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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.


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)

Here is the HIPAA-compliant version of the story:

I have a patient. She (or maybe he) is suffering from a time-sensitive and serious medical (or perhaps surgical) problem.

Despite living in a city of about a million people, there’s only one person I trust for this kind of situation. I can’t tell you more. Here, you will have to trust that I am not embellishing.

But…the specialist is on vacation.

So far, nothing seems amiss. A specialist takes vacation.

But what if I told you that a large hospital chain recently employed this specialist.

So what?

Now what if I told you that the newly employed specialist is salaried. She (or he) makes the same, or almost the same, whether they use that special skill a lot or a little. For example, what if an employed doctor no longer gets paid not to take vacation—like regular people. Said doctor might just take more vacation.

My situation ended well. The time-sensitive problem got taken care of when the specialist came back to work days later. But we had to sweat.

Notwithstanding the argument that more vacation and less work might improve a doctor’s skill, my main point here is that human doctors are governed by the laws of human nature. My patient needed a specialist. (Not rare.) The specialist held a special skill. (Also not rare.) The specialist was enjoying vacation when my patient needed care.

Eventually, we, the people, will become patients.

See the parallax?

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

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