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Greed of few tarnish the reputation of all

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Doctors have voiced concern that a handful of practitioners charging excessive fees are flouting ethical standards and tarnishing the reputation of the medical profession.

At a forum on fees convened by the AMA early this month, representatives from more than 15 medical colleges and specialist societies engaged in a frank discussion about the damage to the public standing of doctors being caused by a small number of high profile incidents where doctors have charged fees well in excess of their peers.

AMA President Associate Professor Brian Owler, who chaired the forum at AMA House, said the vast majority of privately insured medical services were provided at no cost to the patients – 89.7 per cent did not involve out-of-pocket expenses, while the size of gap payments was known in a further 3.5 per cent of cases.

But A/Professor Owler said there was “a significant element of perception” in the public mind that doctors and surgeons in particular charged excessive fees, fed by occasional media reports of patients hit with what appeared to be very large medical bills.

Royal Australasian College of Surgeons President, Professor Michael Grigg, who attended the forum, said the medical profession could not afford to ignore the issue.

Professor Grigg told the forum that although surgeons were well regarded by the public, a majority thought the fees they charged were unreasonable – a perception fed by occasional reports of massive medical bills.

Medicare figures presented to the meeting highlighted the extent to which the problem was caused by a small minority of practitioners, showing that, for example, the average fee charged for a hip replacement was $2001, that 95 per cent of all fees charged were $4194 or less, but that a very small number of doctors were charging fees close to $10,000.

The forum discussed concerns that the activities of a small minority of practitioners undermined public confidence in the ability of the medical profession to regulate itself, to the possible detriment of the majority of doctors and future patient care. It considered how the profession could best respond to the issue.

Professor Grigg told the forum that the College considered those who charged fees seen as manifestly excessive were in breach of the profession’s code of ethics, and faced possible expulsion.

Among issues discussed by those at the forum included the challenge of defining acceptable and excessive fees, and how to better inform both GPs and the general public about charges for procedures and treatment without falling foul of competition laws.

The forum agreed that measures to encourage more responsible fees should not compromise the ability of individual practitioners to charge what they considered to be fair and reasonable to meet the costs of running a medical practice and providing high quality care.

A/Professor Owler said the profession needed to address the issue of excessive charges if it was to maintain public confidence in the medical profession.

Adrian Rollins