Scheme to reward doctors for successful operations raises harsh criticism

Jul 21 2008

A scheme in Britain which appears to promise to reward doctors for successful operations has met with harsh criticism from doctors and patient groups.

One of the UK's largest hospital trusts has suggested that surgical teams may be rewarded with bonuses for successful operations.

Imperial College Healthcare Trust in London is apparently planning to launch a pilot scheme aimed at "rewarding excellence" with better resources and research and giving bonuses for a specific procedure for which patient outcomes can be clearly measured.

The aim is to introduce the scheme in a matter of months and appears to be in accord with the Department of Health which also says it wants to reward surgeons for high performance.

The trust says they are examining a pilot scheme for a particular operation which will measure the improved functionality of the patient and link certain performance-related bonuses to the outcomes.

The trust says discussions with the surgical team will be about rewarding excellence across medical teams, who may in turn receive better resources and research opportunities if they have improved patient outcomes.

Opponents of the scheme say surgeons do not need cash incentives and suggest many would be insulted by the idea that they will only do their best in operations when there is extra money involved.

The Patients Association is also concerned about possible cash bonuses and warns there was a risk that the most complicated cases would be forgotten because they would not guarantee the best outcomes.

There is also of course the suspicion that the frail and elderly could become a neglected group because their surgical outcomes may not be as promising.

The British Medical Association (BMA), the professional association which represents doctors, warns that this could deter doctors from carrying out complex surgery or operating on frail and elderly patients.

Dr. Jonathan Fielden, chairman of the BMA's consultants committee, said it would be "far too simplistic" to reward individual surgeons according to the outcome of operations as this is based on multiple factors, including the severity of the illness and the relative health of the individual.

Individual surgeons have found the idea "incredible" and "offensive" and say they do not need financial inducements to perform at their best.