THE DOCTOR'S PAY
By DR. R. L. KITCHING THE cry is all for a new comprehensive medical service, and all sorts of schemes are proposed, varying from a whole-time State medical service to a modest plan for making wives and children eligible for medical benefits under the present ,National Health Insurance. But the cost of any scheme depends chiefly on what the doctors are paid, and it is rather startling that that is the one point that is never discussed ; the possibility that the present service is defective because the doctors are badly paid does not seem to have been considered at all. The basic aim in any medical service should be to make it possible for good doctors to make the best use of good equipment and facilities. The papers are full of schemes for health centres, X-ray examinations for everybody and so forth ; and people are constantly writing to them to show how the doctors can be improved by teaching the students more of this and that—usually some passing craze such as manipulative surgery. But it never seems to occur to the reformers that when they have got the good doctors arid the good equipment and facilities there is still the question of good working conditions, and that these are simply a question of money.
Doctors are not out for large incomes, and, provided they get good living and working conditions, they do not want a lot of money ; but what the general public do not realise is that money makes an enormous difference to the efficiency of the doctor's service. The general public will have to decide, in the end, what the doctors are to be paid, and it will save a great deal of trouble, and perhaps even a great deal of suffering, if the question is well thought out in good time. There are two main considerations involved in answering it. The first necessity is to decide what standard of living is reasonable, and the second is to make sure
that the efficiency of the doctors is not impaired by working condi- tions that are defective simply for lack of money. It is hard to say what standard of living the public would regard as reasonable. If doctors were asked what standard of living they considered themselves entitled to they would certainly say that the most * This is a quotation from memory, from one hearing,- more than thirty years ago. I guarantee the spirit; I do not guarantee the letter. -W. E. important point is that a doctor should have a public school and university education ; partly because that is still considered to be the best education, but chiefly because doctors have a lot of dealings with the classes who have been so educated, quite apart from attending them as patients. If the doctor is to deal adequately with people in authority—for example, to compel landowners to repair their cottages—he must be able to meet them on equal terms.
The efficiency of a medical service depends on the doctor's income in two ways. If a doctor is always worrying about how to make ends meet he cannot give his mind to his patients, and he may become so sick with financial anxiety that his professional efficiency is very seriously impaired. On the other hand, if he is asy in his mind about money he not only gives his patients his whole attention, but can go a stage further and improve his service ; if he can afford to buy new apparatus and to travel, especially if he can visit hospitals abroad, his efficiency is very greatly increased.
The difference between a well paid and a badly paid medical service is a large question, and all that is possible here is to touch briefly on some of the points that matter most. Firstly, then, family practice is very hard work, and it is peculiar in that it consists almost entirely in dealing with complaints. Complaints of one sort And another, all day and every day, can become very wearing. A doctor ought to have at least as much rest and recreation as the men in other professions ; as a matter of fact he gets much less, and he gets so little simply because he cannot afford more. A second point is that a doctor's life is necessarily a.very unhealthy life and he has only a limited store of energy. It seems incredible that in these days a doctor with a big practice should have to do his own clerical work and book-keeping because he cannot afford a secretary. It 13 a stupid waste of the national resources that keen, imaginative, inventive minds should be blunted by drudgery that is so easily preventable. This waste of time and energy has consequences much more serious than the general public realise, and affects not only individuals, sometimes even costing lives, but the public as a whole. Take, for example, the statistics that are based on the cause of death given in the death certificates. Administrative machinery costing untold millions of pounds to run is built up on these statistics, yet the cause of death is never checked by post-mortem examination, or so seldom as makes no matter. It would pay the country a thousandfold to make it possible for doctors to find time to do post-mortems.
A third point is that the long spells of work tend to cause stale- ness. The best preventive is for the doctor to stimulate his interest by trying new methods with new instruments and appliances, and he ought to be paid well enough to enable him to buy what he needs. It is obvious enough that better instruments make a better operation ; it is less obvious, but equally true, that they make a better surgeon.
But by far the most important reason for paying doctors well is that it would enable them to undertake post-graduate study and family-practice research. Up to now only a tiny number of estab- lished practitioners have attended even one course ; what is needed is the opportunity for every doctor in the country to undertake regular, periodical refresher courses, hospital appointments, and organised research work. Refresher courses would not only prevent the deterioration in the doctor's work due to staleness, but enable him to learn new methods. The public on its part would benefit not only from what the family doctor would learn in the hospitals but also from what little the consultants might learn from the family doctors. Research in family practice would open up a field that has hardly ever been explored ; what has been done has given brilliant results. If any scientist reads this he might consider for a moment the case of Sir Isaac Newton, and try to imagine what might have been gained if Newton had returned to Cambridge instead of drifting away into theology or wasting his time in Parlia- ment. Suppose that that fire had been rekindled. Not that there is any question of a Newton in the medical profession ; the point is that during the past twenty-five years the Ministry of Health might laave had twenty-five thousand panel doctors doing research and post-graduate work in hospitals. Twenty-five thousand doctors, or fifty thousand, would not be equivalent to one Newton, but in-.1 twenty-five years they would surely have found one or two pebbles rather more polished than the rest.
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