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医者を集めることが病院収入と直結?

…昔から違和感を持っていた。
どうして医師の数と病院の収入が比例しなくちゃいけないのかな?と。
ほんとに医者がしている仕事ってそんなたいそうなことばっかりなのかなぁ、と。
コメディカルもたくさんいて医者にはカケラもできない仕事がたくさん病院には
あるのに、どうしてそれらは収入にならないのかなぁ、と。
昔の医師のギルドがつくりあげた医者に医療の全ての権利と収入が集まる構造と
か、その後の政治的な綱引きとか、そういった話をつつくことはぼくは好きでは
ないのですが、本質的なところにかえって、きちんと病院が成し遂げている仕事
の分、病院に収入は入らなければいけない。そのバランスが壊れているから、施
設・投資あたりの医者の比率が高い診療所は儲かり、それらに対する医者の割合
が少ない病院は儲からない。勤務医は周りのスタッフの収入のために働くような
構造ができてしまう(医者の仕事の収入を切り取り、医者だけに振り分ければ勤
務医の給料は跳ね上がる)。だから医者は開業する。

「先生、開業したほうがいいよ」

と、まじめな先生にほどまわりのまじめな気立てのいい職員はアドバイスする。
まじめな先生ほど報われていないと、病院職員たちが思っているから。
にも関わらず、医療界の外のひとたちは、

「開業するなんてけしからん! 責任放棄だ! 儲け成金手技だ!
 開業なんてできなくしてしまえ」

とこぶしを突き上げる。
その差は何なのか。

開業医を減らす圧力をかけるのではなく、病院がしている仕事の分、病院が抱え
ている職員の分、病院に収入が入るようにしなければいけない。病院の仕事の量
は、医者の質・量ではなく、職員全体の質・量で決まるのだから。
医者以外の職員にも感謝をもって診療報酬を振り分けないと、今のいびつな診療
報酬構造は変えないと、苦しい医療は続くだろう。

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