Bad mea­sure­ment

Modern Healthcare - - Opinions / Letters -

In your story about the com­pen­sa­tion of doc­tors (“Wide pay gap per­sists among docs,” ModernHealth­, Oct. 26), the re­searchers talked about the dol­lars per hour com­pen­sa­tion of physi­cians of be­tween $60 and $92. It would be in­ter­est­ing to look at hourly pay re­ceived by other pro­fes­sions or trades. Com­puter re­pair and ser­vice es­ti­mates are $50 to $75 an hour (with no govern­ment reg­u­la­tion and min­i­mal over­head) and nurse anes­thetists con­tract for $75-plus an hour (work­ing un­der the su­per­vi­sion of a physi­cian). Lawyers, ac­coun­tants, ar­chi­tects rou­tinely ex­ceed over $150 an hour (with some over­head). Rou­tinely, you pay more for ex­pe­ri­ence and spe­cial­iza­tion in all ar­eas of pro­fes­sional ser­vice de­liv­ery.

None of these pro­fes­sions or trades rou­tinely en­ters into prac­tice with over $150,000 in debt, has call obli­ga­tions, ma­jor per­sonal li­a­bil­ity risk, clients with­out the means to pay, or fed­eral or state reg­u­la­tory ex­po­sure to the de­gree of a physi­cian. And there is no ad­just­ment in pay­ment for most physi­cian ser­vices for ex­pe­ri­ence. A pro­ce­dure is a pro­ce­dure and an of­fice visit is an of­fice visit. Cer­tainly this is the view of Medi­care, Med­i­caid and ma­jor in­sur­ers.

The ar­ti­cle points out that the evolv­ing short­age in pri­mary care may be the re­sult of this pay dis­par­ity within the med­i­cal pro­fes­sion. The im­plied so­lu­tion must be nar­row­ing of this vari­a­tion, and more equal hourly pay will im­prove this prob­lem. I would sub­mit that the real is­sue is that on an hourly pro­fes­sional rate of re­turn stan­dard, all ser­vices pro­vided by physi­cians are un­der­val­ued, and it is not the dif­fer­ences be­tween spe­cial­ties that are the prob­lem.

My point is that the dis­tor­tion of the mar­ket by the “bud­get-neu­tral” Medi­care view does not lead to a ra­tio­nal al­lo­ca­tion of re­sources for a skilled work­force. Us­ing an hourly rate ref­er­ence point within the pro­fes­sion sets the pro­fes­sion against it­self in a squab­ble over scarce re­sources and is the wrong ref­er­ence point. I won­der in the con­text of what non­med­i­cal providers get paid hourly for ser­vice-re­lated ac­tiv­i­ties if $90 an hour com­pen­sa­tion for your ICU doc­tor, your ob­ste­tri­cian, or the on­col­ogy physi­cian help­ing your fam­ily thor­ough the re­al­ity of deal­ing with a malig­nancy would be thought to be ex­ces­sive. It might help ex­plain the com­ing lack of ac­cess as in­tel­li­gent in­di­vid­u­als pur­sue other ca­reers. R. Bruce Well­man CEO Carle Physi­cian Group Ur­bana, Ill.

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