Gender politics aside, let’s talk about why the way doctors get paid matters to you as a patient. Female physicians don’t just get paid less because they prioritize their families, they get paid less because they prioritize patients. In the fee-for-service model, doctors are paid per patient visit, so the more patients they see, the more they get paid. This means that the worst doctors are paid the most. Health care administrators love “productive” doctors who see 40 to 50 patients per day in 5 to 10 minute visits. These doctors make a ton of money rolling patients through the assembly line, and they produce even more money downstream with all of their referrals and tests and frequent return visits since their patients’ problems are never adequately addressed. One local hospital group times all patient visits, and any physician who spends longer than 15 minutes with a patient is reprimanded. The best physicians are literally punished for prioritizing patient care over profits.
Doctors who spend more time with their patients are better diagnosticians because they listen to their patients, get a thorough history, and perform an appropriate exam. They are less likely to need to order expensive tests or refer out to a specialist. The best doctors consider the cost of care and take extra time to ensure that their patients are getting the most affordable medications and that they are not subjected to costly and unnecessary testing. The best doctors respect their patients’ time and avoid making them return for another appointment for a skin biopsy or joint injection. Spending more time with patients is also important in building trust and motivating them to make healthy changes, such as smoking cessation or weight loss. Female physicians have been proven to have lower mortality rates, probably because they choose to spend more time with patients, make thoughtful diagnoses, order testing judiciously, address financial concerns for patients, and make sure that their patients understand and agree with the treatment plan.
I know many excellent physicians, both male and female, who make patients their priority and give them the time they deserve. However, this is very difficult to accomplish within the current system, and many good doctors get swept up in pleasing their bosses and paying off their medical school loans. The solution, for doctors and patients alike, is direct primary care. By paying an affordable monthly fee, patients get access to a doctor who has plenty of time to give them the best possible care. Doctors are paid fairly because they are providing a valuable service directly to the patients who pay them.
Emily O’Rourke is a family physician.
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