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NEXT time your doctor orders a blood test, refers you for physiotherapy or even sends you to a private hospital, ask whether he's making a buck out of it.
Chances are your doctor will be getting a kickback, payment, a shopping voucher, a share dividend or even help with the rent from the company he's referring you to.
And before you leave the surgery, you might also want to find out if he's about to sell off to a drug company information about the drugs he's just prescribed you.
We all like to think our local GP is honest and hardworking and devoted to his patients rather than his bank balance.
And the majority of doctors probably are. But the medical press has recently lifted the veil on large groups of doctors who are treating patients more as cash cows than as sick people who need to be healed.
Take, for example, Dr Johdi Menon who has tried to set up a scheme that would allow doctors to earn hundreds of millions of dollars a year if they sell information about their prescribing habits to drug companies.
"If doctors can make more money, why not?" is his motto.
It's this type of mercenary money making that had Health Minister Tony Abbott complaining this week that medicine was becoming less a vocation and more like a business.
And he's right to warn doctors that the more they treat each patient as a business proposition they can make money out of, the further their standing in the community will slip.
Australian Doctor magazine has reported on a series of disturbing new money-making enterprises being pursued by doctors over the past 12 months.
They include a new pathology co-operative to be owned by general practitioners.
Diagnostic Medical Co-operative will pay GPs every time they order a blood test. A doctor who orders a full blood count could earn up to $27, almost as much as they make from a 15-minute consultation.
The plan raises serious ethical concerns about whether doctors have a conflict of interest and may be lured into ordering unnecessary tests to make money.
Kickbacks for ordering pathology tests are not new to the medical profession.
Already many GPs get help with their rent from big pathology companies, who pay them for space in their surgery to collect blood or other specimens.
But it's not just ordering pathology that pays.
There's another group of more than 500 doctors in Sydney who have joined a co-operative that pays them for referring patients for physiotherapy, massage, podiatry and other services.
Australian Medical Co-operative owns 18 health centres in the city's west which employ massage therapists, psychologists, physiotherapists and skin specialists.
Australian Doctor reports that one doctor made $20,000 just from referring his patients to the co-operative's medical centres last year.
Every time a GP refers a patient to a centre, it makes a 10 per cent profit and nine-tenths of that profit is paid back to the doctors.
Then there are the 200 doctors who have signed up to a marketing company scheme which pays them in cash or shopping centre vouchers for handing over computer data about the drugs they prescribe patients.
Privacy Commissioner Karen Curtis has given the green light to the practice, ruling that because the information is de-identified it does not breach privacy rules.
The Australian Medical Association has raised concerns about the practice, not the least is that it makes it easier for drug companies to direct market to GPs. But it's done nothing to stop it happening.
It's not just general practitioners who are on the take.
Many specialists own or have shares in the private hospitals to which they refer their patients and, by sending you to their hospital, they earn money not just from the surgery they perform, but also from the business they bring their hospital.
There are now hundreds of Sydney doctors involved in these money-making schemes that are possibly never disclosed to their patients.
And, apart from a few squawks from the AMA, there has been no serious attempt to deal with the serious ethical issues each of them raises.
How can a patient be sure any more that they are being referred to the best pathologist or the best physiotherapist instead of the one that generates the biggest return for their general practitioner?
And how do they know the full blood count or urine test ordered by their doctor was necessary and not just a money-spinner for a GP who gets a kickback for ordering it?
There can be little excuse for this money-making practice by GPs at a time when most are getting a $30,000 pay rise via the increased Medicare rebate.
Mr Abbott is right to threaten doctors that if they don't clean up their acts, politicians will do it for them.
The law now forces financial planners to disclose any commission they get for recommending a product.
It's time the law forced doctors to disclose the commissions they get from pathology companies, allied health co-operatives and drug companies to their patients.
It might not clear up the ethical issues, but it will bring these practices out into the open and patients can judge for themselves whether it's good health care or just good business.
This raises some interesting issues, because it not just GP's who are getting in on the act. What about the Allied health sector as well?
There is a large group of practitioners operating in Victoria and NSW doing a similar thing whereby their pay rate (a % commission of billings) is raised or lowered depending on the amount of inter-practice referrals they write that month.
And what about Pods receiving a set commission on casted orthotic devices? Even if they are paid a flat % of their billings, its in their best financial interests to prescribe a $ 500.00 casted device rather than a $ 75.00 off the shelf device.
It all comes down to the Medical practitioner’s ethics and their ability to make decisions based on patient care rather than their own pocket, difficult for some I grant, but essential if health care wants to be affordable to us all.
I agree there are some serious issues raised when GPs and other health professionals engage in these practices but I can also see some things from the GPs perspective.
As one example, many of the GP's clientelle require regular blood tests and at the end of the day it doesn't really matter where they have the blood taken so why shouldn't the GP make some extra money from it? We are, after all, a capitalist society and medicine is not protected from that. Perhaps it may turn out for the better as GPs may be less concerned about the time they spend with patients eating into their daily wage which could lead to better health care.
In addition, if the patients are aware the GP receives money, does that negate the ethical issue? This seems to be what parts of the article are suggesting.
As for the prescription habits of GPs being sold to pharmaceutical companies - isn't this data supposed to be monitored and collected anyway?
Aside from this, as Stuart has already mentioned, podiatry has its own ethical issues to deal with - the prescription of orthotic devices has a very dark past and it has and will take a very long time before the general public sees orthotics as more than a money spinner.
Perhaps we should clean up our own corner before pointing the finger at another (generally) hard-working profession trying to earn a living by helping people. That is, after all, what 90% of health workers enter the industry for.
Putting your GP's honour to the test
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