THE PROPOSED DOCTORS' UNION.
WE fear that it will hardly prove possible to form a Doctors' Union on the lines suggested in Tuesday's Times. But that there is a crying need for the improvement of the pecuniary position of the ordinary medical practitioner, both in town and country, we have no sort of doubt. Nothing could be worse than the condition to which unlimited com- petition has reduced the lower ranks of the profession. In truth there is no profession, not even that of the lawyers, in which the unrestrained struggle for remuneration has more evil results. We are Free-traders to the backbone in all matters where no moral questions are involved, but it is impossible not to note that the profession of healing is one which ought not to be exposed to the pressure of competition without limit. Moral reasons make it impossible for the doctor to protect himself against the effects of competition as can the ordinary seller of personal strength or skill. The doctor cannot refuse to see and spend time and trouble over a dying man, though he may be certain that he will never get any pay for his trouble. The architect may refuse to design a house for an insolvent man, however urgent the appeal, but the doctor cannot say he will not attend a bankrupt whose leg has been broken by an accident. The fierce competition between the doctors drives down fees, however, to the very lowest, and does not take account of the fact that the doctor cannot be sure of collecting even this small remuneration.
If a doctor could say, may have to fix my fee at a very low figure, but at least I shall get that,' things might be left to right themselves. But as we have pointed out, he practically cannot do that, because appeals are made to him on grounds which humanity and morality forbid him to disregard. There is thus a double "squeeze" on the doctor to diminish his profits, —first, that of a fierce competition such as all other prees- alone are exposed to, and then that of a human feeling which it is almost impossible to disregard. Up till now the doctors, to their great honour, have never given in to the temptation to treat their skill in healing as a mere marketable commodity, and have always given scope to the feelings of charity. Those who know anything of the inside of a poor people's doctor's life know how often a doctor faces storm and cold and dis- comfort to relieve suffering for practically no remuneration. The country doctor does not ask whether it is worth his while to drive six miles on a wet night, and when he himself is very likely far from well, merely to inscribe a five-shilling visit in his books which he will probably be unable to collect. It does not occur to him to consider solely the commercial aspect of the transaction. He goes as a matter of duty. It is greatly to be feared, however, that if something is not done to improve the position of the humbler members of the profession this state of things, so honourable to the doctors, will cease to exist. The doctors are gradually being driven to the wall, and there is reason to fear that at last they will in self. defence be obliged to take up a purely commercial attitude in regard to their patients,—the attitude of the tradesman who argues : This shop is not a pauper asylum. You will get good value for sixpence, but nothing for nothing.' It would be nothing less than a national disaster if this were to be the result of unlimited competition. It is of vital importance that the members of the medical profession should regard themselves as something higher than mere honest salesmen, —that they should feel, in fact, that they are the holders of a sacred trust. We are not visionaries, and do not, of course, suppose that the doctors can all be unlimited philanthropists, but we hold most strongly that it is essential to maintain the general idea that doctors have a duty towards the com- munity. If once this dies out, and the merely commercial aspect of the medical profession takes its place, the art of healing will suffer a gradual and certain degradation. "In the shop as in the shop" will be the motto, and whatever is thought fair and honourable in the shop will be approved in the dispensary, and even in the sick-room. The doctor will sell you his skill at so much the ten minutes, but he will feel that it would not be business to sell you anything else, or to let you have what he now so often gives you as well as his skill,—sympathy, devotion, and self-sacrifice. 'I cannot go through the trouble of persuading your little girl to let me set her arm, without a double fee. It really would not pay me to do so. The getting her not to be frightened must always be done by the parents if only ordinary fees are paid.' That will be the sort of thing that the doctor on a purely commercial basis will say with perfect good nature to the dis- tracted mother. Nay, he may even bargain over the bed of the wife, and tell the father in a difficult case that he cannot undertake the work necessary to save both mother and child unless he is paid accordingly. One will be ten shillings, and both a sovereign.' Needless to say, we do not suppose that in reality we should ever quite reach such a state of things as this. But it is along the road that leads there that we shall be travelling if the doctors are forced into taking up a purely commercial attitude towards their patients. There is yet another evil to be dreaded if un- limited competition is allowed its full force in the medical profession. Doctors are always under a terrible temptation to play upon their patients' weaknesses, and use those weaknesses as stepping-stones to wealth. People sometimes wonder why doctors hate so bitterly those of their calling who have earned the name of quack. The explanation is simple enough. The quack is the man who has yielded to the tempta- tion to trade upon his patients' feelings, and who has skilfully used the dread of death and suffering, and the intense and passionate desire of mankind to avoid them, as means of advancement. The man who trickily and unfairly advertises himself as possessing some special gift of healing, who claims a monopoly of alleviating suffering, and who covertly sug- gests that he has secrets not known to his fellows, is doing the public an injury, and degrading his own nature. It is to be feared, however, that such unprofessional and degrading tactics are on the increase. The fierce struggle for a living has made hundreds of men practise these methods of advance- ment who would otherwise have shrunk from them with loathing. They have seen no prospect open to them if they stuck to the more honourable traditions of their calling, and in desperation they have tried to snatch a living by stooping to the artifices of the quack.
