| In the midst of an exploding national | | | | And while the fact that prescription drugs in |
| healthcare crisis, there's much talk about | | | | this country cost patients between thirty and |
| slashing drug prices and cutting health | | | | fifty percent more than in Europe is an issue |
| insurance company profits. While these are | | | | warranting attention, the equally important |
| valid debates, many physicians are actually | | | | fact that doctors' pay is also dramatically |
| offering an equally controversial solution: | | | | inflating healthcare costs is rarely |
| cut their pay. | | | | discussed. American physicians make between |
| | | | two and three times more than their |
| Hearing a physician suggest a pay cut for him | | | | counterparts in other industrialized nations. |
| or herself is a bit like witnessing a | | | | The average doctor here earns between |
| politician opting out of a kickback. Sure, it | | | | $200,000 and $300,00 a year. Primary care |
| happens but most of us will never see it, and | | | | physicians earn less -- usually between |
| tend to believe such a thing a dangling, | | | | $125,000 and $200,000 annually -- and |
| idealistic myth too elusive to pull down into | | | | specialists earn more. Making $400,000 a year |
| reality. Many healthcare economists and | | | | and above is not unheard of for radiologists |
| physicians, however, are suggesting just | | | | and other doctors with additional years of |
| that. Dr. Alan Garber, a practicing internist | | | | training. |
| and director of the Center For Health Policy | | | | |
| at Stanford University, thinks offering | | | | No one is debating the respect doctors should |
| medical doctors a lower, fixed salary, | | | | be given for their years of intensive |
| accompanied by bonuses for healthy patients, | | | | education and, in most cases, enormous |
| may be a crucial step to working out of the | | | | talent. Medical schools run around $30,000 a |
| crisis. | | | | year now, putting most graduating medical |
| | | | students in considerable debt. They should be |
| "The problem is the way (physicians) earn | | | | compensated, and allowed to earn what is |
| their money. They have to do stuff. They have | | | | necessary to lead comfortable lives and clear |
| to do procedures," said Dr. Peter Bach, | | | | their credit reports. But European doctors |
| pulmonary physician at Memorial | | | | only earned $60,000 to $120,000 a year in |
| Sloan-Kettering Cancer Center in New York | | | | 2002, according to a survey sponsored by the |
| City and former senior advisor to Medicare | | | | British government. This, in turn, means much |
| and Medicaid. In other words, doctors are | | | | lower medical costs are transferred to the |
| paid by the procedure, not by whether the | | | | public. |
| procedures go well, if their patients | | | | |
| actually need them, or if their health | | | | Europeans pay less, overall, for their |
| improves. | | | | healthcare partly because they pay their |
| | | | doctors a comfortable, but far lower, salary. |
| In contrast, doctors are not financially | | | | The discrepancy between nurses' and doctors' |
| rewarded for routine exams or "cognitive | | | | pay, as well, is simply unacceptable to many |
| services," such as researching different | | | | when nurses often work just as many hours, |
| treatment options, or giving patients advice | | | | and provide just as intensive -- albeit |
| on how to improve their health without | | | | different -- care as physicians. |
| medical visits, tests, or prescription drugs. | | | | |
| This, despite the fact that healthy eating, | | | | The idea of paying doctors a fixed salary, |
| exercise, and the end of tobacco use would | | | | possibly with bonuses for healthy patients, |
| "significantly" cut cancer deaths, according | | | | is not without its problems, however. Such a |
| to the American Cancer Society -- up to 66%. | | | | system may encourage physicians to only see |
| Primary care physicians and pediatricians | | | | those patients they believe can be easily |
| provide more of this routine care and rarely | | | | treated, for example. It may also do the |
| perform complicated procedures, so, in | | | | opposite of encouraging rigorous and thorough |
| general, they're paid a lot less. | | | | testing, as doctors would theoretically be |
| | | | paid the same for twenty minutes of |
| The pay-by-procedure method, which offers | | | | evaluation as for twenty hours. |
| little financial incentive to enter family | | | | |
| practices or pediatrics, is fostering a | | | | The additional pressure to meet the demanding |
| shortage of qualified physicians. Twenty | | | | needs of a growing population during a time |
| percent of people in the U.S. have | | | | when physicians are in short supply may |
| "inadequate or no access to primary care | | | | further increase this tendency. It's clear, |
| physicians" because of this shortage, | | | | however, that something has to be done. As |
| according to reports released in March. In | | | | usual, most of the solutions will be hashed |
| 2004, 75% of counties in Texas lacked an | | | | out in Congress and through the media, but |
| adequate number of primary care physicians to | | | | it's up to those of us actually receiving the |
| meet their needs. Twenty-four counties didn't | | | | care that may, or may not, save our lives to |
| have one at all. For cities like Dallas, | | | | push for those decisions. |
| Houston, and Austin -- which handle an almost | | | | |
| unimaginable caseload and are already | | | | Being aware of issues affecting the |
| experiencing deficiencies in the number of | | | | accessibility and quality of healthcare is an |
| most types of healthcare providers -- any | | | | important part of minding your health. How |
| further deficiencies could cause serious | | | | you take care of yourself will certainly |
| problems. | | | | affect you as you age, and eventually your |
| | | | wallet, as well. |