SALARIED DOCTORS
Sta,—I hope you will allow me to make a few comments on your paragraph headed " Salaried Doctors." I write as one who had experience for some years in a medical practice in a poor district, followed by 25 years as Medical Secretary of the British Medical Association. Now, in a position of less responsibility, I look at this question of the future of medical practice mainly as a potential patient. Therefore I entirely agree with you that " the public, too, has interests and it must defend them " as I hope that the doctors can be depended on to defend their own side.
After much reading on this subject I am convinced that the public does not yet realise what a State Medical Service will mean to it. It has been carried away with the prospect of access to every kind of medical service without the fear of financial stress or even disaster. But, alas! there are " snags." A comprehensive medical service, such as is antici- pated, could only be carried on if the public, as well as the doctors, were regulated, and I am very doubtful whether the public is prepared for anything of the kind. Take one example: At the present time, those of us who like to have our doctor at home can do so. But in a service in which medical " Centres " are bound to be a leading feature, patients who are able to attend at these Centres will be expected to do so. If all, for their own convenience were at liberty to have the doctor at home the Service would break down even with a much larger number of doctors than is available. I try to imagine Members of Parliament, Judges, eminent Journalists and Editors, and even the readers of The Spectator, waiting their turn at a glorified out-patient department, but my imagina- tion is not equal to it. This is not a " bogey," but something which is inherent in an organised Service open to all. Naturally the eminent people above mentioned would seek a way out, and it seems to me that the alternatives would be (1) to apply to those doctors who had refused to join the Service and who, incidentally, would be regarded by the public (probably wrongly) as the best men ; or (2) to allow the doctors in the Service (and presumably paid for giving of their best to everybody impartially) to accept private fees for exceptional services, given not because of their necessity on medical grounds, but because there is a demand for them on social grounds. There is the making of a new class distinction here.
As an old reader of The Spectator it seemed queer to me to see it belittling the right of any calling or profession to pay due regard to the financial results of any social changes likely to affect them. Rightly or wrongly we respect those who by honest work have gained a success of which the usual criterion is financial competence. A salaried medical service seems to me to be one in which there would be no " blanks," but also no " prizes " when compared with, say, law or commerce. Is such a prospect likely to attract high character and ability? In asking this I do not ignore that rare minority who have such a strong sense of vocation that money rewards mean little to them—but they must always be a minority. I am earnestly in favour of making attendance of all kinds available to everybody. The B.MA during my time, and qiner, has pressed the Government to extend the principles of medical insurance to all who need it—with no result up to now. It was surprising to me that you made no reference to these efforts, but said that the doctors pearly succeeded in ruining the National Health Insurance. Doctors, like many other people thirty years ago, made many mistaken prophecies about the effect of the Act. But it is a fact that once they began to work it they not only did their best to make it a success, but, knowing its defects, have constantly pressed the Government to extend its benefits. The problem now is: How far and by what methods? I have pointed out some of the risks of the adoption of the salaried service plan ; and there
are others.—I am, yours faithfully, AIFRED Cox. 17 Trevor Place, Knightsbridge, S.W. r.
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