The Centre for Innovation in Complex Care hosted a debate on April 8, 2011 focused on the resolution that “the single most important step in improving hospital quality is having physicians paid and employed by hospitals.” Healthydebate.ca covered this issue on April 6, with a story on How Hospital Doctors Be Paid?
At the debate, Kevin Smith, President & CEO of St. Joseph’s Healthcare Hamilton argued for the resolution, and Ron Sapsford, Chief Strategist for the Ontario Medical Association argued against the resolution. Bob Bell, President & CEO of University Health Network moderated the debate. Andreas Laupacis and Terry Sullivan, of healthydebate.ca judged the debate, and found no clear winner.
The debate continues
Short videos summarizing the pro and con arguments from both debaters, as well as some comments from the moderator are below.
Kevin Smith, pro: the single most important step in improving hospital quality is having physicians paid and employed by hospitals.
Ron Sapsford, con: the single most important step in improving hospital quality is having physicians paid and employed by hospitals.
Bob Bell, moderator of the debate.
The comments section is closed.
Physicians have traditionally attended hospital in-patients based upon a continuing community relationship and patient-need often regardless of their ability to pay fees. Three major forces have contributed to changing that situation: 1. socialization of health care, 2. bureaucratic remodelling of hospital administrations and 3. switch to ER-dominated admissions rather elective admissions. This has depersonalized the bidirectional loyalty between patient and physician leading to a more industrial model of care where the on-call physicians take their scheduled rotation at providing patient care. Paying these physicians a salary in hospital to attend in-patients makes sense since they have limited commitment other than their professional time.
Interesting that the Ontario Hospital Association is asking these questions. I for one wouldn’t want my doctor to be an employee of the hospital. My doctor should not be put in a position of conflict of interest between his paycheck/employers best interest and mine, his/her patient. I think the more interesting question is do we need 211 seperate hospitals, 211 seperate boards and CEOs?? Should we be making them more accountable to the LHINs??
Thanks for your comments and question. What do you think are some of the barriers to making hospitals more accountable to the LHINs?
I think the Healthy Debate site is doing a great job, and I enjoyed these three clips very much. However, I do think that the comments made by the three contributors are not well served by the question “Do you think that the single most important step in improving hospital quality is having physicians paid and employed by hospitals?” Particularly since only one of the three commentators (Ron Sapsford) directed his comments at this question.
This kind of question is common in web-based journalism (see polls at The Globe and Mail or The Toronto Star), but they do very little to shed any light on important issues. Such questions polarize opinions, without drawing out critical points. Further, this one is phrased in such a way as to generate false negatives. Presumably, the goal of the question is to draw out whether readers think there is value in exploring salary options for physicians. Yet, the value and importance of considering salary systems do not turn on whether it is “the single most important step” or not. One might think that it is very important (maybe the second-most important step!), but based on how the question is posed, one would have to answer “no,” thus suggesting that one does not think salary models are important.
I think the very thoughtful comments from the three contributors would be better served by questions that draw out critical reflection on their points. The complexity of these issues may very well preclude the use of multiple-choice polls, or at least reshape the kinds of questions you can meaningfully ask. I think questions like these might serve to capture the complexity of this issue and better serve to start critical debate:
“Do you think there is currently adequate evidence to make an informed decision about the effects of salary models on health service delivery in Ontario?”
“Do you think Ontario should consider a pilot project to study the effects of a salary model on quality of care and physician productivity?”