CMPA fees
CMAJ 1997;156:1378
In the article "Dubin calls on CMPA to eliminate fee differentials, adopt flat fee for all physicians," CMAJ 1997;156:685-7 [full text / en bref]), Justice Charles Dubin suggests that "in the spirit of collegiality, physicians should equally share the responsibility of the cost of professional insurance." I suggest that, in the spirit of reality, we keep our malpractice insurance regulated by actuaries and based on group risk.
There are many inequities in this world, but it is not for the people at the bottom of the decision-making ladder to have to smooth them over. Government, which ultimately pays physicians in this country, and medical associations and registration bodies, which are involved in the regulation of the fee structure, need to ensure that physicians in high-risk groups receive more money to be able to afford their malpractice coverage.
We cannot allow the legal system and litigants to remove huge sums of money from the medical establishment in the form of claims settlements without realizing that we will have to pay more into the system. If we practised under a private fee schedule, patients requiring the services of a physician in a high-risk category would have to pay more for that service because of the insurance costs involved. The answer appears simple. Pay the high-risk physicians more so that they may insure themselves adequately.
Finally, I assume no one needs reminding that we already have a differential fee structure. As the pay differentials are adjusted over time, the cost of insurance should be taken into account.
Christopher J. Galanos, MB, BCh
Radville, Sask.
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