that'participated tho less the remuneration, for it stands to, reason that if twenty doctors are doing the work six can perform, and the same amount ia available for twenty as sis, the payment is reduced in consequence. The friendly societies, therefore, contend that so lon» as tho system prevails the doctors will never be satisfied with the remuneration, even if they were paid 30s. per member, which they admit they were going to demand but for the war. The system, therefore, must' be changed, as it is not the remuneration that is small, but the system of appointments wrong. To remedy this tlio friendly societies asked the doctors whether tncy would nominate six of their number to act as lodge doctors, ur allow the societies to nominate six of their doctors to perform the services required by lodges, the societies guaranteeing each doctor ,£SOO per annum, plus tees tor all operations, accoucheinents, and the administration of anaesthetics, i with the right of private practice. This ' the societies calculated they were enabled to do without' raising tho members' contributions one penny, but simply at tho old annual rate of .15s. per member pooled and divided atnougst a limited I number of doctors, instead of an unlimited number as appertained before the dispute. This proposal the doctors turned down, yet they accuse the friendly societies of '.sweating.

At the conference the sweeping statement was made by a doctor that doctors could not live on .£10(10 a year, and the societies' delegate said: "And yet you expect men receiving JIISO or less a year to raise a family and pay these increased demands." No Increase of Fees to Private Patients. The doctors contend that the cost of living necessitated the increase of lodge fees, but they were asked at the conference if they hud increased the fees for private practice; they- replied, ".No." Doctors felt that they bad to give up something, and they were inclined to give up lodge work. At the conference they contended that their transport expenses had gone up, and admitted that they used the same cars for private as well as for friendly society practice, yet they asked the friendly societies to take the* full burden of the extra cost of the I doctors' living and transport expenses. If, as the lodge doctors contend that friendly society work does not pay, why do they adopt.their present tactics? They are adopting the dog-in-the-manger policy of refusing to do the work themselves and endeavouring to block other men willing from taking up the positions which tliey allege are "sweated." They all want to have a share in tho friendly society work—each is afraid that if ho agrees to a limited number of doctors being selected that he will not be one of the chosen, lience in their statement they carefully refrain from touching 011 the system of appointments, but harp on the alleged sweating payment of 15s. per member per annum. The old system, had many disadvantages: maliy of the members complaining that when they visited the consulting room they were treated more as charitable aid 'patients than meml>ers of societies paying for services rendered, and made to feel their position rather keenly. This position has caused more exits from the societies than any other causes. Xiv having their own medical officers this trouble would be overcome, as the care and.attention of friendly society members would be the consideration. The doctors complain of the work involved, but the societies contend that if a stricter examination was made of members on their initiation it is probable tlmt their work would be mucli lighter and the funds of the societies much stronger, for I hey can point to cases wliero members became a burden on the sick funds shortly after passing the doctor. Tho doctors stress tho point that three lodges signed

and ontered into tlioir now agreement. Tlio joint committee believe tlwt the agreement was rushed through these lodges without full consideration and in the absence of a proper report from their delegates. Excerpts from Agreement. The societies contend that the annual rate of 21s. or 245. per annum per member asked for under the new agreement submitted by the doctors was more of a red herring drawn across the scone during the controversy that has taken place between both parties, and that whilst the societies were willing to agree to the other clauses they would liavo proved most irritating and annoying to members,

and it is doubtful whether the conditions imposed would have been for long tolerated by friendly-society members. Under tho old agreement 'he societies paid the doctor us. tor u new member for the first quarter, whether the member was examined at the beginning or towards tho cud of tho quarter. Under the new agreement they asked for Bs. !)d., 75 per cent, increase.

Another new clause in tho ngTeement is that provided for the re-exammation of a member who, by some circumstances perhaps unfortunate, over which he has 110 control, has been taken off the doctor's list. He cannot be reinstated unless he is re-examined, for which the doctors charge 3s. (id. whether ho passes or not, making a payment to them for that particular quarter of the sum of Bs. (id., plus payment of all arrears at 3s. 9d. per quarter during the period he was off tho doctor's list, and fur which no medical attention was given. Under the _ om agreement a member could bo reptaceti on tho list without the payment ot arrears and no re-examination. _ This clause would bo extremely irritating in its working. A member may nave been a member of a lodge for -0 years and paid his contribution regularly. -lio loses his employment or meets with somo misfortune which liliancially embarrasses him. Jio lalis behind with his contributions, aud. is temporarily taken off the medical list. He manages after a lapse of nine months to improve his financial condition, and pays up his arrears, tie nas to be re-examined bv the doctor, and as a result limU time after 20 years ot health he not > ov; sound, and is rejected. I'-.i! ,lumber and Ms family is deprive u.- ail lime, of medical attention as a lodge member at a time when most in need of it, and.lias actually contributed to the doctors 20 years contributions, for which he receives no benefit. What' position do ■ friendly societies find themselves in in such a case? ... i Another clause which the societies do not agree with is that providing that no lodge doctor shall consult with any other medical practitioner ineligible for membership of the British Medical Association. Clause 14 provides for the payment of 3s. per mile per visit from 8 a.m. to 8 p.m. for every mile or fraction of a mile in excess of two miles, and ss. per milo from 8 p.m. to 8 a.m., when the doctor'is required to visit a member living beyond two miles of the doctor's residence. This is in addition to the 21s. per annum, r.nd is demanded by the doctor from .the member concerned. Another clause which is irritating is number 2G, which provides that for every visit made by the lodge doctor between tho hours of S p.m. and 8 a.m. to a member, a fee ot ss. is chargeable, in addition to the 21s. per anntnn. This brief resume will give the public some idea of the monetary demands thai may be made by the doctors in addition to the annual payment of 21s. per member. Tho societies do not want Ministerial aid, as asserted in the doctors' statement, they are quite capable of managing their own affairs; but what they do want is protection for their employees—four fully-qualified- medical practitioners to whom will be paid, without involving one penny additional expenditure, adequate salaries for the work which tho local medicos will not do. In conclusion, the societies contend that their payment is adequate, and is much superior to many of the medical officers' salaried positions in this Dominion, and they contend that they arc not justified in keeping to' a,system that is unsatisfactory to both 1 parties; nor would they be conserving the interests of their members were they to continue the old system at an increased cost when they can work on a much better and more satisfactory system without extra cost. As business men, entrusted with the management of a commercial concern, they must study their members' 'interests, and intend doing so, notwithstanding tho threats and fury of the British Medical Association.