But once reduce medicine to a profession in which the better men are mere tradesmen, and the less scrupulous men quacks who deliberately take advantage of the weakness of those who are suffering, or in dread of suffering and death, and society will have received a terrible impulse towards demoralisation. Because we dread such a state of things, and because we view with concern the terrible poverty and the cruelly hard lives led by the majority of the lower ranks of the profession, we should be glad beyond measure could some means be found for correcting these evils. That something might be done by the organisation of a powerful Union we do not doubt. The barristers have un- questionably benefited by a close form of Trade-Unionism. Their profession is like the doctor's, open to many tempta- tions owing to the pressure of competition, but the existence of strict rules has helped to keep these evils in check. There is plenty of poverty among banisters, but that poverty has not been allowed to introduce a competition which would demoralise the profession. The main restriction is, of course, the imposition of a scale of fees below which a barrister may not take work. No doubt these rules are to some extent evaded, but not sufficiently often to enable the solicitors or their clients to get counsel's help at the rate of about is. an hour. We agree therefore that it might be useful for a Doctors' Union to prescribe a minimum fee, and to view with disfavour the attendance of non-pauper patients at any less sum. At any rate they might absolutely prohibit the taking of any portion or instalment of the minimum fee. That is, they might insist that a doctor must either charge the minimum fee or else take no remuneration whatever. This would prevent underselling. Next, another minimum might be placed on the fee per member taken from a club or association. A member of the Union might be forbidden to be a club doctor at less than what should be settled as a fair rate of remuneration. Lastly, the local committees of the Union might schedule other scales of fees for special dis- tricts, or agree, as is even done now in certain places in a half-hearted way, to charge according to the rateable value of the patients house. Within these limits competi- tion might be allowed to work freely. In effect the Union would say, "Get your living as best you can, provided you do not try to get it by offering to work for impossible fees." This plan seems to us better than the more elaborate one proposed in the Times, but at the same time we admit that we have no " inside " knowledge, and write merely as outside observers. There remains one point, —How are the doctors to be got into the Union, and once there to be kept there? Most certainly the doctors would be very unwise to imitate the tactics of some of the Trade-Unions, and try to coerce recalcitrant members of the profession into joining by some form of boycott. In oar opinion it would be far better for the doctors in the Union not even to refuse to meet outside doctors in consultation. They should agree to do so if the said doctors were otherwise qualified, and provided that the patient paid an additional fee, which might be fixed high, such fee to go to the general funds of the Union. But in all probability there would be little difficulty in getting the doctors to unite. The majority of them are so eager to get some relief from the present situation that they would, we feel convinced, join at once. We wish the project, then, all success, for we are convinced that there is a real need for some plan which will secure the ordinary practitioner better re- muneration, and a protection against the impulse to keep his head above water by adopting a purely commercial attitude towards his great and honourable calling.
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