The Company Doctor

Sydney Morning Herald

Thursday June 1, 2000

Judith Whelan

THE corporatisation of general practice is one of the first issues to confront Dr Kerryn Phelps's Federal presidency. Around Australia, particularly in Perth, listed corporations have been buying general practices to run as businesses, offering the doctors jobs as employees.

The doctors pocket a large amount of money, and still work with their patients with lots of new equipment and without the strain of running the practice. But will the financial imperatives of the company dictate how the doctors do their jobs?

Some practices are part of a ``vertical integration"; the company-owned radiology and pathology practices are on the same premises or at least nearby. Are doctors encouraged, or even forced, to refer and refer often, to them?

GP corporatisation was the best attended and most controversial of the policy discussion groups at the AMA's national conference, and the most pointed questioning about doctor independence and its implications for patients was from Phelps.

Dr Barry Catchlove was the first to speak, presenting a report he had prepared for the Department of Health and Aged Care in his relatively new job as a consultant with KPMG. The report was reasonably in favour of corporatised practices so long as a diversity of general practice types was maintained.

Whether that can be maintained is precisely the concern. Catchlove pointed out that about 50 per cent of Perth GPs ``are either in these ventures or being approached". But the group was later told by Andrew Tongue, the department assistant secretary in charge of general practice, that corporatisation was affecting only 5 per cent of practices around the country. ``But when it starts ... it can happen very quickly," he said.

Phelps's questions emphasised her concerns for the profession's independence and its relationship with patients: ``It's the number of wheels we are seeing being reinvented." Would this mean Australian-style HMOs (managed care) like they have in America, she asked.

``The GPs being bought up ...What happens to their referral practices? Then there's the dilemma of the profession as opposed to the corporate entity. And what happens to the outsiders, the GPs who are not part of this system?"

She was clearly against it, and her passion and clarity on the issue were mentioned by several doctors the following day as having swayed their minds toward her as the choice for leader.

After her election, though, her position on the issue was very much directed by the resolutions formed at the conference. ``We will have to look to ensure that while corporatisation appears to be happening, that it proceeds in an ethical framework," she told her first press conference.