From Professional to Sub-Contractor - the Swift Decline of General Practice

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From Professional to Sub-Contractor - the Swift Decline of General Practice

Rejoinder to Watts and Pinskier

Kevin White
Senior Lecturer, Department of Sociology, Australian National University, Canberra, ACT

Abstract

I'll start by thanking Ian Watts and Nathan Pinskier (hereafter W and P) for their commentary on my paper 'What's happening in General Practice' (White 2001). Their propositions are as follows:

that General Practitioners (GPs) are centrally motivated by a vocational orientation to their patients
that GPs are in a joint decision-making relationship with their patients, patients who have far more power than I have allowed
that GPs are participating in the information revolution, accessing the net, and using their computers to conduct research on their own practice characteristics.

At the most general level they argue that I have overstated the impact of corporatisation, and that by and large how GPs are remunerated does not affect their performance. As they put it '[t]he issue is not one of ownership but of behavior. It is possible to provide high quality medicine in any well managed setting'.

There is virtually no evidence for any of these propositions, and rather than pursue abstract sociological theorizing about the situation, I will draw on recent papers in the Medical Journal of Australia (MJA) to defend my position. The overall argument of W and P's paper is that things have changed but are not different, and much of their discussion goes on as if the world is not different, with general practice still existing in a sphere of its own. I would argue that corporatisation has significantly weakened any vestiges of vocational commitment of GPs; will have a very detrimental effect on the doctor-patient relationship; will undermine the already minimal amount of research in general practice; and that if anything I significantly underestimated the impact of corporatisation on the health system.

Corporatisation is here to stay and will continue to increase. As Barry Catchlove, former head of the Health Insurance Commission (HIC) and director of Maynehealth, puts it, hoping to stem corporatisation 'would be to do what king Canute proved was impossible - holding back the tide' (Catchlove 2001: 70). The corporatisation of health care from general practices, to radiology, pathology and hospitals has irreversibly transformed the landscape of health care provision in Australia (Collyer and White, 2001). Evidence of how serious this impact has been on GPs is the change in terminology in W and P's paper transforming doctors from 'professionals' to 'contractors' to 'sub-contractors'; a point I return to by way of conclusion. I now turn to their general propositions.

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References

Catchlove B (2001) GP corporatisation: The why and the wherefore, Medical Journal of Australia 175: 68-70.

Chew M and Williams A (2001) Australian general practitioners: desperately seeking satisfaction, Medical Journal of Australia 175: 85-86.

Collyer F and White K (2001) Corporate control of healthcare in Australia, Discussion Paper No 42 Canberra, The Australia Institute.

Costa C (2000) Corporatisation of general practice: A professional viewpoint, New Doctor 74: 1-4.

Fitzgerald P (2001) The Ethics of doctors and big business, Medical Journal of Australia 175: 73-75.

Gupta L, Ward J and Hayward RSA (1997) Future directions for clinical practice guidelines: needs, lead agencies and potential dissemination strategies identified by Australian general practitioners, Australian and New Zealand Journal of Public Health 21(5): 495-499.

Mott K (2001) The Consumer Perspective, Medical Journal of Australia 175: 75-76.

Peterson C (1999) Stress at work: A sociological approach, New York: Baywood.

Schatner P and Coman G (1998) The stress of metropolitan general practice, Medical Journal of Australia 169: 133-137.

van der Weyden M (2001) Australian general practice at a fork in the road: Which way forward? Medical Journal of Australia 175: 62-63.

White K (2001) What's happening in general practice: capitalist monopolisation and state administrative control: a profession bailing out? Annual Review of Health Social Sciences 10: 5-18.

White K (2000) The State, the market and general practice in Australia, International Journal of Health Services 30: 285-302.

Young J and Ward J (1999) General practitioners' use of evidence databases, Medical Journal of Australia 170: 56-58.

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