‘Incredibly distorted market’ drives physician compensation

Regarding the Transformation Hub article “Rapid rise in hospital-employed physicians increases costs,” (ModernHealthcare.com, March 16), the evolving dynamics of physician compensation are fascinating. I’m a surgical specialist in a small practice serving a not-for profit hospital that remains independent of a large system (for now). It is a nonacademic tertiary-care center for a geographically isolated population of 500,000 people with smaller feeder hospitals in the vicinity.

The hospital employs about half the medical staff. Most of its employed surgical and medical specialists’ pay falls in the top 10% of Medical Group Management Association survey salaries; it has done this out of fear of losing service lines.

The hospital is now seeking to loosen and remove this self-imposed noose by creating a physician-led multispecialty entity within the health system but off of the hospital’s balance sheet. The employed specialists will either have to agree to a compensation haircut or leave. Many probably will leave.

Our sense—as physicians—of our own financial worth has been distorted by what we have been able to negotiate for ourselves in an incredibly distorted market. Ask anyone paid in the top 10% if their services are actually worth that dollar amount and most will reply “of course.”

Specialist salaries will “right-size” and primary-care salaries will rise. The question is whether we can create change from within to do this smoothly. Otherwise we will be rocked from the outside by disruptive external forces. Unfortunately, one of the casualties will be patient access to care, particularly in rural areas.

Dr. Mark Edney Salisbury, Md.