Should doctors be forbidden to complain about money?

The Patient Centered Medical Home is supposed to be the solution to our primary care woes.

Endorsed by both the American Academy of Family Physicians and the American College of Physicians, this new model of primary care creates a team-based approach to patient care, with a cadre of care managers and nurses assisting physicians to manage patients with chronic disease. If the model is widely implemented, it would keep patients out of the hospital, save money, and divorce doctors from the dreaded fee for service payment system.

But getting from here to there is proving to be an arduous task.

The Wall Street Journal detailed one practice which made such a transition. Unfortunately, equipping today’s practices with the necessary technology and workflow changes is expensive. And the financial incentives meant to transform these practices barely makes up for the cost.

According to the piece,

For a five-doctor practice, the Advisory Board Co., a health-care research firm, projects the total first-year cost at between $126,000 and $346,500, including two added nurses.

The upshot: Doctors fear a squeeze as they try to ramp up changes in tandem with evolving reimbursement schemes. “You’re asking a practice that may be only marginally viable as a business to invest in significant infrastructure,” says Glen Stream, president of the American Academy of Family Physicians. “Is the payment model going to be there to support that?”

Progressive-leaning pediatrician and health policy expert Aaron Carroll doesn’t like the slant of the piece, saying that in today’s recession-recovering economy, doctors shouldn’t complain about money:

Every time I see a piece in the media about doctors complaining about money, I cringe. What the article fails to mention is that the clinic is “struggling” because it’s also likely paying its physicians a nice six-figure salary. There seems to be this feeling that many (not all) doctors share that they are “entitled” to large salaries. Yes, they have a high cost of education, and yes, the years of training they had to go through is extreme. But still, when your nice six-figure salary becomes a slightly lower six-figure salary, you don’t get to go around complaining that you’re “struggling to make ends meet”. It’s sad for you. It’s going to make your lifestyle a little less awesome, likely. I’m not unsympathetic. But consider your audience.

Well, maybe. It’s true that physicians who plea that they “struggle to make ends meet” will be met by an unsympathetic public ear. But there’s a general public belief that most doctors are rich, drive luxury cars, and hang out at the golf course. In primary care especially, it’s a caricature that’s far from the truth.

Despite what Dr. Carroll calls a “sob story,” it’s still one that deserves to be told. The public shouldn’t be shielded from the real-world financial decisions facing today’s small, independent primary care practices. It’s the only way to puncture the myth of the “rich” doctor, which in primary care, is a slap in the face.

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

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