Hippocrates or hypocrisy?


The renewed call by doctors’ groups to open up pharmacy ownership to non-pharmacists beggars belief given the medical profession’s own experiences with corporatisation, says Anthony Tassone

For reasons we can only ponder, the AMA and the Royal Australian College of GPs seem fixated with pharmacy regulation, urging regulators to open up pharmacy to the same corporate forces that have had such a negative impact on medical care.

The Queensland Branch of the AMA recently made a submission to the Qld Parliamentary inquiry into aspects of pharmacy regulation, stating: “AMA Queensland endorses the Federal AMA position to allow broader ownership of pharmacy businesses. The AMA agrees that control of medicines dispensing should remain the responsibility of registered pharmacists, however the current ownership restrictions prevent the development of healthcare models that could benefit patient care.”

Benefit patient care? It is hard to see how the corporatisation of pharmacy would benefit patient care, and presumably the AMA has no evidence to back that up, given its own criticisms of corporatisation of medical practices.

For example in an ABC Health and Wellness episode titled Trust me: I’m a corporation the broadcaster stated: “Bodies like the Australian Medical Association (AMA) and the Doctors Reform Society argue that under the corporate model, doctors’ responsibilities are towards their employers – the corporation – rather than their patients, with major consequences for patient health and professional satisfaction.

“In a paper put out for its members, General Practice Corporatisation, the AMA said: ‘A corporation’s need to generate profits for third parties has the potential to distort normal professional patterns and lead to less than optimal outcomes for the consumer in terms of costs, convenience and health outcomes’.’

“Further on the report says there are suggestions corporatised medicine results in poorer outcomes for consumers. The AMA, in General Practice Corporatisation, says that:  ‘Some GPs in these medical centres have complained of occupational stress due to a lack of control over the work environment, complex interpersonal disputes, covering for the professional deficits of colleagues, pressure to turn patients over rapidly, loss of personal relationships with patients, [and] professional compromises to meet the requirements of owners’.”

The RACGP joined the AMA’s pro-deregulation of pharmacy chorus in its submission to the Pharmacy Review in 2016, stating: “Claims that deregulation of pharmacy location and ownership rules will result in corporatisation and poorer service provision are unfounded.”

Yet just a few weeks ago the RACGP admitted GPs were turning away complex patients because they weren’t sufficiently lucrative – a clear case of corporate medical practices putting their shareholders ahead of patients.

Talk about Hippocrates meets hypocrisy.

The Federal Department of Health has also published some views on corporatisation in general practice.

The State of Corporatisation: A report on the corporatisation of general practices in Australia found that in a corporate environment “management of the practice may not meet, or may be slow to meet, doctor and patient needs – potentially endangering lives”.

Other remarks the report made include:

  • Large medical practices can also reduce accessibility for patients. A patient will have fewer options about which location to attend if the medical centre is created by consolidating GPs from the surrounding area into the one central practice.
  • Some corporate practices introduce no-appointment systems. Because patients don’t see the same GP on each occasion, they do not build the same relationship with and trust in a doctor over time, and GP’s aren’t as familiar with the family and social conditions of their patients.
  • At its worst, a GP working for a corporate body may not act as an agent of their patient, but of a corporation whose main concern is profits.
  • For any primarily profit-making body there is a strong incentive towards “cream skimming” – establishing a business model that encourages the more lucrative patients while those with more complex needs prefer to attend practices with different models of care.

The AMA and the RACGP have their own issues to deal with in their own sector, yet they seem bitten by the green monster – jealousy. Having relinquished so much control over the terms and conditions of general practice for their members, they want the same poor outcomes inflicted on pharmacy. This despite the absence of any evidence in terms of corporatisation producing improved patient care and health outcomes or job satisfaction for practitioners.

As part of its submission to the Harper Competition Policy Review in 2015, the Guild commissioned the Institute for Choice at the University of Adelaide to undertake a qualitative survey of consumer preferences for community pharmacy relative to alternative models of service delivery.

This analysis confirmed that 89 per cent of consumers trust their local pharmacists very highly or completely. Two-thirds of respondents supported the principle that professionals like pharmacists should own the businesses they work in.

When it comes to corporatisation of primary care, do two wrongs make a right? 

Definitely not when it won’t serve the interests or preferences of patients.

While it would be hard to ‘wind back the clock’ on ownership regulation of medical centres, inflicting poor policy on others is not the answer and is downright flawed logic.

 

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