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1Lobge practice
By D. Rosenberg, Member of Organisation Committee, B.M.A.
I can just see you fellows gathered round in the Students' Room . saying, "Oh, this doesn't interest me." So let me give you a few facts and you'll soon see that it will. Victoria's population is 1,1.79,000. The Friendly Society members number 165,000. Multiply this by three, the average per F.S. member, and we get about 500,000 persons entitled to treatment through lodges.
This total includes the most provident members of the community, who have contracted with their 55 friendly societies to provide them, for about £4 per member per year, with doctor, medicine, payment of £1 per week when ill, and a funeral benefit of £20 at death. About 600 out of the 1,200 medical men in Victoria are lodge doctors.
You naturally ask (1) what service must be rendered by the doctor ? ; (2) what remuneration does he receive ? ; (3) what are the advantages ?;
(4) what are the disadvantages ?
In reply, a lodge medical officer is compelled, under the common form of agreement, known colloquially as the Wasley Award,*to give all services demanded by the patient except anesthetics, general or local, operations under anesthetics, general or local, confinements, miscarriages, and dis- eases due to misconduct. If you open an abscess without giving a general or local anesthetic, you cannot charge anything extra. If you set a frac- ture, or reduce a dislocation, or do an X-ray, apply diathermy or radium, remember that you cannot claim payment for these services, though, to the credit of the F.S. system the patients do not usually demur. Included in the service is the administration of vaccines, and serums, though you can charge for the material used in these cases.
Included also are the elaborate tests for blood urea, blood sugar, B.M.R., and blood counts, which you have learnt to do so expertly and which make you so up-to-date, as compared with the old lodge doctor who lives round the corner and gives that bottle of medicine so loved by the lodge patient.
The answer to No. 2 is—for male members of lodges, 20/- per year in Melbourne, Ballarat, Bendigo and Geelong, elsewhere 25/-. This sum includes treatment for the family be it ever so large or small. For female lodges 12/- is paid per member.
There are all kinds of names of local lodges—some very fanciful.
There is for example the Boadicea and the Olive Leaf Lodge, but all are grouped into their various Grand Lodges or. Orders, also fancifully named.
There is the Australian Natives' Association (A.N.A.), with its corres- ponding women's order, the A.W.A. The Manchester Unity Independent Order of Oddfellows (M.U.I.O.O.F.). This is the order that is erecting that palatial building on Stewart Dawson's corner. Now, should the lodge with which you contract be blessed with the initials O.S.T. (Sons and Daughters of Temperance) or I.O.R. (Independent Order of Rechabites),
YOU will receive 16/- in respect of any woman lodge member though in a mixed lodge of men and women. All other mixed lodges pay the 20/- be the member male or female.
In addition to the extras mentioned above, you get 2/ 6 for every person you examine for the lodge, and 2/6 for every night call. This is
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most important because if you don't ask for these fees, you will find that your lodge patients will forget to call you till you have finished your work in the surgery. Many's the lodge doctor who has what he calls his "night round" to do and gets up at B.M.A. meetings, and says that he finds he can't collect his night fee and so doesn't ask for it. He becomes very popular in his district and dies young. After a trip of 2 miles from the surgery you 'get a minimum of 3/6 per mile by day and 5/- by night. This is called mileage, and is a big factor in country practice.
In the cities, lodge members obtain through their dispensaries medi- cine, as much as they want of it, including, without extra cost, Boracic Acid, Cod Liver Oil, gauze, lint, and bandages, and also patent medicines, e.g., Syr. Coccillana Co and Ungt. Renaglandin Anesthetic at wholesale rates. It costs the lodges only 8/- per family per year through their dispensaries.
If you supply medicines in the country where there is no contract with a chemist, you are paid a minimum of 10/- per year for it. The chemists in the country made a new agreement with the lodges and get 16/-, so I suppose the remuneration of the doctor for the same service will probably be increased.
3. The advantages of this practice apart from the satisfaction of treating the less wealthy members of the community at a lower rate than those more fortunate, are that you have an assured income without having to do bookkeeping other than seeing that your lists of patients coincides with the size of your cheque for their attendance. These lists are sent to you quarterly—so are your cheques. If they don't coincide get an explana- tion from the lodge secretary. He is usually a decent fellow ; if he isn't, then it is your own fault if you are paid less. One doctor, who got his lodge accounts audited, found that he was paid a total of £30 per year short.
One of the great advantages financially is that you see the patient right from the commencement of his illness and can recommend what treatment, medical or surgical, you think best for him. The appropriate consultant is usually of your recommendation. I shall have more to say about the advisability of getting a consultant and when to get him at some future date.
A big lodge list, even 500, is as good for you as the O.P. of a hospital.
If you do your work well it is a big advertisement. Good work is the best kind of advertisement you can get. If you slur it your reputation will suffer. Don't let it be "a bottle of medicine and a sick certificate".
Disadvantages : The extras are disappearing from lodge practice as rapidly as private practice is disappearing.
Mids. are leaving lodge practice for the Women's and the Queen Vic- toria. Children go first to the Baby Health Centres and are then sent to the Children's Hospital or to a favourite specialist.
Minor ops. crowd out the O.P. of the general hospitals. Good capable lodge doctors who used to do over 100 mids. a' year and at least 50 P.N.G.
and Tonsils a year, now do throat work and about 25 mids. a year. That is why the nose and throat departments are overcrowded and the hospitals are appealing for money. You won't make much out of extras nowadays.
Should you require specialist advice the lodge system, with very minor exceptions, does not give it to you. An X-ray in a doubtful case, a cardio- gram, a maxillary antrum report or an expert fundus oculi report, or even
a microscopic examination of some pus is to be obtained by the patient at his own expense from a specialist, or inconvenience at a public hospital.
Yet withal, you can, by your enthusiasm and hard work make lodge practice what you will. Many men have graduated to specialism through it ; many have made it their life's work. When you graduate you will receive a copy of the lodge agreement from the B.M.A. Study every word and line of it. Your seniors fought a long costly dispute with the Grand Lodges years ago to secure these terms. Admittedly they are far from perfect, but they were the best that Judge Wasley could award. Guard each clause, make it your own business, and if in doubt let the organisation committee—experts in this work—solve your problems.