Why do anaesthetists charge a fee?
In the public hospital system, the anaesthetist is employed or contracted by the hospital. The hospital generally pays the anaesthetist an hourly rate or a salary for their services.
In the private hospital system there is a “fee for service” model. The anaesthetist, like the surgeon, has “visiting rights” to the hospital, but is not employed by the hospital. Neither is the anaesthetist employed by the surgeon – the anaesthetist and surgeon are working together for the same outcome for their patient, but they are providing separate services.
The anaesthetist is contracted for thier service by the patient, and this is why the patient is billed by the anaesthetist. This is similar to a client contracting an accountant, electrician, or taxi driver to provide a service for them, and then being billed for that service.
Theoretically a patient can investigate which surgeon they would like to operate on them, and investigate which anaesthetist they would like to anaesthetise them, and then contract them both separately and arrange a time to perform their operation. In practice this rarely happens, although it can and has been done. There are several reasons that this is rare.
Firstly, most surgeons and also most anaesthetists have a weekly timetable that is already structured with commitments, and becoming available to team up for an individual operation is not always easily achievable.
Secondly, the surgeon and anaesthetist, along with the nursing team, have often worked with each other on the same regular list for a long time, leading to the “theatre team” becoming familiar with each other and working well together. There are inherent and well documented safety advantages of a team that is established and is working well compared to when a new team of unfamiliar individuals is put together, regardless of how skilled each of the individuals in the new team are.
So even though one does not usually make an informed decision about who to contract as their anaesthetist as they would with their accountant or electrician, the way that the service is provided as a contract between two people is similar.