There are mounting worries in the nation about the exodus of doctors from the “big five” specialties — internal medicine, surgery, gynecology, pediatrics and emergency medicine. However, a number of things could be done to encourage doctors to remain in these fields.
The first is to create a worry-free work environment for physicians in the big five specialties. To that end, careful thought will have to be given to the question of doctors’ criminal responsibility. One often sees news reports about drunk drivers who have to pay millions of New Taiwan dollars in compensation for knocking somebody down, yet doctors who treat accident victims may be liable to pay compensation amounting to tens of millions of NT dollars if they fail to save their patients. Consideration should be given to the harm caused to doctors by medical disputes.
The nation should set up a patient injury compensation system for the benefit of the public, and doctors should be encouraged to take out medical liability insurance to reduce the financial burden they may face in the course of litigation. Furthermore, doctors who get involved in medical disputes should not be subject to harsh criminal charges.
Next, reasonable increases should be made to the clinical fees paid to doctors in the “big five” specialties. Fees paid under the National Health Insurance scheme consist of four main components: consultancy fees; diagnosis and treatment fees; medication fees; and dispensary fees. Examination fees are basically the same for all clinical specialties, but diagnosis and treatment fees vary, and this has an impact on doctors’ incomes. Consideration should be given to raising diagnosis and treatment fees for the big five specialties. For example, if, following consultation and examination, a doctor of internal medicine uses an ultrasound scanner to examine a patient’s abdomen, the doctor could be paid an extra ultrasound diagnosis fee. When surgeons perform operations, they could be paid an extra surgery fee.
These days many doctors choose to go into psychiatry or physiotherapy because these fields offer relatively high incomes from diagnosis and treatment fees. In psychiatry, diagnosis and treatment fees for talk therapy are quite high, as are those for rehabilitation in physiotherapy, and medical disputes are relatively rare in these two fields. Family medicine and ear, nose and throat medicine are suitable for independent clinics, so these two fields also attract a lot of doctors.
Third, to a reasonable extent, physicians working in the “big five” specialties should be allowed to participate in the private market. Ophthalmologists receive relatively high incomes from diagnosis and treatment fees, and they also earn money from private payments for eye care. Dermatologists are less liable to get involved in medical disputes than internal medicine specialists and surgeons. They enjoy easier lifestyles and are able to develop their private market, so dermatology has also become a popular career choice
Finally, the government should offer funding for medical students in the “big five” specialties, and it should set a condition that such students have to serve in these departments for at least 10 years after graduation. Taiwan’s experience has been that the time for which publicly funded medical graduates had to serve in their designated fields was too short. After completing their obligatory service, doctors whose studies had been paid for by the government often switched to specialties that offered higher incomes, so the public funding scheme for medical students did not bring great benefits.
Wang Cheng-kun is dean of the E-Chyun Dermatology Clinic.
Translated by Julian Clegg
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