Spotlight on doctors referring patients for treatment in clinics they own

A leading orthopaedic surgeon says patients will suffer in proposed changes to medical guidelines that could prevent clinicians from referring patients to treatments or clinics they have a financial stake in.

The New Zealand Medical Council is reviewing expectations for doctors on how to manage conflicts of interest when treating patients. The draft guidelines state clinicians should be “very cautious” about referring patients to facilities where they have financial interests.

“You should only do so if you have explored other options with your patient, and there is no suitable alternative that meets your patient’s needs,” the draft guidelines state.

But Dr Peter Robertson, a director of the private Ascot Hospitals and who also works in public orthopaedic clinics in Auckland, said that move had the potential to “totally alter the way practice occurs”.

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“If you’re not allowed to … refer patients on for testing [or] treatment under your own care, it makes a complete mockery of continuity of care,” he said.

The clause is an addition to existing 2012 guidelines for doctors when managing conflicts of interest. These guidelines may be used by disciplinary bodies to assess the standard of a doctor’s conduct.

In the latest edition of the New Zealand Medical Journal, published on Friday, Robertson said the impact of this additional clause was likely to be “detrimental”.

“It is difficult to imagine the degree of disruption of continuity of care, and system breakdown, that would occur at primary care level if the requirement for referral away from a doctor-owned practice for subsequent investigations and treatment were implemented,” he wrote.

“[T]his approach is likely to add cost, cause delays and exacerbate capacity challenges.”

His comments follow repeated cries from clinicians and patients that the health system is increasingly difficult to access, with some nurses going as far as handing patients in Wellington’s ED contact details for the health minister.

The Medical Council’s chairperson, Dr Curtis Walker, was not available to be interviewed. But in a statement, Walker said the council did not directly regulate business models adopted by doctors.

“However, council does expect doctors to acknowledge and actively address any potential compromise to patient care or risk of harm to the health and safety of the public that could arise from their commercial practice.”

The draft statement was intended to outline what is expected of doctors when they interact with any commercial interests – from drug companies and private health insurers to collecting fees for speaking at private conferences, Walker said.

Roberston stressed he had no issue with transparency about potential conflicts of interest and these should always be made clear to the patient.

He also agreed there should be a clear separation between clinicians and drug companies which “exist to look after their investors and their shareholders”.

But doctors who invested in treatments or private facilities generally did so because they backed the treatment or technology on offer, he said.

Walker said submission the Medical Council would consider submission on the proposal at its “next available council meeting”. The updated statement will be released in the first half of 2023.