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If All Physicians Were Salaried, Would Access To Care Decrease?

My last post centered upon the funny-sounding word, ‘parallax.’ I was using it to describe how middle-age athletes see their sport.

But it seems to me that parallax relates to healthcare policy.

First, the definition:

Parallax: an apparent change in the position of an object resulting from a change in position of the observer.

Here goes…(in less than 360 words!)

As America and its government grapple with how much austerity can be tolerated, the cost of healthcare consumption holds center stage.

And…

Everyone knows a portion of the rising costs of healthcare stem from paying doctors a fair wage. (Worry not; I’m not prepping you for a rant about declining reimbursement and higher regulatory costs. This would be too fatiguing. Plus, doctors’ wages lie way beyond the scope of a clinician’s blog.)

Let me tell you a real-life story about a recent situation? It’s meant to illustrate one of the many healthcare policy conundrums. And it shows how one’s views of healthcare policy may depend–on the position of the observer. (ie, parallax) Read more »

*This blog post was originally published at Dr John M*

Salaried Physicians Don’t Necessarily Provide Less Expensive Care

The Happy Hospitalist, generally an excellent blogger, wrote yesterday about how salaried docs must be delivering better care than those greedy FFS docs, because the Cleveland Clinic does a terrific job with docs on a salary.  I suspect their excellent outcomes have nothing to do with reimbursement model and a lot more to do with systems and a strong gatekeeper model.

He totally missed the elephant in the room in the Big Group Clinic model: who gets the money for doing the work.

He cites as an example a GI doc who left the Clinic for independent practice and quadrupled his income.  Let’s say he’s working as hard as he did in the Clinic; is he billing more than the Clinic did?  I doubt the Clinic wasn’t billing the usual amount for the work, so 3/4 of this docs’ billing went where?

I suspect it went into the overhead of the Clinic.  This isn’t a knock on them, it works for their group, so fine.  Other groups do essentially the same thing.  It’s legal and morally defensible, and some docs don’t mind being salaried.

Salaried docs in a big Multispecialty Clinic have different incomes, but not as radically disparate as the non-clinic model.  As a way to somewhat equalize RVRBS issues it works (I wouldn’t want to be in the room when salaries come up, though).

What salaries do not do is get docs to work harder, see more patients.  Some docs are very dedicated, motivated people who would work for rent and grocery money.  Others on a salary would do the minimum: if every patient is more work and more liability without more pay, well, why work more/harder?  As an incentive to produce nothing beats getting paid for it.

(This isn’t an endorsement of excessive or un-necessary procedures; there are greedy jerks in all professions).

Also, a happy side effect of getting paid for what you do rather than for having a pulse is those who work hard resent those that don’t (but who would make the same on salary) a whole lot less.  Way less inter-group stress.

Salaries aren’t all bad, but they’re not the Key to Great Healthcare.

Discolsure: I’ve worked ED’s both ways, and much prefer fee for service.

*This blog post was originally published at GruntDoc*

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