Ban doctors from working in both private and public sectors, urges specialist

Ban doctors from working in both private and public sectors, urges specialist

NHS doctors should be banned from working in the private sector, because it’s unethical and directly affects the quality of care NHS patients get, argues a cardiologist in The BMJ* today.

The two sectors are incompatible, says John Dean, consultant cardiologist at the Royal Devon and Exeter Foundation Trust, speaking as someone who formerly worked on “both sides of the divide.”  

He explains that he started doing private practice because he felt that he needed the money “to renovate the house, educate the children, and so on.” And he was sure that he could keep the private work separate from the day job. But “it became increasingly difficult to keep the lid on the private jar as the contents expanded, and spillage was inevitable,” he writes.

The business of medicine and the practice of medicine are at odds, he argues, with private medicine encouraging doctors to make decisions based on profit rather than on need.

“No matter how high I set my own moral and ethical standards, I could not escape the fact that I was involved in a business for which the conduct of some involved was so venal it bordered on the criminal—the greedy preying on the needy,” he insists.

A consultant cannot be in two places at once, he writes, and time spent in the private sector deprives the NHS of this valuable resource. Private practice “has direct adverse effects on the NHS,” he writes, adding that this realisation prompted him to give it up.

But the most pernicious aspect of private medical work, he says, is the indirect effect it has on a consultant’s NHS practice. “It is difficult to justify subjecting private patients to unnecessary tests and treatments if you avoid doing them to NHS patients. So you have to operate the same system in both wings of your practice to ease the stress of this cognitive dissonance,” he writes.

And private practice creates a perverse incentive to increase your NHS waiting times, he says, because the longer these are, the more private practice stands to benefit. That’s why specialties with short waiting times, such as oncology, offer few opportunities for private work.

“Jealousy over private income is a major source of conflict between consultants in many hospitals,” he suggests.

And while patients think they are paying for higher quality medicine, the main advantage is simply that paying for treatment enables them to jump the NHS queue. “Private hospitals are five star hotels but for the most part no place to be if you are really sick,” he suggests.

The inescapable fact is that money is at the root of it all, he says, which is why believes healthcare leaders “should draw an uncrossable line between private and public medicine and tell doctors to choose: you cannot work on both sides of the divide.”

*John Dean. Private practice is unethical—and doctors should give it up. BMJ 2015;350:h2299. doi: 10.1136/bmj.h2299

By Caroline White,

On Medica, Wednesday 06 May 2015

View this article