Chapter Nine. A Frustrated Profession

"Whatever crushes individuality is despotism, by whatever name it may be called." John Stuart Mill C H A p T ER N I N E A Frustrated Profession TIN every compulsory set-up, the overwhelming majority of the medical profession lives in a never-ending feud with the administrators and their political backers. The feud may be simmering at one time or erupting at another, but this domestic Cold War is being carried on by both sides with a bitter, time-consuming intensity that diverts a great deal of energy into a totally unproductive channel. A REVEALING The following conversation, in June 1949, CONVERSATION with a distinguished member of the Netherlands' "social" bureaucracy is worth re cording: - "How much do your general practitioners earn?" A. "They are paid a capitation of 4.68 florins for each potential patient registered with them." - "You mean to say that the doctor receives a per capita fee of about $1.60 a year in American money?" (This was before the September, 1949, devaluation. It is $1.10 at present.) A. "That's it exactly."

- "How can he live on that?" A. "You speak like a doctor. He can have as many patients as he can handle." - "How many general practitioners are there in the country and how many members in your panel system?" 80 81 ] A FausTRATEJ> PROPES SION A. "Out of the total population of9}-'2 millions, the panels cover 6" million people and there are about·" 6,000 prac titioners." - "That gives an average of 1,000 patients per panel doc tor, or an annual income of some $1,600 for each ($1,100 by now). Presumably some have more and some less patients which still leaves the question open on how they exist in view of the fact that the' cost of living in Holland, controlled as prices are, is not very much lower than in the United States." A. "Well, the doctors should get what they need from their private patients. There still are some' 3~ million people left who are not panel members." - "What about the doctor in a working men's district where everybody is registered? He cannot have many private patients to speak of?"

A. "Then the number of his panel patients is the greater. Some of them have 4,000 or more." - "If so, how much time can a practitioner devote to each of them?" A., "We figure on an average of three minutes per consul tation. What is wrong with that? An experienced physician does not need more time on the average." - "That includes the time devoted to paper work such as filling out forms for sending the patient to a specialist or to a hospital, writing out prescriptions, etc.?" A. "It does." THE Private practice constitutes the professional MEDICAL Frontier under govemmentalized medicine. (Hol FRONTIER land now is planning to extend the scheme to the farm.) As the Frontier shrinks, so -do the profession's chances to supplement its earnings from, outside panel practice. What is more, its bargaining power vis-a-vis the govemmentalized set-up shrinks. More and more physicians become economically weak. in the literal sense and have to accept the terms offered or imposed by an all-powerful monopolist. They face a single. organization that "bargains"