F. Scott Fitzgerald once said to Ernest Hemingway, “You know, the rich are different from you and me.” Hemingway replied, “Yes. They’ve got more money”.*
I was sitting in a meeting of the Council of the College of Physicians and Surgeons when F. Scott Fitzgerald’s comment came to mind. It’s true. The rich are different from you and me. For one thing they don’t have to advocate for themselves; others will do it for them.
The Council Meeting
The College of Physicians and Surgeons regulates the practice of medicine in Alberta. The College is governed by a Council—13 doctors and 4 lay people—that meets four times a year. And bless Council’s little heart; the public is welcome to observe their meetings.
Ms Soapbox, with her esteemed colleagues, the Whitemud Citizens for Public Health and the Consumers’ Association of Canada, attended the May 31 Council meeting.
Things were going swimmingly until Council reached Item 11.1, Concierge Clinics, then all hell broke loose (in an understated and orderly fashion, these are doctors after all).
What is a Concierge Clinic?
A “concierge clinic” is a private medical clinic that offers “a host of services to clients who pay a substantial annual fee.”** Some services are “insured” ie. paid by the government with your tax dollars and some are “uninsured” ie. paid by the client by way of an annual fee.
(Disclosure: I joined a concierge clinic in 2007 when I moved back to Canada and discovered, much to my dismay, that virtually no doctors in Calgary were accepting new patients).
Why is the College of Physicians and Surgeons concerned?
The Queue Jumping Inquiry exposed the fact that some doctors working in concierge clinics pushed their patients to the front of the colonoscopy screening queue. The bad press generated by this revelation prompted the College to examine its Standards of Conduct governing the ethical practice of medicine. Were the existing standards “robust” enough to ensure that doctors working in concierge clinics met “the College’s expectations regarding delivery of care in these settings?”**
A less delicate way of asking the question is: Were doctors in concierge clinics complying with the standards governing the delivery of publicly funded healthcare to Albertans.
Dr Mazurek’s report to Council
Council staff presented their initial findings in March 2013**but Council was not ready to make a decision and requested an additional review of the standards in place across Canada.
Dr Mazurek conducted this review and presented her findings and recommendations to Council on May 31. Her recommendations were based on the principles Council had (apparently) agreed to at a retreat in Feb 2013.
Suffice it to say that her recommendations kicked over a hornet’s nest (albeit in an understated and orderly kind of way). Dr Mazurek didn’t make it past the first principle before Council members started peppering her with questions:
Why did you use the more stringent standards from Ontario and Manitoba? Why didn’t you go with looser standards from more lax provinces? Alberta’s standards are among the most lax in Canada. Council had asked Dr Mazurek to tighten these standards, not loosen them even further.
Why is this a College problem? (In other words, the government and Alberta Health Services created this mess, let them clean it up). The College regulates the profession and disciplines its members. It owes it to the doctors to make the standards governing their behaviour as clear and transparent as possible.
Maybe we should define bad behavior and then work our way back up to the principles. At this point I had to resist the urge to jump up and say: Hello! Did you read Dr Mazurek’s Feb 21/13 memo? You’ve already agreed to a set of principles.
And here’s the one that took my breath away—Are we introducing discrimination based on a person’s ability to pay? (In plain English: are we discriminating against the rich?) This is what triggered my F. Scott Fitzgerald moment. The rich are different. They don’t need to attend a Council meeting to argue in favour of unregulated concierge clinics. They simply convey their views to a Council member who happens to work at a Calgary concierge clinic and he carries their message for them.
All is not lost
The meeting dissolved into confusion as the doctors debated among themselves. Were MRIs and CT scans “insured services” or not? Should all doctors get “standby pay” or was that a violation of Standard 18 (9)? Is it better to create “principles based” or “rules based” standards? The Council President tried to push for a decision and failed. The doctors were deadlocked. In the end the President resorted to the tried and true tactic of referring the matter back to the staff (again) for further study.
There was one bright light in all the confusion. It came from an unexpected source. Dr Trevor Theman, College Registrar, admonished his fellow Councillors with this: “I’m offended as a member of this College by some of the things I’ve seen in the press and I’m distressed that I’m not getting signals of distress from others around this table. You set the ethical guidance for the profession—the ethical standard…” His words hung in the air. No response necessary.
The rich have more money, but…
The rich are different from you and me. They have more money. But we have Drs Theman and Mazurek who are forcing Council to recognize a simple fact–failure to tighten the standards to prevent inappropriate behavior in concierge clinics will send a devastating message to the public about who’s in charge of Alberta’s public healthcare system (Hint: it’s not the public).
Dr Mazurek’s follow up report will be presented to Council in the fall. Guess who’s going to be in the audience to ensure that the good doctors don’t lose their resolve!
*Deirdre N McCloskey, European Review of Economic History, 12, 138-148
**Memo to Council by Dr Karen Mazurek, Feb 21, 2013, available on the College of Physicians and Surgeons website under About Us, Council, Council Meeting Schedule, Mar 7 & 8, 2013