Rating Systems: do they penalize doctors?Assuming that the rating systems are fair and transparent, rating systems have the potential to halt the inevitable downward spiral in earnings. Fairness and transparency means that the doctor has access to the elements that define his/her score and that he/she is in a position to verify and correct these. In the absence of a rating system, each new doctor that graduates is added to a faceless pool at the same level as the more experienced ones. For managed care this means more numbers, more competition and less income. A rating system establishes a hierarchy. The new graduate slots into an established level and competes within that level. As he gains more experience, obtains more qualifications, or has more ratings from his patients, he moves into a different level and can compete for more difficult patients. The advantage here is that with more earnings per unit time, he is better able to spend time and provide a different level of service to his patients. Alternatively, he/she may prefer to stay at the same level, see more patients, but refer out the more difficult ones. In either event, the one may not necessarily earn more than the other – but they would certainly not earn less. Furthermore, they will continue to provide care at the level that best suits them.