Mayo Clinic for all?

Maggie Mahar waxes eloquent on the Mayo Clinic, and contrasts their care and outcomes compared to other health systems in the country.

While true that they provide higher quality care at lower costs, this is partly due to scale and the fact that the Mayo monopolizes health care in the Rochester, MN area. It’s a similar situation to Kaiser Permanente in California.

One cannot extrapolate the Mayo system nationwide, as the health system is fragmented by numerous hospital and small physician groups. Uniting them would require a full bore single-payer system paying doctors a strict salary, which is an unlikely possibility in the current political climate.

As an aside, I also wonder about the concept of strictly salarying physicians without any sort of incentives. Do senior, more experienced physicians resent getting paid the same as new graduates? What about doctors who provide the best outcomes being equally rewarded with those who perform the worst?

I’m not privy to the Mayo salary structure, but I can anticipate significant pushback if every doctor was paid the same.

Comments

Maggie Mahar
Kevin–
All physicians in a department are paid the same salary. They also all have the same size office.
The very low turnover shows that these doctors are happy with this situation. There just aren’t the resentments and jealousies that you see at many hopsitals. I’ve now talked to quite a few docs from May–and on salary at other places.
Many appreciate the collegiality and the lack of competitiveness–not having to look over your shoulder to see who might stab you in the back. (As you know, politics in many hospitals are brutal.)
I’m told that doctors at Mayo become “acculturated” in the first year or so. (Those who don’t aren’t asked to stay.)
And because the docs at Mayo are such fine clinicians they take great pleasure in their work. When you are that good at something, it is emotionally and psychologically very rewarding. The money reward just isn’t as important.
One thing Marc pointed out is that he, and other Mayo doctors can be found going into work on the week-ends–even though they are not paid extra and are not required to.
They’re just not working for the money. They’re working for the sake of the work.
Having been a writer most of my life I confirm that I work very hard whether I’m being paid well or not. It doesn’t really make a difference in terms of the number of hours I put in. . .
Finally, I really do think the place makes a difference. NYC and L.A. , for instance, are all about money. And many things here (NY) are very expensive.
In Minnesota, money just isn’t such a driving force in life . . .
B
Single-payer does not necessitate salary pay for physicians, although it is one option.
Anonymous
it’s like asking why can’t everyone hit 73 homeruns? why can’t the same guy hit 73 homeruns every season?
i am quite sure the mayo hospital finances are not exclusively supported by their clinical work. while i think there is a lot that can be learned from them, i would have to be convinced that their expenses are in line with other hospitals as well.
i’m confused with the comment that because they are fine clinicians they take great pleasure in their work. i’m not sure that conclusion can be made, nor am i sure that it can be concluded that the money reward isn’t as important. certainly it imo does not imply there cannot be fine clinicians elsewhere who don’t take great pleasure in their work. nor do i think that receiving slightly more money (in aggregate) implies they are less than fine clinicians elsewhere.
i see lots of docs going in on weekends that are not required to without getting paid where i work, or at least not getting paid anything substantial. some are catching up on paperwork, some are making social calls. i wonder if maggie surveyed the doctors she knows if the majority do in fact go in on weekends without pay, a fact that seems to impress her but one that i do not believe is so rare.
Anonymous
money isn’t the driving force in Minn. because it is MINNESOTA. I’m taking a year off from med school to do research in the midwest and I can support my girlfriend and myself making barely over the federal poverty line (granted, no kids, etc.,). In fact, we live better (have more purchasing power) than when we were in Boston and she was making more than twice what I make now.
If we, as a nation, try to scale up Mayo/Kaiser to a national model you’re going to NEED cost-of-living adjustments.
maggie mahar
Kevin & anonymous
One correction–which I've inserted in my post . . .
During doctor's first five years at Mayo he receives "step increases" each year– then he tops out, and after that, he and everyone else in his specialty earns the same amount.
So a physician who has been there 30 years and is world-famous earns the same amount as someone in the same specialty who has been
there 6 years–but not the same as someone who has been there 2 years.
Also, the longer you stay, the more vacation days you get each year. This seems to me eminently sane. Rather than dangling more money before a 50-year-old doctor's nose to get him to work harder and harder, bring in more revenues etc., they give more time away from a stressful job, which probably creates healthier and happier physicians, better able to help their patients.
Regarding Mayo having a monopoly in Minnesota or Kaiser Permanente having a monopoloy in
Northern California–it's true, this means thaey don't have to get into an arms race with other hosptials, buying equipement or investing in amentities they don't need just to attract insured patients.
But why does Kaiser have such a monopoly in Northern California? Because patients are, generally, happy with the care. Families stay with Kaiser for generation. Physician satisifaction is also high–low turnover, and watiing lists to apply for a job at Kaiser.
Nothern California Eeployers have told me that people wouldn't come to work for them if they didn't offer Kaiser as one of their options.
My guess is that if other academic medical centers could figure out how to become as "patient-centered" as Mayo is, they too could draw a much larger market share.
This is what Cleveland Clinic has tried to do–imitating Mayo in many ways. Though, from the little I know, Cleveland Clnic also has a
research emphasis and a desire to become a medical colossus that is
quite different from the Mayo culture. (Admittedly, I don't know as much about Cleveland Clinic.)
anonymous– of course there are many fine doctors who love their work, work very hard, and are paid much more than Mayo docs.
I was simply saying that in many professions (as well as the arts) if you love your work, the moeny is less important. If you are in a business that you find basically boring, it takes money to motivate you.
As for lower cost of living in Minnesota– I'm not sure that's a big factor if we're talking about the difference between earning, say $300,000,000 at Mayo or $700,000 in NYC. One can only consume so much.
The difference is that the doctor in NYC would be likely to accumulate much in the way of savings, and assets (2nd home). But both docs are able to go out ot dinner whenever they feel like it–whether dinner is $75 for 2 with wine (in Minnesota) or
$250 for 2 with wine (in N.Y.)
What I'm saying is that I think one could roll out Mayo's salary structure any place in the nation, and doctors would be able to live just fine–though specialists in N.Y. might well perceive $300,000 or $400,000 a year as "paltry" and you might have a harder time attracting docs from N.Y.

Mayo Clinic for all?

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