SPECIAL FEATURE (As seen on Scope): Unity among Pathologists needed to tackle reforms on compensation – PSP PF Chief
Philippine Society of Pathologists (PSP) Committee on Professional and Laboratory Fees Chair Roberto D. Padua, Jr., MD, FPSP calls on all Society members to get involved and unite in a common goal of undertaking much-needed standardization in laboratory fee schedule for pathologists. “At the heart of this important advocacy is simple – we need to raise and update pathologists’ compensation standards proportionate to the current economic condition and to the value of our services as medical specialists”, according to Dr. Padua.
The Committee has held monthly meetings for the past year with the objectives of conducting an assessment of existing professional and laboratory fees in the country and formulating associated guidelines.
The fourth canon of the Code of Ethics of the Philippine Society of Pathologists (PSP) says,”I shall not compete for laboratory services on the basis of fees.” However, through the years, Pathologists are in unhealthy competition with their fellow pathologists on the basis of fees leading to cut-throat practices wherein predatory pricing are used. Violation of this code comes from reports of some pathologists drastically lowering their professional fees in order to heavily promote their services and eliminate or undermine fellow pathologists from their current practice.
50-Peso Paps Reader’s Fee?
Evidence of how this stark reality affects the practice is in the current reader’s fee for Pap smear. According to Committee Member Ricardo Victorio S. Quimbo, MD, DPSP, “There are pathologists accepting P50 as a professional fee for Paps smear! In the US, Pap smear is very critical and well-funded because of the high risk for lawsuits. Liquid-based preparations and cytotechnologists were instituted to decrease lawsuits. In the Philippines, a 150-peso Pap smear is considered expensive by OB-GYNs. This is a sad situation for this cancer screening test that is seemingly taken for granted.”
The very low price for this laboratory service may be shocking but it is increasingly becoming customarily charged as more and more pathologists are forced to relent. This detrimental effect of price competition is emphasized by Committee Member Demetrio L. Valle, MD, FPSP, ”This unethical practice degrades our profession. It makes the practice unpleasant by pushing pathologists to see each other as competitors and undercut each other’s employment status. Hospital and laboratory owners and, unfortunately, other doctors, use the cut-throat price as bargaining chip to further lessen what pathologists should rightfully receive.”
Much worse, due to these dubious practices and lack of regulation, the reputation of pathologists as valuable part of the health care team is trivialized and takes a blow. This sad reality creates a vicious cycle in which decreased compensation may lead to poor performance and lack of attention to necessary laboratory management, which further undermines the image of the profession.
Update and Enforcement Much Needed for Guidelines
The Committee conducted a review of existing recommendations on professional fees starting with Administrative Order (AO) 59 Series 2001 as amended by Department Memorandum No. 37-A series 2003 by then PSP President Jose Ma. C. Avila, MD, FPSP. The AO mandates that Society members follow the minimum mandatory Fee Schedule to prevent competition on the basis of fees that lead to cut-throat competition and unethical practices. Upgrade of this AO is imperative given the fact that the recommendations were given more than a decade ago and evidently do not reflect the current economic condition. Proposals to currently update Reader’s Fee in both Anatomic and Clinical Pathology tests are also formulated.
Citing the report Department of Health (DOH) Task Force To Study The Shortage Of Pathologists And Medical Technologists In The Provinces And Rural Areas (May 2014): “There are shortages of Pathologists in all regions and provinces and most urbanized cities. There were a few urbanized cities that had Pathologists in excess of the required number of Pathologists demonstrating a maldistribution”.
Part of their recommendations are the following: A) Provide Medical specialist items for Pathologists in provincial, district, and municipal hospital laboratories; C) Adequate compensation for Pathologists in the provinces; D) For Private hospitals to follow the PSP guidelines for professional fees; E) Promote cooperation among pathologists and minimize unhealthy competition; F) Pathologists should be accorded same professional respect, including monetary benefits, such as a fair share of professional fee in Philhealth case rate.
The cooperation of the Department of Health (DOH) is crucial. Council of Professional Relations Chair Bernadette R. Espiritu, MD, FPSP says, “We need to sit down and have a formal dialog with the DOH in order to create strategies on implementation especially through licensing regulations. Moreover, our Society has the power and authority to impose and act as liaison with DOH and Bureau of Health Facilities and Services (BHFS).”
Radiology and Anesthesiology Medical Specialties as Models of Reform
The Philippine College of Radiology (PCR) and Philippine Society of Anesthesiology (PSA) were able to effectively implement professional fee guidelines that evidently brought considerable structure and benefit to their respective societies mainly through members’ unity and political will.
PSP Treasurer and Committee Member Herbert G. Pascual, MD, FPSP points out during his past discussion with the PCR president about the matter, “They were beset with the same problems, but they were able to overcome obstacles and have standardized PF. One of their strategies is to strengthen group practice and to mobilize inclusive professional partnerships whether you are just starting in your career or already established.”
Dr Demi Valle added, “In my view, these Societies, in going boldly forward towards advocacy of its members, were able to increase the stature of their professions and, more importantly, were able to strengthen their institution by building concrete support for its members. If they can do it, so can we.”
The Voice of Pathologists Must be Heard
A step towards reform, as important as this, will undoubtedly require an honest and trusted discussion amongst members of the Society to create a deep understanding of the issue and its attendant solutions and long-term implications. Wide survey and consultation of pathologists across the spectrum of age groups, setting and location of practice and interests will sustain constructive dialog and craft a sustainable plan from the consensus.
Dr Valle stressed, “There will be sectors, especially on the part of the hospital and laboratory owners, that will be expectedly resistant to change. However, they will follow Society recommendations as long as the Society stands firm and united. Once consensus is reached among members, stakeholders should be informed of Society rules and regulations regarding professional fees for compliance.”
With these challenges in mind, Dr Roberto Padua concluded, “The PSP must enforce the recommended minimum mandated laboratory fee schedule and professional fees of Pathologists for both Clinical Pathology and Anatomic Pathology, as stated in the letter of Dr. Jose Maria C. Avila dated April 8, 2003 and in the Administrative Manual of the PSP, Inc. and create updates and additional implementing strategies, as necessary. This advocacy is vital in order to further uphold and promote the welfare and integrity of our Society. ”