Should doctors charge other doctors?

Waiving fees for colleagues is more than just a professional courtesy. All medical practitioners have a responsibility to look after the health of colleagues and to lower barriers to doctors’ wellbeing.

AMA (NSW) was recently contacted by a long-standing member about his experience with a local general practitioner. Both he and his wife attended appointments with the general practitioner and were required to pay a gap fee following the consultation. 

The member who raised the issue had never billed a colleague or their family over many years of practice. While not a rule, this is common practice for many doctors. 

The money was not the issue. But rather, the member was concerned about what this signalled for the profession as a whole.

While he recognises the economic complexities of current practice, his worry is that professional courtesy and respect for colleagues appears to gradually becoming lost.

Professional courtesy is not unique to medicine but has long been associated with medical practice. In addition to marking the mutual respect for another’s commitment, training and expertise as a medical professional, providing care at no cost (or reduced cost) to colleagues was originally adopted as a means of discouraging doctors from treating themselves or their families. This long-standing tradition is referenced back to the Father of Medicine, Hippocrates.

English physician and ethicist, Thomas Percival wrote a classic essay in 1803 that reaffirmed the importance of providing complimentary professional care between physicians and surgeons, and their immediate family members. 

In 1847, the American Medical Association included this concept in its Code of Ethics. However, in 1994, it revised this position – advising members that waiving fees for colleagues was not an ethical requirement and that physicians should use their own judgement when extending this professional courtesy. The reversal of opinion reflected the complexities of health remuneration in America, which includes co-pays and insurance-only billing.

While this may be the situation overseas, medical practitioners in Australia have greater flexibility. 

The AMA (NSW) Ethics Committee agreed with the member that failure to extend complimentary care to colleagues appears to be a sad and lamentable reflection of a few medical practitioners where more than good manners are becoming lost.

The real failing is actually the impact on doctors’ health. Now, perhaps more than ever, we must be looking at ways to lower barriers for medical colleagues to access care. The global pandemic has affected everyone, but frontline healthcare workers have been among the hardest hit.

Research by Mental Health Australia revealed more than 70% of healthcare workers surveyed said the COVID-19 restrictions had a negative effect on their mental health and wellbeing, while 67% said working in healthcare during the pandemic had been bad for their home life.

Healthcare workers reported several health impacts including prolonged tiredness and fatigue, sleep problems, and mood swings.

Almost half of all survey respondents (49%) said they have not sought specific mental health support.

Many doctors are reluctant to seek help often due to not wishing to impose on colleagues. While cost is unlikely to be a prohibitive factor in itself, professional courtesy is always appreciated, in all its forms. Removing barriers for doctors to access care not only benefits the whole profession, it has wider benefits. If we can look after each other, then we will be in a better position to look after our patients.