Doctors remuneration

[Racerbear02]

I was watching an item on the BBC news about GPs in the UK and how they are going to be underfunded and how they should be open for longer, more convenient hours.

I got to thinking about my French doctor, he is in the cabinet from before 0900 till 1400, he goes out to visit patients in the afternoon and then comes back around 1800 and works till 2200 or later.

Are French doctors paid by the number of patients that they see?  or is it a fixed rate like in the UK? 

If it is the former, then that might be a way of encouraging UK GPs to do what people want??

[NormanH]

They are a profession libérale, which means that they are not salaried, but paid for each patient they see.

However the fee they charge is fixed, at least if they are conventionné.

It helps to explain why they do routine checks themselves that might be done by a Nurse, such as Blood pressure, and why some are reluctant to give repeat prescriptions but prefer to see the patient each time...

[Racerbear02]

Thanks Norman

I rather guessed that might be the case [:)]

Over to you Mr Cameron

[Benjamin]

Just as an add-on to Racerbear02's question here are the opening times of our local surgery in a largish country village.

Monday 08.00 to 18.30

Tuesday 08.00 to 18.30

Wednesday 08.00 to 19.45 Used to be closed on a Wednesday but now open with an extra 1hr.45 added on.

Thursday 08.00 to 12.00 and 14.00 to 19.45 Recently added the 1hr.45 in the evening. Staff training 12.00 to 14.00

Friday 08.00 to 18.30

Saturday Closed

Sunday Closed

None of the several GPs at the practice work all of these hours but it's impossible to work out what hours individuals work.

As Racerbear says "over to you Mr Cameron".

[Patf]

French doctors' pay: I've looked into this before, they end up earning much less than a British GP.

Mine does minor surgical things too, for which he charges extra. And certain types of injection - none of which my friend's doctor does.

All reimbursed ?60-70%

[NormanH]

I think that given equal clinical competence the French way of paying Doctors tends to be very wasteful in that it pushes them to see patients more often and leaves little for ancillaries (who are paid less) to do. 

[minnie]

In our area, in a change from previous years, the flu vaccination is to be administered by the infirmieres this year and not Doctors as in previous years. I imagine that this is a cost cutting exercise as the charge was less than 7 euros.

[Gardian]

[quote user="NormanH"]They are a profession libérale, which means that they are not salaried, but paid for each patient they see.
However the fee they charge is fixed, at least if they are conventionné.

It helps to explain why they do routine checks themselves that might be done by a Nurse, such as Blood pressure, and why some are reluctant to give repeat prescriptions but prefer to see the patient each time...
[/quote]

I think that you're being a bit harsh Norman, but then I suppose that it'll depend on your GP.

We're lucky I think. She'll issue 6-monthly prescriptions (I guess that it'll depend on circumstances) and happily have the district nurse do blood pressure, blood samples etc in the interim. After 6 mths, she does insist on seeing you though, which seems sensible and is probably a requirement.

 

[NormanH]

That sounds rather like the UK model, but quite unlike anything I have come across in France.

In fact I had no idea that there was such a thing as a District Nurse in France , or even any sort of nurse attached to a surgery.

Our Medical centre in town has 4 GPs and a locum plus a receptionist, but none of the other services such I used to find in the UK. For those you have to go to the appropriate service (Lab, X ray centre, Pharmacy etc or call in the services of a Nurse (who is also a profession libérale, so self-employed))

When I had just come out of Hospital and had to have dressings changed I had to try to find a nurse   who was prepared to do a home visit in the City centre where parking is difficult for myself,  and finally managed to find one after several refusals.  Most of these won't visit just to do blood tests however as they are paid so little, so I have to go to the Lab for that. In some of the more 'difficult' areas no-one will do  medical visits any more.

The GP insists on seeing me each month to take my blood pressure and renew my  prescription and certainly won't relinquish those fees to a nurse.

This is my third different one and all have been the same on this, although one just ran the whole show himself surrounded by the records in piles around him; no IT support and not even a receptionist just his mobile phone.

It may be different in the country where there are shortages of Doctors, and so circumstances may force them to compromise.

Given the difference between the fees a Nurse gets and those a GP is entitled to for a simple act such as taking BP you can see why I say the French system is wasteful.

[Patf]

In the rural small town near here where there are 2 main generalistes, one does all these "small" jobs himself, the other sends his patients to specialists such as rheumatologues, who charge a higher fee.

[mint]

Norman, you and I are in agreement yet again....on the unnecessary wastefulness of the French Health Service.  Indeed, I have written in the past and at some length about how wasteful certain elements of the health service are here,

As a bit of gossip and perhaps of legitimate interest, our médecin traitant is now banned for 6 months because he has done "des grosses bétisses"; he's defrauded the sécurité with false claims.  And not for the first time!

