| In the midst of an exploding national healthcare crisis, | | | | percent more than in Europe is an issue warranting |
| there's much talk about slashing drug prices and | | | | attention, the equally important fact that doctors' |
| cutting health insurance company profits. While these | | | | pay is also dramatically inflating healthcare costs is |
| are valid debates, many physicians are actually | | | | rarely discussed. American physicians make between |
| offering an equally controversial solution: cut their pay. | | | | two and three times more than their counterparts in |
| Hearing a physician suggest a pay cut for him or | | | | other industrialized nations. The average doctor here |
| herself is a bit like witnessing a politician opting out of | | | | earns between $200,000 and $300,00 a year. Primary |
| a kickback. Sure, it happens but most of us will never | | | | care physicians earn less -- usually between $125,000 |
| see it, and tend to believe such a thing a dangling, | | | | and $200,000 annually -- and specialists earn more. |
| idealistic myth too elusive to pull down into reality. | | | | Making $400,000 a year and above is not unheard of |
| Many healthcare economists and physicians, however, | | | | for radiologists and other doctors with additional |
| are suggesting just that. Dr. Alan Garber, a practicing | | | | years of training. |
| internist and director of the Center For Health Policy | | | | No one is debating the respect doctors should be |
| at Stanford University, thinks offering medical | | | | given for their years of intensive education and, in |
| doctors a lower, fixed salary, accompanied by | | | | most cases, enormous talent. Medical schools run |
| bonuses for healthy patients, may be a crucial step | | | | around $30,000 a year now, putting most graduating |
| to working out of the crisis. | | | | medical students in considerable debt. They should be |
| "The problem is the way (physicians) earn their | | | | compensated, and allowed to earn what is necessary |
| money. They have to do stuff. They have to do | | | | to lead comfortable lives and clear their credit |
| procedures," said Dr. Peter Bach, pulmonary physician | | | | reports. But European doctors only earned $60,000 |
| at Memorial Sloan-Kettering Cancer Center in New | | | | to $120,000 a year in 2002, according to a survey |
| York City and former senior advisor to Medicare and | | | | sponsored by the British government. This, in turn, |
| Medicaid. In other words, doctors are paid by the | | | | means much lower medical costs are transferred to |
| procedure, not by whether the procedures go well, if | | | | the public. |
| their patients actually need them, or if their health | | | | Europeans pay less, overall, for their healthcare partly |
| improves. | | | | because they pay their doctors a comfortable, but |
| In contrast, doctors are not financially rewarded for | | | | far lower, salary. The discrepancy between nurses' |
| routine exams or "cognitive services," such as | | | | and doctors' pay, as well, is simply unacceptable to |
| researching different treatment options, or giving | | | | many when nurses often work just as many hours, |
| patients advice on how to improve their health | | | | and provide just as intensive -- albeit different -- care |
| without medical visits, tests, or prescription drugs. | | | | as physicians. |
| This, despite the fact that healthy eating, exercise, | | | | The idea of paying doctors a fixed salary, possibly |
| and the end of tobacco use would "significantly" cut | | | | with bonuses for healthy patients, is not without its |
| cancer deaths, according to the American Cancer | | | | problems, however. Such a system may encourage |
| Society -- up to 66%. Primary care physicians and | | | | physicians to only see those patients they believe |
| pediatricians provide more of this routine care and | | | | can be easily treated, for example. It may also do |
| rarely perform complicated procedures, so, in general, | | | | the opposite of encouraging rigorous and thorough |
| they're paid a lot less. | | | | testing, as doctors would theoretically be paid the |
| The pay-by-procedure method, which offers little | | | | same for twenty minutes of evaluation as for |
| financial incentive to enter family practices or | | | | twenty hours. |
| pediatrics, is fostering a shortage of qualified | | | | The additional pressure to meet the demanding |
| physicians. Twenty percent of people in the U.S. have | | | | needs of a growing population during a time when |
| "inadequate or no access to primary care physicians" | | | | physicians are in short supply may further increase |
| because of this shortage, according to reports | | | | this tendency. It's clear, however, that something has |
| released in March. In 2004, 75% of counties in Texas | | | | to be done. As usual, most of the solutions will be |
| lacked an adequate number of primary care | | | | hashed out in Congress and through the media, but |
| physicians to meet their needs. Twenty-four counties | | | | it's up to those of us actually receiving the care that |
| didn't have one at all. For cities like Dallas, Houston, | | | | may, or may not, save our lives to push for those |
| and Austin -- which handle an almost unimaginable | | | | decisions. |
| caseload and are already experiencing deficiencies in | | | | Being aware of issues affecting the accessibility and |
| the number of most types of healthcare providers -- | | | | quality of healthcare is an important part of minding |
| any further deficiencies could cause serious problems. | | | | your health. How you take care of yourself will |
| And while the fact that prescription drugs in this | | | | certainly affect you as you age, and eventually your |
| country cost patients between thirty and fifty | | | | wallet, as well. |