Monday, 20 June 2016

Man, Incorporated

I realise now that my last post ended with the promise of a Part 2 and that was several months ago.
Well, you know what they say- time flies when you're having fun!

But, that brings me neatly to the point of this post. If you have read my previous posts, you could say that they could all be summarised thus: How to have fun. How to enjoy your working life, how to have a better work/life balance.

And, hence the pause; I was merely working on a unifying theme!

So, going back to basics. How do GPs earn money? And is there a difference between them and hospital consultants?
To my mind, in UK as an NHS GP even though we are called independent contractors, GPs are firmly tied into the health Ecosystem controlled by the Govt. Earnings may vary but the percentage spread is actually very narrow all things considered.
Working hours (core hours)  are  dictated by NHS as is prescribing & referrals. Add in the NHS pensions, retirement rules, Rent control on premises etc and you realise that you are at best a mere cog in the huge NHS wheel- toiling away and putting in your best years for the Govt Machinery.

This is true for the vast majority of people in developed countries. The carrot is Universal Health Care and good standards of living.

Contrast this with Consultants. Paradoxically, they would class themselves as NHS employees and not independent. But, most have a private practice and have much more leeway in practicing/prescribing etc atleast in their private line of work.

So, moving to Australia I have realised that this is the biggest change. I am no longer a cog in big wheel. There is no capitated patient base. There is no guaranteed income.
This could be a big pitfall. But, if you consider yourself as a GP Consultant just like an NHS Hospital Consultant, things become clearer. You can work for a 'hospital', i.e the surgery you work for (and that will earn you a steady income) but what you need to do to establish yourself is to market yourself and find your niche. Just like a hospital cardiologist for example. They all do general cardiology in hospital but in their private practice they all have special interests- one does Echos, another electrophysiology and so on.

Once, we find our groove not only in relation to our personal goals and aspirations, but also the right fit for the community we serve, we can be truly independent masters of our destinies. No one can then dictate income, retirement, working hours etc. I am still coming to grips with this and not to put too fine a point on it I consider this to be a paradigm shift in not only our thinking but ultimately in the way we practice medicine.

So, that brings me to the title of this post. If, we as GPs or Drs can choose to exercise control over our working lives in this fashion, why does it have to stop there? Is there a need to accept the convention of working your whole adult life, putting money into a pension, paying into income protection etc etc and merely existing as a 'productive unit' for someone else? Even independent contractors, like GPs in Australia are working units for the govt.

Just as we should become Consultants based in the community if we want to exercise autonomy in our working lives, we should be our own consultants for retirement planning, social security and tax planning. Do you have to put your pension fund in the country of your residence? What if you incorporated yourself as a company? Not so strange after all.
 Someone did the same back in 2013 : http://www.wired.com/2013/03/ipo-man/


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