Thursday, July 30, 2009

Should all physicians be on salary?

This is the Sermo "poll du jour." Former governor of Vermont and DNC Chairman, Howard Dean closed the recent debate with Dr. Daniel Palestrant on CNBC by saying: “All physicians should be on salary.” If you are a physician, do you agree?
  • What impact will making physicians salaried employees have on patient care?
  • What action would you most likely take in the event that the Federal Government attempts to make all physicians salaried employees?
  • Would you accept more federal involvement in your healthcare practice, on behalf of your patients care?
  • Would this involvement improve overall efficiency in your practice? For you? For your patients?
  • What if doctors are forced to negotiate payment rates with the US Secretary of Health and Human Services?
So far, we have over 700 responses on this Sermo poll. Let's see what gets published in a few weeks. If you missed the CNBC debate on TV, you can catch it here: CNBC debate between Gov Dean and Sermo


  1. It works for the Mayo Clinic, where all the docs are on salary, but the incentives are tricky. While it removes the incentive to overtreat, some docs seem to retire in place and see fewer patients if they're on salary, which can wreck havoc with patient scheduling.

    The current setup, where primary care physicians are paid starvation wages by insurers and Medicare and neurosurgeons are millionaires, is clearly crazy. The incentives to overtreat are ridiculous. A heart specialist gets nothing if he sends a patient home with a prescription to lose weight and take an aspirin a day, makes $$$ if he does bypass surgery, the $ incentive to do unnecessary bypass surgery cannot be denied and even if he doesn't consciously make a decision to overtreat he will tend to do so. Putting him on salary would remove that incentive. But some other incentive would have to be put into place to make sure he wouldn't retire on the job, and I have no idea how Mayo Clinic manages it.

  2. Putting a doctor on salary will be ok with some doctors ( a minority I'd predict), but not all. It works for Mayo, but there are other rewards and incentives for doctors at Mayo. Most hospitals or practices can't provide the same "reward" to doctors who want to work hard and take good care of their patients. Payment to physicians for their skills and investments of time and personal sacrifices should be based on some other metric than just doing a procedure, however, including time spent with a patient, complexity of the decisions made, quality of care provided, etc. - often very tricky to measure with hard and fast data. Money (salary, whatever) doesn't have to be the only "payment" either. Smart people need to get creative here, and think outside the box instead of only about money paid. How about helping a good doctor run a better practice, such as the government providing staffing, back office support, free Healthcare IT, more tax deductions, reduced malpractice costs, student loan repayments, Tort Reform, a week at a congressman's summer villa on the Cape, etc etc? You get my point.

  3. I hope that's a good point as if Doctors are paid salary as it happens in Mayo clinic it removes the different treatment meted out to Doctors by management of many hospitals specially in hospital in India where private hospitals donot give salary but rather work based incentive that may likely increase malpractice as Doctors tend to adopt various means to earn more and by giving salary this will help more ethical practice of medicine and remove a competetition among Doctors to earn more.