Tort reform for doctors in exchange for less salary

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.

It’s part of the social contract: doctors accept limited salaries in exchange for limited liability; patients accept that they cannot sue doctors for millions of dollars in exchange for a guarantee of access to decent health care.

True or not (certainly not true if you ask internists and family practice docs) the perception in our country is that doctors are “rich.” We represent some sort of elite class of Americans who send their kids to private schools, drive Lexuses and Audis, join country clubs, and spend summers in the Hamptons. It’s absurd, of course, as the majority of docs in the trenches can attest.

But perception is king. Therefore, it seems that meaningful tort reform is unlikely until we do something to alter that perception. I have no problem with decreased salaries and lowered reimbursements. But the reason physicians make what they do in this country goes way beyond malpractice insurance. You want to transform the physician class into civil servants, fine. But do something about the exorbitant cost of medical school. Address the threats of frivolous lawsuits. Ease the burdens of running an office by subsidizing EMR. It’s a package deal.

As physicians we need to be a little more flexible. The roar from the primary care sector comes off sometimes as a whiny demand for more money (take it from the specialists if you have to) and less work. And the more lucrative specialties (neurosurgeons or dermatologists) need to consider a world in the very near future where they earn 50-70% of what they make now.

But it has to be a two way street. The social contract in the United States has always been tilted in favor of the entrepreneur, the capital man, the Wall Street trader. We don’t compensate individuals in this country based on the moral value they provide to a community.

Few would argue that teachers and firemen and pediatricians and social workers are paid commensurate with the effect they have on local citizens. And we’re fine with that. We’re a country that has thrown in its lot with free enterprise and open market capitalism. That will never change. Doctors are now finding themselves marginalized financially in much the same way as the kindergarten teacher, the social worker at the battered women’s shelter. I see the inevitability of it.

But there has to be a reasonable compromise. You can’t ask doctors of the future to earn less and work more without subsidizing the training and schooling, without addressing the medical malpractice crisis. I’m willing to sit down at the bargaining table. But as the recent attempts at health care reform demonstrate (no mention of tort reform or medical school subsidization in either bill), too often no one is willing to sit down across from us to negotiate.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

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