One question that occasionally comes up is whether doctors should be paid a flat salary or not.
Currently, the majority of physicians are paid fee-for-service, meaning that the more procedures or office visits they do, the better they are reimbursed. This, of course, gives a financial incentive to do more, without regard to quality or patient outcomes.
One proposed solution is simply to pay doctors a flat salary, with bonuses for better patient outcomes.
Well, according to a recent Kaiser/NPR poll, that idea is a no-go for patients. 70 percent of patients think its better that a “doctor gets paid each time they see you,” while only 25 percent think a yearly salary is better.
As an aside, I find it interesting that any public poll result that goes against the progressive health policy agenda is considered a “weak opinion,” but really, this isn’t a surprising result.
Economist Uwe Reinhardt hinted at the cause when he said that most Americans believe “that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it.”
Perhaps the public believes that a salary is similar to the capitation debacle in the 1990s, where doctors were paid a fixed fee, which gave them an incentive to deny care. And any perceived attempt to restrict care will be met with visceral opposition by the American public.
Which again shows how difficult it will be to engage patients with any dialogue that involves cost control.
Related posts:
- Should doctors be on a salary?
- Why it’s difficult to put doctors on a salary
- Patients still trust their doctors, and how that can influence health reform
- Poll: How should doctors make patients responsible for their own health?
- Should doctors be paid to e-mail their patients?
- Poll: How should we pay doctors, and why we need to change the financial incentives
- Salaried physicians are lazy doctors
{ 12 comments }
I’m a salaried doc. I doubt my patients have any idea how I’m paid. What a ridiculous poll question…and why on earth would we care what the public thinks? Might as well ask them what they think the right interest rate is, or the correct price of bread. All I need to do is fill my own clinic, which is always full.
What a massive shortage of doctors that would create. It would be a race to the bottom to see how little one could work and still recieve the salary. What one motivated doctor does now would take 3 salaried doctors to do. Think DMV, post office, VA.
This wasn’t a survey of “patients”; it was a survey of “representative Americans”. Not all or even most Americans appreciate the deficits of our health care system as much as those of us who actually need and use that system regularly.
12:26 Anonymous: That’s an interesting point, isn’t it? If a typical “motivated” PCP can only afford to spend 15 minutes or less with a patient now, and can’t afford to do unconventional, unpaid patient contacts (e.g. email), doing “less” work could well result in an improvement in quality of care for the reduced number of patients.
With regards to the salaried doc, I think your point supports the other posters. If your clinic is full, what incentive do you have to add new patients? For many (most?), that would be none.
I’ve experienced this sort of healthcare as a military dependent. When you can get it, the care is great as the docs spend time with you, etc. (as long as they don’t have their head buried in the EMR). However, I’ve had innumerable instances of trying to get an appointment and there being none available.
When I worked in a clinic on salary and it took me a while to figure it out but I eventually did, at which time I:
Fired the patients I didn’t like.
Filled up my schedule with patients I did like.
And closed my practice to new patients.
Worked for me.
Even better are the people who book and don’t show up–crossword puzzle time.
Why do we always have the people who have immigrated here from the more socialist European countries because they are so economically stagnant trying to import the very value that made them that way.
Uwe is a brilliant ma–but he is at heart a collectivist and advocates collectivist solutions. If you impose a collectivist solution on an individualistic society, it will not work–no matter how well it works in places where the populace is so inclined. In fact it will fail dramatically.
i would love to be on salary, get out of work on time, call only when you are actually on call. end of the day I’m done.
sounds great…
The question doesn’t even mention doctors’ salaries. The question only asks whether patients want to pay doctors a flat fee each year for their care, or if they want to pay up each time they go to the doctor. And of course patients are notoriously optimistic about their health and don’t want to pay for visits that they don’t perceive as needed.
A “yearly amount” does not necessarily guarantee a fixed amount (salary); a doctor could take on more patients and work longer hours to increase his/her yearly income.
Sounds much like our education system – every teacher is paid the exact same amount (on a schedule of years of service), and it doesn’t matter what the quality of their content is. Oh, except for bonuses for test scores, which leads to “teaching to the test” (or cherry picking patients that will have good outcomes). Leads to one thing – currently the students who can’t hack it in their preferred discipline decide, “ah, I’ll just go into eduction.”
Is that the student you want treating your cancer?
What a ridiculous question – patients have no clue how to translate such a question to their own experience.
I do have a question – this is a Kaiser survey…. how does Kaiser pay its doctors?
And my next question – why was this survey conducted? What were they hoping to prove or disprove? What are the outcomes intended to influence?
A sizeable number of patients think doctors are paid too much, regardless of the mechanism.
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