The Employment Dilemma for Consultants Private Practice in the UK
‘Should I stay as a private practitioner or give myself up to employment’?
After a lifetime in healthcare, both in the public and private sectors of the UK, I never really thought that the time would come when I would see that a change was needed in the way that the private sector handles the application of private consultant practice.
Since the Dr Shipman scandal, consultant physicians in the UK have been subject to a wave of change, at times bordering on significant criticism of the way they practice both in the NHS and in the private sector. It’s hard to think of another group of healthcare professionals who have endured the onslaught from the government, the regulators, their NHS masters, and indeed anyone that feels the criticism is appropriate, and yet some of those critics have little understanding of what consultant physician practice really entails and the pressure and responsibility that go with the job.
In the private sector of the UK, things are becoming complex for the consultant, his practice costs are spiralling and his practice revenues are falling.
Medical defence costs have spiralled out of all proportion over the last 3 years. A consultant in spinal surgery, for instance, will more than likely have seen his defence costs triple over the last few years to well over six figures. Those who specialise in complex surgery will have seen the same happen, and some consultants are being refused defence cover as their practice is judged to be risky, or in other words, costly. This, combined with the rising costs of practice facilities, the costs of administration of a practice and the fact that the Competition and Mergers Authority (CMA) has removed the financial support they used to get from private operators, makes the lot of the consultant pretty miserable at present.
Added to this cost pressure, there is a decided trend towards lowering reimbursement from health insurers. The top-line revenue for any consultant practice is under significant pressure, and the relationship between some of the major UK insurers and consultants could be argued to be at an all-time low.
I was speaking to a group of young surgeons at London’s well-respected Royal Free Hospital recently who were close to moving into the consultant grade. When asked if they were considering developing private practice alongside their NHS work, the response was a decided no. They simply said they could not afford the cost of private practice, and the reimbursement for new consultants from one UK insurer was deemed to be too low to make this an attractive proposition. So, it looks, at least from my straw poll of young doctors, that the new feedstock of consultants into the UK private sector will diminish. Not a good sign, really, for those of us who wish to have ourselves and our families cared for in the independent sector.
Is there an alternative to the application of private practice? Is there an opportunity for a consultant to still practice privately but without the cost pressures and the trend towards diminishing revenues? Is this the time for a consultant to consider employment in the private sector?
As little as five years ago, had I mentioned to any consultant group that they should consider being employed by a private hospital organization, I would most likely have been turfed out of the room! But things are different now and time has moved on, and one may wish to consider that the long-honoured practice in existence for over 50 years whereby consultants bill a fee for service alongside the hospital facility fee is more than likely not fit for purpose. Private patient episodes can generate multiple bills for the insurer to settle. Under a system whereby the consultant is employed by the hospital, the insurer gets one bill. Good for the insurers. But those rising practice costs currently borne by the consultant, especially defence costs, disappear, and become a cost to be borne by the hospital. In a similar vein, the hospital will assume responsibility for the application of medical governance concerning the practice of the consultant, and surely any consultant in single-handed practice and even those working in groups will welcome the support of such a change. So is it time for the consultant to move under the protective umbrella of the private hospital organisation by obtaining employment? Some will argue otherwise and some may be right but I think the time has come for the consultant to consider his practice under a different organisational structure. Employment within the private sector may be a worthy consideration.
