Fee-for-service remuneration

Letters

CJEM 2001;3(1):6-7

To the editor:

Your editorial¹ in the October issue of CJEM appropriately highlighted some of the problems associated with fee-for-service (FFS) payment plans. One of the biggest problems with FFS in any branch of medicine is that it encourages financially motivated physicians to produce "doctor dependent patients," encouraging, for example, visits for self-limiting viral illness and unnecessary re-checks. This flies in the face of the current philosophy of making patients (or, should we say, people in general) more responsible for their own health care and status.

One aspect of your editorial might, however, suggest to FFS emergency physicians that their lives will become significantly easier with alternate funding arrangements (AFA). Like you, we work under an AFA in a high volume, high acuity setting. We are (relatively) happy with our earnings, and our coverage is (reasonably) adequate. We do not, however, have "more time to spend with patients in the trauma room," we still work long shifts without eating, drinking (or, for that matter fulfilling the other end of the oral intake arrangement). We still have 17 decisions hanging over our heads, are constantly bickering with admitting services and disgruntled patients, and the "short snapper" patients are still the most desired because their beds can be freed more quickly. It is the rare shift that we are reminded how much we enjoy our job by an interesting and challenging patient presentation, or even an enjoyable procedure — more often, we are obliged to refer the patient, for whom our skills were developed, so that we can continue to wade through the hordes of undifferentiated patients climbing onto the conveyor belt.

FFS should die, and soon, but there are many other systemic issues that will need to be resolved before our longevity is increased.

Sam G. Campbell, MB BCh
Mary-Lynn Watson, MD
Department of Emergency Medicine
Queen Elizabeth II Health Sciences Centre
Halifax, NS

Reference

1. Innes G. Eat what you kill [editorial]. CJEM 2000;2(4):228.