Prof Michael Taggart believes (BMJ 2015;350:h2882) that Doctors should expect to repay state investment with NHS service. This happens elsewhere, but we get all concerned with the Human Rights Act and freedom of movement/workers. There is a small loss of liberty which is worth sacrificing for order and predictability….(Bonapartism) Doctors could repay in the form of work, or they could buy their way out.. In this way there would be no shortage In unpopular areas.
The vigorous debate instigated by Dean about the ethics of private practice1 has set me pondering what seem to be a few incongruities.
As a university based academic scientist I receive no pay for any overtime work, of which there is plenty, and I am contractually obliged to seek permission from my current employer if I wish to undertake additional salaried employment. From this setting I am, therefore, presenting the view of an outsider looking in, and in so doing, I may be blinded to some important nuances of the topic.
Firstly, UK medical graduates have benefited from an education provided by the state. It does not seem oppressive to expect doctors to repay that investment with service to the NHS. If members of the public detect an over-eagerness in doctors to undertake private practice, this may dent their confidence in the commitment of some of the profession to the NHS. Sometimes perceptions are important.
Secondly, a common argument is that having a private practice in tandem with NHS responsibilities has a positive benefit for the latter. I could be open to persuasion on this point only if, in private practice, one is caring for UK based patients and not for health tourists. Perhaps this differs across the UK.
Thirdly, if the impetus for having a private practice in addition to NHS work is not predominantly one of profit, then why take an additional salary? Perhaps there is evidence of circumstances where the extra monies from private practices are put to egalitarian uses.
Fourthly, in my position the contractual stipulation mentioned above is in place, I presume, to prevent a conflict of interest. For many in this sort of circumstance, it may seem odd if there is relatively unfettered access to private sources of income for medical work that is traded on a reputation garnered through NHS funded employment.