The NY Times recently discussed the phenomenon of salaried doctors. They use Bassett Healthcare in Cooperstown as their launching off point and bring up some interesting points. Should doctors work for incentives or stay on a salary?
I have been a salaried physician my whole career. Sometimes the salary was set low with a bonus that were easier to reach while at other times the salary was set higher but the bonus was much more difficult to attain. I know that having an incentive to work harder (not run them through like a mill) is better for me. Personally, I see that extra patient or two a day that needs to get in instead of sending them to the ER. That saves our healthcare system money. Would I do that without an incentive? I want to say I would but I may be lying.
Here is some points to bring up from this article:
- The clinics lose money
- One doctor will sometimes accompany (patients) during a procedure performed by another
- They always call each other or shoot each other e-mails
- No matter how many tests or procedures are performed, they take home the same amount of money
- no one loses money by passing a patient to a colleague.
Call me crazy, but losing money is not such a good thing for a business. I have found that when doctors or people are guaranteed a salary, many of them they don't mind doing anything else but seeing patients. It gives them a break. It also leaves a lot more patients needing doctors. Those last two bullet points about the number of procedures performed or not passing patients on to someone else is really a phenomenon not seen by primary care doctors so it is irrelevant to me. It is an issue for specialists, though. They quote a gastroenterologist who left the group and now has quadrupled his pay. They state that "a recent national survey found that gastroenterologists earned $457,000 on average, with the top 10 percent making $715,600." That is called "scoping for dollars". I think that is the problem right there. I am not saying that GI docs shouldn't make more than I do but the disparity is outrageous. The playing field needs to be evened with more pay for cognitive care and less pay for procedural care. Making doctors in this country ALL salaried can, in my experience, make them lazy. I am in favor of bonuses. I guess we are at the crossroads of capitalism and socialism again. I would rather take the former and have my doctor have an incentive to fit me in his or her busy schedule.