I like the man so I can't really understand why he needs to do such a stupid thing.

[Gardian]

[quote user="NormanH"]It may be different in the country where there are shortages of Doctors, and so circumstances may force them to compromise.
Given the difference between the fees a Nurse gets and those a GP is entitled to for a simple act such as taking BP you can see why I say the French system is wasteful.
[/quote]

I think that you're right, but its something that suits everybody.

By that I mean that there are quite a few infermieres around here: I have a feeling that they work a.m.only, but 07.00 - 13.00. 'Bloods' have to be done by 11.00 and are picked up for all the mobile nurses from a central point so that they can be taken to the lab 15kms away.

If our GP had to mess around doing routine BP's, blood tests and wound dressings, you'd have to wait even longer than you normally do to get in to see her. That's because she's so punctilious BTW - you never get 'short-changed'.

 

[NormanH]

Well as is usually the case we don't disagree, there is just a disparity of experience between town and country as well as between regions.

We might well both end up in Montpellier for something serious, though I suppose in your case it might just be Nîmes, since there is a certain rivalry...

[confused of chalus]

Our doctor does blood pressure, ear syringing and the like, but sends us to the Red Cross for our blood tests. Almost all the district nurses in the commune are attached to the Red Cross, and I had presumed that it was the same everywhere. Obviously not!

Kathy

[Benjamin]

[quote user="sweet 17"]

....on the unnecessary wastefulness of the French Health Service.  Indeed, I have written in the past and at some length about how wasteful certain elements of the health service are here,

[/quote]

I think we'll all be able to relate different experiences but the good parts of the French system, from a patient's point of view, were the scans.

Mrs Benjamin has had a few in her time and to have an MRI scan lasting over an hour (brain and spine) then to wait ten minutes until the Radiographer appears with the scan and discusses any differences between the latest one and the previous one which you've taken along is truly amazingly efficient. We've still never seen the scan which she had on returning to live in England three years ago and certainly the Neurologist has never called her back to discuss the result. That is the last one she will ever have in England.

Maybe the other procedure which the ladies can relate to is a mammogram. Scan taken, sit for ten minutes and the Radiographer appears wjth the scan and his written report. As she was bitten by a horse on the side of her breast when she was a teenager there is always something to discuss.

The results of a mammogram in England took six weeks to arrive! That's the last one of those she'll have due to her age.

[Patf]

A good point Benjamin, and one which I've often appreciated personally. And I add - sending the patient a copy of the blood test results, even if it's difficult to interpret.

Hoping Mrs. B. is doing ok?

[Gardian]

[quote user="Patf"]And I add - sending the patient a copy of the blood test results, even if it's difficult to interpret.
[/quote]

Do you get a 'range indication' with the result?  By that I mean a suggestion that above or below x is a cause for concern?

At the risk of stating the obvious, we do here from our local lab. We even get a call from the lab within four hours of the sample being taken if its gone way out of limits + our GP gets told too.  

[Gardian]

Just returning to the original post, I've been doing some 'mental-back-of-a-fag-packet' calculations.

Our GP does 6 - 7 surgeries per week. Whichever way you do the numbers (after adding half a dozen or so home visits), you come up with a figure of €80k - €90k p.a. gross.

However ................ deduct the full cost of the receptionist / secretary, premises & related costs, vehicle for home visits, and you probably get back to a taxable income of €50k-ish.  I guess that quite a bit of the above costs would be offsettable against tax.

In the UK, there's all this talk about GP's earning £100k+.  Well, who knows?  It would seem to depend on the size of their patient base. Until someone who has been really close to this can tell us, we'll never know what x patients x £y = in terms of likely gross income. ('Daft Doctor' ???)

However, they will have costs too.  A modern practice location, 4 -5 GP's, an army of (grumpy) receptionists, a Practice Manager and so on.

The point I'm making is that the real difference may not be quite as big as we think.

 

   

[idun]

Ah I reckon that the difference is radical.

I have two european GP's at my current practice, one being a german, and I would have imagined that pay was pretty good there for Doctors.

My french GP told me that he had spoken to a UK GP and he could not believe how much his anglais colleague earned. They had compared take home pay.

And I know a retired GP, retired early and he reckons that one should have a million £'s in the pension pot. I frankly do not understand pension pots and don't want to. I just know that that sounds a pretty obscene amount of money to me, no idea how a pension pot could be so 'big'......... and one must live lavishly on a pension from such a sum.