Season’s greetings

It is almost impossible to believe that yet another year has passed! A most eventful year it was too, with both good and bad news for anaesthesiologists throughout the country. May we take this opportunity to wish all members a peaceful festive season, and a successful and satisfying 2003.

On the positive side, we have become far more involved with medical aids and have made our voices heard with regard to remuneration for services. A major battle was fought and won concerning the role of the anaesthetist in endoscopic procedures, and even more importantly, regarding the wording of medical aid rejection codes. Unfortunately, this is destined to be an ongoing point of contention. We have also remained active on the tariff committee and continue to provide anaesthetic information and consent forms with the invaluable assistance of AstraZeneca and GlaxoSmithKline Pharmaceuticals. 

On the negative side, there continues to be an exodus of anaesthetists to other countries – friends and colleagues to all of us. It is most distressing to be constantly reminded of the uncertainties and challenges which face us both as professionals and as members of society. AIDS, soaring increases in medical aid contributions with decreasing benefits, litigation on the increase, delays in remuneration… all of these contribute to a fairly negative perception of our long term future as independent medical practitioners. Be assured that AIPA will tackle these issues with skill and determination, in an effort to safeguard the rights of anaesthetists in private practice, and we are looking forward to yet another year at your service.


THE BOULDER OF SISYPHUS

It is a great honor to be invited to contribute to a great and influential newsletter like the AIPA NEWS. This is not sarcasm, (though sarcasm is one of the many services I provide), but recognition of the fact that the audience are all specialist anesthetists with critical minds and valid opinions! So to it, and let us examine some of the broader issues in the future of the Profession of Anesthesia.
The intention of this contribution is to keep the members informed of what is debated at the AIPA meetings; and to offer my own subjective interpretations of what it means to the future of the profession. This should be a springboard for debate from the members so please send your comments to aipagout@worldonline.co.za  and add “for the attention of Sisyphus” on the subject line.
Sitting at the November meeting and listening to the chat going round the room, a comment by the Adam Smith to the effect that ‘every where in the land business men sit in dark and smoky rooms, and conspire against the public good,” came to mind. Hence the need for a SECURITIES EXCHANGE COMMISSION in the US of A, and our very own COMPETITIONS BOARD to regulate and enforce free competition. The rational for regulating competition is that the natural order of things is to drive towards monopoly, or collusion between members of a commercial oligopoly, (who can argue about that!), and thus the need for regulation. An underlying assumption is that perfectly free competition is the ideal to strive towards because this would give the consumer the best quality (of service or goods) at the best price. However it can easily be shown that under free and open competition the profit margin drops to zero for the participants who are then are unable to maintain capital, or a return on capital and thus the micro-economy of each participant disintegrates and the choices faced by each participant are to leave the industry, ply one’s trade elsewhere (emigrate) or regulate the industry one’s self. The Taxi wars are a pertinent example of this point, as a little reflection will show. Our own industry has problems of regulation, in our case, over regulation. If one considers this point, then with strict regulation comes obligatory protection. Why? Because with regulation the regulator takes on implicit responsibility for the economic wellbeing of the regulated One sees the first signs of this in the council’s decision, that if a funder insists on the same day admission of a patient for surgery, and denies the surgeon and the anesthetist the opportunity of adequate preparation for surgery then the funder must carry full responsibility for any adverse consequences to the patient. This is important because it is the intention of the funders to impose “global fees” on the industry thus saddling the profession with both the clinical risk and the financial risk. To my mind, this is double jeopardy and a very unacceptable option for the profession and for the patient. Thus it seems that, whilst restricting our economic freedom, the council is giving us professional freedom, which will then become the lever with which we manage the funding and hospital environment in which we work. Is this relevant, you ask. Well, yes, if you remember that the most frequently used word during the meeting was “negotiate”. Negotiate within the profession, with the funders and with the hospital groups and so on. This then begs the question; are we as anesthetist competent to negotiate? I suspect not; though we think we are. My suggestion is that your association should undertake training in this field either at own cost or at the cost of the accumulated funds of the association. Funding by the industry is not an option for two reasons; the council has severely limited the means by which the industry can sponsor the profession, and secondly, this is not directly medical education. Please, don’t bury me with objections! I have already heard them all. Consider whether you are sacrificing long-term strategic gains for short-term concerns. Look at the finances of a competently negotiated equitable fee structure, which satisfies our needs against inept negotiation, which leaves us with our lips firmly attached to the hind titty.
I must admit to ignorance of the medical negotiating process, (I haven’t been there) so it perhaps unfair comment. I do know that our negotiators work long hours and give of themselves and sacrifice their personal time and practice time for the benefit of us all, often with only criticism and no thank you. My plea is for us as an association to ensure that they are as equipped as well as possible with the skills needed to be effective in their task.
The New Year has come around again, and I believe the fees have been increased by 8%, in a year, which has seen a 40% inflation rate. You have also seen in the newspapers, the concerns of the Registrar of Medical Schemes about the high cost of “managed health care” and the resources it diverts from defraying medical expenses of members, to funding of essentially uninformed and lay management of the doctor and the consequent poor outcomes for patients. All these issues are levers that can be deployed in protecting the interests of the patient, and of the profession.
CPT 4 is to be introduced in the latter half of 2003 in its entirety, so be prepared. Make sure your software vendor is up to speed on CPT 4 and familiarize yourself early with all the facets and implications for your practice.
Correspondence is welcome, please send your comments by letter, fax or especially e-mail: attention Sisyphus.
Yours truly,
Sisyphus



Subscriptions

We would like to remind those of you who have not yet paid your subscriptions for 2002 @ R100.00 and from 2003 that at R150 per year, AIPA remains excellent value for money. Remember that we are a non-profit making organization whose main aim is to represent the anaesthesiologist in private practice in any way necessary. As such, we rely on your membership contribution for maintaining the administration of AIPA. Please contact Elaine Yacoby to confirm your subscription status or to make payment. And please tell your anaesthetic colleagues about the work we are doing to ensure our successful participation in private practice, as we would like to increase our membership.

If you would like to pay electronically via the Internet, our banking details are as follows: 

ABSA Bank, Rivonia Branch, code: 63-23-05, Current no. 0713273708
: (Please fax deposit slip)

General
· Our web page is up and running, so if you would like further information about AIPA or just want to browse, have a look at
Website: www.anaesthetist.com/aipa

· Anaesthetic patient information forms (blue) and anaesthetic consent forms (green) are still available FREE OF CHARGE. You can order these forms by contacting Elaine at AIPA. 

Please make use of them to encourage patient education about the anaesthetist and the anaesthetic, as well as informed consent for anaesthesia and responsibility for payment. 


Registrar of medical aids

Don’t forget that complaints against medical aids can be directed to the Registrar, who will contact the medical aid and insist on a response to your complaint within 30 days. Alternatively, they will take disciplinary action, so this is well worth considering if you are having problems.

Contact details for the Registrar are as follows:
Registrar of medical aids
ATT: Linda Gabela
012 431 0500
Private Bag X34
Hatfield
Pretoria 
0028
e-mail: complaints@medicalschemes.com


Finally…

AIPA welcomes new members and thanks existing ones for their support. A special mention to AstraZeneca Pharmaceuticals and Maksie Liebenberg in particular for providing a venue and refreshments for our monthly meetings – it is deeply appreciated. 

The committee of The Anaesthetic Independent Practitioners Association