Dr Austin Trinidade, PRO of the T&T Medical Association, says regional health authorities (RHAs) cannot stop doctors in the public health sector from also having private practices since they cannot compensate them adequately.
He said instead consultants should be allowed private practice on the days their contracts permit.
Trinidade was responding to Health Minister Terrence Deyalsingh’s claim that doctors are spending more time in their private practices and not showing up for work at public hospitals even though they are paid to do so.
The minister raised the issue at a public health consultation in San Fernando last Thursday.
The minister expressed concern that the issue of doctors working in private practice while being employed in the public health health sector was being studiously avoided at the consultations.
Trinidade said T&T is not the only country with doctors working in both public and private practices.
“In most parts of the world doctors who are specialists are permitted private practice in addition to their hospital practice.
“What is unusual about Trinidad is that doctors below the post of consultant also carry out private practice, sometimes in direct competition with their seniors.
“This leads to both sets abandoning hospitals, leaving them to be manned by junior inexperienced staff.
“That is not a widespread occurrence but we acknowledge that it does happen,” he said.
Trinidade said most specialists divide their time fairly between the private and public sectors and their contracts allow them a certain number of days a week to attend to their practices.
“Since most specialists privately earn four to five times what they are paid in hospital, there is no way that the RHAs can stop private practice and compensate the doctors adequately. The specialists will just leave and the health system will collapse.
“What is required is that only consultants be allowed private practice on the days their contracts permit, and that during hospital hours they are afforded the resources to provide a fair and good service to the nation,” Trinidade said.
The issue is addressed in the report of the seven-member Winston Welch committee which was appointed in November of 2015 to review the health care system.
The December 2016 report states that the issue was debated vigorously and at lengths.
“It could have been envisaged that the public sector employment would play a secondary role for some doctors in this arrangement.
“Over the years, however, there have been many expressed concerns in the public arena and from the employer as well that many doctors have not been true to their obligation,” the report said.
The Welch committee said there had been the contention that many doctors spend most of their working time in private practice and are hardly available at their place of employment.
It also said some doctors are actively engaged directly or indirectly in soliciting patients to their private practice, some have become medical entrepreneurs with businesses seemingly in competition with the state sector.
In addition, doctors are more actively engaged in management of their businesses and some non-medical operatives are channelling patients to doctors’ offices.
