The tension between physicians and health policy experts


There’s an underlying tension between physicians and health policy experts.

Health policy experts take subtle jibes against physicians in their analyses, with many feeling American doctors are overpaid, which exacerbates health costs.  They tend to be politically progressive, and generally dismiss the issues that most doctors care deeply about.  Medical malpractice, tort reform and the cost of medical education, for instance.

And doctors can be antagonistic to policy experts.  As most wonks are not physicians themselves, doctors generally discount their opinions, since they haven’t gone through the rigors of physician training, and are shielded from the day to day realities of practicing medicine.

Yes, I’m generalizing, but those are the themes I’ve observed from the health reform conversation over the past few years.

But if we are to fix our health system, both sides need to come together.

Consider a recent NEJM piece, which asks the following:

Are U.S. physicians sufficiently visionary, public-minded, and well led to respond to this national fiscal and ethical imperative? It’s a $640 billion question.

Merrill Goozner, a progressive policy commentator, answers:

The short answer, of course, is no. If they were public spirited, would they lobbying as hard as they are to restore physician pay — the so-called “doc fix” — which will cost the government another $300 billion for Medicare over the next decade?

It’s a subtle physician-antagonistic response that policy wonks on the progressive side — Goozner, Ezra Klein, Maggie Mahar, and Paul Krugman, to name a few — occasionally make that only exacerbates the discord.

Yet, to successfully reform our health system, doctors need to be at the forefront, not policy experts.  And I’m not saying that because I’m a physician myself.  The data says so.

A Gallup poll, conducted in 2009,  found that physicians garnered the highest level of public trust when it came to health reform.

Click to enlarge

Patients still trust their doctors. Which is why it baffles me when policy experts don’t give doctors many olive branches when making their health reform arguments.  Given the rancor surrounding the debate, it seems that reformers could use all the support they can get.

Take the contentious issue of physician salaries, for instance.  Most progressive wonks feel that American doctors are overpaid, and in their ideal world, would like a single payer system where doctors are on a salary in line with the rest of the world.  Ezra Klein, for instance, continually points to France to illustrate this point.

Well, it’s no surprise that doctors are hostile to that worldview.  Of course, no one likes to get their pay cut.  But, why not balance the argument by including the cost of American medical education?  Yes, American doctors are paid more than any other physician in the world.  But look at what it costs to train them:

Click to enlarge

If policy experts included medical education reform (or medical malpractice reform) with their arguments for paying doctors less, it would be better accepted by the medical community.  I’ve written before that more than a few doctors would exchange medical school debt relief in exchange for a strict salary.  Or medical malpractice reform in exchange for less pay.

I appreciate the data-driven arguments that policy wonks present to illustrate, and potentially solve, our dysfunctional health system.  But charts by themselves cannot convince the public, whose acceptance is key to any variation of health reform.

To do so, health reformers need doctors on their side.  Why policy experts don’t make more of an effort to sway more doctors is a mystery to me, and a tragically missed opportunity.

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


View 53 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories