Physician regulators get paid so much more than front line doctors

Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on “medical professionalism” was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:

  1. the principle of primacy of patient welfare
  2. principle of patient autonomy
  3. principle of social justice

The first set of professional responsibilities for physicians was a “commitment to professional competence.” While I would truly like to believe this article was sincere, increasingly I am concerned it was a regulatory ploy — one that is more concerned about financial gain than patient benefit.

Let me explain.

I have spent time reviewing the 2011 IRS Form 990  “Returns of Organization Exempt from Income Tax”  (the last ones publically available) for each of the member boards of the American Board of Medical Specialties (ABMS) and the ABMS itself.  I used the website Guidestar.org to gather these.  I assembled the salaries and benefits of the senior executives from each of these organizations in descending order and was surprised what I found (here is the complete 2-page pdf of the data for your review).

No more than the top three executive salaries of these organizations represented over $16 million in total compensation in 2011 alone.  But even more troubling was the inverse relationship that existed between the top-paid executives of these private ABMS member boards and the 2011 compensation for working subspecialty physicians they are supposed to represent. Recall that pediatrics, family medicine, and internal medicine are consistently some of the lowest paid physician subspecialties.

Here is a chart I made of the top 10 board members’ annual income compared to the same subspecialty physician salaries in 2011 as reported by Medscape:

Physician regulators get paid so much more than front line doctors

Clearly, the U.S. physician credentialing system as it exists now overwhelmingly rewards people with regulatory oversight rather than those who provide patient care.  Was this the intent?  More specifically, was the intent of the ABIM’s medical professionalism manuscript to line the pockets of the ABMS member boards in lieu of social justice?  What kind of justice is this?

The answer now is not so clear.

To add insult to injury, realize that front line physicians are increasingly burdened by very high medical school and residency debt for much of their career.  As part of their rite of passage into their subspecialty, they must pay the credentialing fees that pay the salaries of these regulators.  Should we insist our doctors pay such high fees to support these expensive salaries?  How might patients be affected, especially when they have reduced access to doctors who must undergo repetitive certification and re-certification exercises.  How do patient’s benefit when the certification process appears so flawed?

To me, it seems that we are not seeing a definition of medical professionalism in the credentialing juggernaut that these private organizations have created.

We’re seeing the definition of greed.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • SonoIo

    To me, it seems that we are not seeing a definition of medical professionalism in the credentialing juggernaut that these private organizations have created.

    We’re seeing the definition of greed.

    Amen.

  • SteveCaley

    Yes, but a kinder, gentler, less directly harmful form of greed, perhaps. Fordism and Taylorism presume that the person who actually DOES a job is a nitwit, and has to be followed by management so they don’t sneak around the back of the building and smoke dope on company time.
    Multiply that across the scale of American Business, and you have a dozen people riding on the back of one productive employee. They tried to do it in Nursing, and broke its back. Now, it’s doctors. Once we can prove that the need for regulatory oversight is far more than the actual doing of the job, we can proceed to have it collapse into dust, too…. And except for the patient, it works out just fine…

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Once you begin to accept that physicians are becoming exploitable labor, particularly as the trend to employment continues, the numbers are not surprising at all.
    Take a look at the pay for labor union bosses, which is approximately 10 times what their workers are making, and there’s a lot of hyperbole in their official documents as well.
    http://www.washingtontimes.com/news/2013/jan/10/labor-union-bosses-salaries-put-big-in-big-labor/?page=all

    • southerndoc1

      Do labor union bosses work as aggressively against the interests of their membership as medical board execs do?

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I don’t think so :-) but it seems that they too are having a grand time representing people they know nothing about.

  • LeoHolmMD

    That was shocking. I thought they did well, but that is outrageous. Thank you for exposing.

  • Brad_Majors

    Yet, physicians won’t rebel because it isn’t their nature. Even though it is logical to do so.

  • ninguem

    There seems to be a rough correlation.

    The Boards of the relatively high-paying specialties pay their directors relatively low.

    The Boards of the relatively low-paying specialties, pay their directors much higher salaries.

    • LeoHolmMD

      Yeah, what’s up with Pedi?
      It may have something to do with x amount of dollars extracted per member?

  • DD Cross (MD)

    “Should we […] . . . ?” No. Through skilled manipulative machinations folks who’d otherwise be found selling used cars, penny stocks, or finagling one off-kilter money-making scheme or another are pretty much defining “quality” in healthcare. The fact that American physicians continue to buy into this nonsense is another example of the erosion of the profession.

  • edwinleap

    Wes, thanks for your work in bring this to light! Excellent. I find it interesting that there is a powerful link between the boards and the residency directors.

  • edwinleap

    Another point to ponder: why is it that when drug companies want us to use their drug, it is a conflict and we aren’t even supposed to breath the same air. But when boards, which make money on their own tests, tell us to do it, it’s good for everyone. Inconsistent? A bit…

  • LeoHolmMD

    Why would administering a standardized test to more people create more work? If I give a test to 10 people or 10000, what would it matter? Perhaps more staff are required, but this does not explain the compensation of the board member.

  • rbthe4th2

    Thank you. I’ve griped before about not seeing these “admins” salaries. I want my PCP’s to get a good share and these people should make the same salaries THEY do – or maybe LESS – if they’re not seeing patients.

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