Can Salaried Doctors Advocate for Patients?

Highschool studentMost kids pause before telling parents what happens at high school.

Speaking up can be dangerous.

The video in music class that promotes psychedelics, or the cannabis fog in the stairwells, could drive Mom and Dad into a fit of parental activism. Parents can ruin scholarship applications.

Will a student get an A after her mom attacks the teacher about his (suspected) drug habits?

Doctors face the same decision. We already discussed Free Speech here, and here. Why would any doctor risk hospital privileges except for major issues?

Salaried Doctors Muzzled?

Whether it’s Belize or show business, people learn to keep quiet about bad behaviour.

While discussing free speech this spring, a former colleague tweeted:

How much more could nurses say if they did not fear being fired for speaking out about violence?

Another insider said:

“You know, it’s the ability to be able to write stuff like this [on your blog] that makes being an independent contractor so important.”

Salaried Doctors: Better for Patient Care?

There is nothing so intolerant as the latest fashion.

Fee for service (FFS) is the new smoking. People wrinkle their noses at it. No one dares to question whether FFS is as evil as everyone says.

Salary is in. FFS is out.

We touched on this debate in the following posts:

  1. How to Pay Doctors? Salary, Piecework, or Quality?
  2. Salary vs. Fee For Service: Good vs. Evil?
  3. How to Get Fired in Healthcare. Impossible?

No matter how doctors are paid, patients want doctors to advocate for patients care. But physicians cannot advocate, if they worry about losing their jobs for speaking up.

Physicians, who earn their income from one source, will never feel completely free to advocate for patients, regardless of whether their pay comes through FFS or salary.

Even being part of an association, or medical academy, dampens what docs can say. Physicians in a hospital, and those who hold leadership positions, must be careful. I could not have published my book, No More Lethal Waits, while I held an admin position.

Who Holds Medicare to Account?

The auditor-general audits financial matters, every now and then, but has little insight into what happens inside healthcare.

Unions cannot speak; they live on government handouts.

Associations cannot speak; it might jeopardize invitations to meetings of power.

The College of Physicians and Surgeons cannot speak; they risk government take-over.

Politicians cannot speak; they want re-election.

Bureaucrats cannot speak; they need to keep their jobs.

Patients can speak, but they do not have insider knowledge.

Journalists speak all the time. But they only know what government feeds them and say what their editors allow.

Only physicians, as independent contractors, can speak up for patient needs.

When government runs and controls everything, patients need doctors, as independent contractors, to speak up when the ’system’ fails.

Wherefore Art Thou, Whistleblower?

As medicine adopts more salaried and capitated models, patients lose doctors as whistleblowers. Physicians are either too busy taking care of patients, or too scared to speak up.

Who will speak for patients in the salaried, capitated, controlled and regulated Medicare of the future?

Doctors represent the biggest roadblock to fully managed care in Canada. Doctors can speak out. Elected representatives go out of their way to disparage doctors as greedy, imperfect agents; corrupted patient advocates, at best. Quiet doctors make governments happy.

Like high school students, who see drugs at the school dance, doctors must decide whether or not to publish what they see.

What do patients think about a system that punishes doctors for speaking up?

Salaried doctors, in the current system, have too much to lose; they must keep quiet. Is that good for patients?


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4 Replies to “Can Salaried Doctors Advocate for Patients?”

  1. As a patient, I want doctors to be free to speak out. And there should be safeguards in place to protect “whistleblowers”. Whether it be to suggest improvements to the system or to criticize and expose unacceptable practices. Sad to say I feel the same way about doctors (and the system) “protecting” incompetent doctors, or those who are indifferent to acceptable standards within the profession. Everyone loses when the ability to speak out against “wrong” is quashed. But I do understand that the current government has little concept of integrity and accountability which makes it next to impossible for “right” to be sufficiently valued and protected.

    1. Great points, Valerie!

      You are right: we need accountability both ways. The best method is to give patients more control of where their tax dollars go.

      Thanks for taking time to write!!



  2. Hi Shawn,
    I agree it is really worth remembering the precarious position of those who Whistleblow in Canada.
    Support for “Whistleblowing” in general in Canada is poorly supported by law and by government. One of the only two organisations in Canada to focus on advocacy for whistleblowers the Federal Accountability Initiative for Reform (FAIR) closed last year after it’s influential director David Hutton stepped down.
    Our ability to advocate as physicians will continue to be eroded if we fail to address these underlying
    issues. Remember the “Muzzled Scientists”…
    Thank you for bringing up this important issue Shawn.

    1. Great comment, Helen!

      So sorry that it took me so long to put it live!!

      (Way too busy….)

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