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EDITORIAL

Specialist Physicians (Family Medicine) in private practice

When the discipline of specialist physicians in family medicine 

was registered by the Health Professions Council (HPCSA), the 

doctors who got on to the new register were required to apply 

for a specialist private number from the Board of Healthcare 

Funders (BHF). This meant the doctors who previously had a 

general practice number (014) were issued with a specialist in 

family medicine practice number (015). These physicians started 

to submit their claims to medical schemes using the 015 practice 

number as specialists in family medicine.

To our amazement, medical schemes were rejecting the 

claims and continued to remunerate the doctors as general 

practitioners. When the BHF was approached, they reiterated 

that their role was to issue appropriate practice numbers to 

physicians so that medical schemes could be guided by this 

to determine appropriate remuneration. As a result of this 

problem, specialist physicians in family medicine were forced 

to continue submitting claims using the 014 practice number 

for general practitioners or the schemes simply ignored the 015 

practice number and continued to treat these doctors as general 

practitioners.

Attempts to resolve this matter with medical schemes have been 

unsuccessful for some years.  In November 2015, this matter was 

brought to the attention of the Director General at the National 

Department of Health and the South African Medical Association 

Executive Committee had a meeting with the Council for medical 

Schemes (CMS), the body responsible for the practice conduct 

of medical schemes and administrators. The CMS is empowered 

to act only if evidence of rejected claims by specific medical 

schemes is provided to them. It was therefore agreed that all 

specialist physicians in family medicine were to submit all their 

claims to medical schemes using their appropriate 015 practice 

number, from 1st January 2016. Any rejections arising there after 

were to be brought to the attention of the CMS for investigation. 

In December 2015, the private practice division of the South 
African Medical Association wrote to all medical scheme 
administrators informing them of this decision. To assist 
the medical schemes in their determination of the level of 
consultation fees for the discipline, it was pointed out that the 
fee should be at a level of consulting specialist physician fees, 
this being a consulting discipline.

What remains now, is for the Academy of Family Physicians to 
take responsibility for the implementation of this undertaking by 
the CMS by doing the following:
1. Form a committee dedicated to private practice matters. This 

committee should preferably be driven by specialists in full 
private practice.

2. This committee is to support members in their negotiation of 
fees with medical schemes. 

3. The Academy should inform all its members of this 
development by communiqué, website and SAFP Journal 
article

The committee is to be tasked to formulate frameworks for the 
private practice of specialist physicians in family medicine. This 
to address:
• Remuneration and engagement with medical schemes
• Relationship with other family doctors in private practice (GPs, 

Family Physicians who are not specialists) and relationship 
with other specialist disciplines.

• Patient referrals between disciplines
• Specialist physicians in group practice with other non 

specialist family doctors
• Contracting arrangements with medical schemes and 

provider networks 

Shadrick Mazaza 

Pierre de Villiers 

Neethia Naidoo