Methadone Clinic Limits Doctor’s Employment
One of Ontario’s little known private secrets is that most methadone, a staple of opiate addiction treatment, is primarily provided by for-profit clinics. Last week a doctor who works in one of these private clinics casually told me that her contract with the clinic forbade her from working for another methadone provider.
The context for the comment was that a clinic was looking for a part-time physician and she could not apply for the job. I guess her “employer” is concerned that she might steer some of her patients, and their money, to the other clinic.
This artificial barrier to the efficient use of skilled medical professionals increases public cost. Many methadone doctors work part-time. They undergo an extensive training program to gain their methadone licence and are in short supply. It is easy to imagine that a doctor working a part-time shift at one clinic might have a schedule that fits a part-time shift at another clinic that needs a physician. There is an obvious solution to this employment mismatch which works for the doctor, the clinic with the short-staffed shift and the provision of methadone treatment, but is not workable because a chain of methadone clinics wants to protect its business.
And most of the money being played with is public. OHIP, Ontario’s public health insurer, pays for the doctors’ visits, drug tests and other medical care. The Ministry of Health covers the cost of the drug and disability insurance, welfare or seniors’ drug plans, all public money, pay most of the dispensing fees, which are in the range of twelve dollars a dose. The bottom line is that this is a publicly funded program primarily delivered for-profit chains who create restrictions that decrease the efficient use of the resources needed to provide a necessary service.
A similar contractual difficulty limiting good quality health care came to light a few years ago when private companies were increasing their presence in the delivery of publicly funded home care. Comcare, a for-profit in the same business conglomerate as Dynacare, one of Canada’s three multinational medical laboratory companies, had an employment contract clause forbidding its employees from talking about their policies and procedures. This gag clause works against a central safety mechanism in our health care system: the moral obligation, and for registered professions, for example, nurses, doctors and therapists, the legal obligation to report dangerous conditions.
Contracts like these add cost and dysfunction to our heath care system. Unfortunately I am sure they are only the tip of the iceberg. Rather than uncovering snippets of information over coffee, a basic accountability stipulation would be that companies receiving public money must make all their contracts affecting staff and the provision of care public. After all we are now posting union contracts, management pay scales and hand washing statistics for public institutions on-line. Lets level the playing field.
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