Doctors should work weekends, and how reformers alienate physicians

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.

And he’s right, to a point.

I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs that hospitals employ on Saturday and Sunday.  And, since Mr. Orszag is an economist, the cost factor is noted.  Tests that get pushed off until Monday cost the health system serious dollars.

The problem I have is that Mr. Orszag, like most health reformers, offers doctors little incentive in return.

Like most people, doctors like their time off.  In the United Kingdom, the NHS addresses the issue of after hours care by offering primary care trusts, which receives government funding for care at night and on weekends.

What does Mr. Orszag suggest to support American physicians working weekends, other than telling them they should?  Increased pay?  A reduced paperwork burden?  More support for beleaguered primary care doctors?

Instead, nothing.

Why not have doctors sympathize with your point of view by offering incentives?  Studies show that patients are heavily influenced by their doctors.  If health reformers want to sway public opinion, getting doctors on your side seems to be the ideal strategy.  Instead, more often than not, they’re alienated by Mr. Orszag and his progressive ilk.

The same can be said for physician salaries.  It’s no secret that most health reformers want to reduce physician salaries.  Fine.  I agree there’s a significant pay disparity between primary care doctors and specialists that needs to be moderated.  But in order for physicians — specialists, in particular — to accept that stance, why not offer something beneficial in return?  There are more than a few who would trade lower pay for, say, true malpractice reform.

It’s confounding how progressive health reformers continually antagonize the medical profession when, in fact, their job could made be so much easier with doctors on their side.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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