Many specialists in New Zealand work part-time in the public health system and part-time in their own private practice. They do not generally do this to make extra money because there is usually more than enough work for a specialist working full-time in private practice. Specialists work in public hospitals for several reasons. Complex surgery usually gravitates to the public sector, so the specialist maintains skills that would otherwise be lost. Most specialists feel some sense of obligation to the public and view their public health stint as “paying their dues”. Finally the modest sum they are paid does occasionally serve as a useful backstop when the private practice experiences an occasional slow month or the doctor goes on holiday.
In return, the public health service gets sufficient specialists to cover all their on-call requirements and the hospital is not left with dozens of underemployed specialists during the day. This arrangement is a far cry from the double-dipping doctor who has just had to pay $143,000 back to his DHB. The specialist in question was working full-time for the hospital but taking off two days a week to work in his private practice.
Deborah Powell of the Resident Doctors’ Association tries to make out that this is a common situation and that DHB’s turn a “blind eye” to it. She also suggests that it is registrars that take up the slack when this happens. In the MacDoctor’s experience, this is rather exaggerated. Specialists squeeze in private work outside of their public commitments. Unfortunately, the public health service is horribly inefficient. A specialist clinic may be schedule to end at 12 noon and drag on to 1.30. The specialist has been paid for an 8-12 session. If the specialist has no other commitments, s/he will usually be happy to stay and finish. But if his/her private consultations start at 1pm, it would seems quite reasonable that the specialist leaves the registrar to complete the clinic. This is what Ms Powell is talking about, but it has nothing to do with specialists ripping off the system and much to do with the inefficiencies in the health service.
The reality of New Zealand Medicine is that specialists usually work far more hours in the public health service than they are paid for. There are probably one or two gaming the system in rural areas where there is a single specialist providing a service, but this is a exception, rather than a common problem. Deborah Powell is overstating the problem by several orders of magnitude.