The following op-ed was published on August 22nd, 2008 in the USA Today.
“Why should I care if doctors get a pay cut?” my patient recently asked me.
Therein lies the delicate dilemma physicians face today. While the common perception is that the medical profession is well-compensated, there are serious implications in targeting physician pay to control medical spending.
Congress recently passed a bill protecting doctors from a 10.6% cut in Medicare payments, overriding President Bush’s veto in the process.
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The U.S. boasts the world’s most expensive health care system. Costs exceed $2 trillion annually and outpaces inflation and growth in national income. In an attempt to cut costs, Medicare has instituted a formula that calls for regular decreases in physician payment of more than 20% by 2010.
The number of physicians who do not accept new Medicare patients is dramatic; in states like Texas, this number can exceed 40%. No wonder, as Medicare pays less than half of doctors’ fees. This scenario comes as a record number of Boomers approach Medicare age.
Those without Medicare are not spared the consequences. Seniors sometimes delay their care, leading to expensive treatment in the emergency department. Doctors who lose money seeing Medicare patients could pass on the costs to the privately insured.
According to the Kaiser Family Foundation, there are more significant drivers of health costs, including new prescription drugs, technology and administrative needs. Princeton economist Uwe Reinhardt estimates that physicians’ take-home pay represents roughly 10% of national health care spending. Cutting physician pay by 20% would only reduce spending by 2%.
A more effective option would be for the government to enhance the nation’s primary care by paying physicians to coordinate care between specialists, install electronic medical records and encourage patient communication via e-mail or telephone. The New York Times recently reported that a pilot program increasing primary care spending in North Carolina saved Medicaid upwards of $160 million in 2006.
Furthermore, improving access to providers such as internal medicine and family physicians would provide timely care and keep patients out of the hospital and emergency room.
With medical spending estimated to rise nearly 10% annually, costs need to be curbed. But by focusing on physician payments, government alienates the profession for little in return.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
