Walking the Tightrope
Ashik Amlani gives his personal perspective on financial rewards in medicine
Many of you reading this will, at some point, have considered your eventual salary in a medical career. This may be especially true of those still in school and in the early years of university, who have yet to experience the life-saving aspect of the profession for themselves.
If you Google ‘doctor salary uk’, you are greeted with a mind-boggling 17,400,000 results. A figure that serves to highlight how vital a consideration remuneration may be to medical students and doctors alike. I find it hard to believe, however, that a student who has never before worked as a care-giver would be more motivated by the intangible reward gained from saving a life than by the prospect of a £100k+ salary once qualified.
I used to think being a doctor was about being paid lots of money to cut people up. As I have progressed, though, I find my feelings somewhat different. Being in a hospital full time really does throw into sharp focus the care giving aspect of the job, and strangely this feels more gratifying than the pay check.
In fact, studies have shown that financial reward does play a part in motivation, but more so in dentists than in doctors. Doctors place value on other factors, such as an interest in science, a desire to work with people, and the feeling they get after ‘saving a life’. Consider this cynic well and truly humbled.
But is money the best motivator, or are abstract feelings really more likely to deliver results? Somewhat counterintuitively, the evidence suggests that money plays a less significant role in determining healthcare quality than other factors. A recent report on the ‘Quality and Outcomes Framework’ (a pay-for-performance scheme for GPs introduced in 2004) states that the scheme ‘has not resulted in improved ill-health prevention or health promotion by general practitioners’.
The private sector is potentially very lucrative, and I have personally witnessed doctors discussing and working on private cases on NHS time. Surely the distraction of monetary gain, to the detriment of NHS patient care, is a case of the system gone wrong? Add to this the issues regarding the intrinsic cost of giving out these rewards as well as negative patient selection (in order to avoid penalties) on the part of the doctors, and you have a damning argument against offering financial rewards.
With the imminent introduction of the now infamous healthcare reforms, concerns are mounting that these changes will increase the influence of the private sector, and offer more opportunities for a profit driven healthcare system.
One of the proposed ideas is for the GP consortia to offer financial incentives deterring GPs from sending patients to hospital. You don’t need me to highlight the potential pitfalls of this system.
As seems to be the case with medicine, we walk a tightrope when offering financial rewards. Too little, and the profession will fail to attract new talent: too much leads to distraction and wasting of precious resources. As always, a balance must be struck, and it remains to be seen who will really profit most from this system: the doctors or the patients?
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