With the upcoming presidential nominations on the horizon, one of the go-to topics for candidates has been health care. What's wrong with it. How we can fix it. Is it Obama's fault? But there is actually one key piece of the puzzle missing which actually can create a win-win situation. It's a very simple strategy -- pay doctors more.
When the idea of paying doctors more money for their work is proposed, many people have the same gut reaction. Why should the rich get richer? Unfortunately, this is an instinctual reaction rooted in a false picture of today's health care practitioner. The so-called golden era where doctors treated patients and made them better and as a result were wined and dined by drug company representatives or drove a fancy sports car to work are long gone. Reimbursement rates for the same services have been on the decline for decades. Most doctors find themselves unable to support a practice without joining a large group of other doctors or working for a hospital. Yet, there is a simple solution to this problem -- pay the doctors more.
With overhead expenses so high and reimbursement rates so low (if you can actually get the insurance company to pay, that is), doctors have to cram as many patient appointments into a single day as possible just to keep the lights on. Now, if the doctor got paid more per visit, he or she could see less patients in a day, see each patient for a longer period of time, and likely make better, holistic choices for the patient. With the longer visit time with the doctor, the patient would be happier. With a higher paycheck the doctor would be happier. It would be a win-win. That is, if the insurance company didn't have its say.
Dealing with the bureaucracy of insurance company billing and sending paperwork back and forth to overcome the almost guaranteed denial of reimbursements requires a small army. Behind the scenes of every doctor's office is a room full of people surrounded by stacks of paper, making phone calls and sending faxes just to get the physician practice reimbursed for the patient visits. In addition, the necessity to make as much money as possible from every patient encounter leads to further pressure on the physician to perform possibly unnecessary procedures -- procedures that aren't necessarily dangerous to the patient, but ones that simply could be done without had they not provided an additional revenue source. Furthermore, many surgeons are shocked when they see how little they get paid for the complex surgeries they perform. Sadly, it often appears that they would make the same amount of money performing one surgery as they would simply seeing three or four patients in clinic, thus leading many surgeons to significantly limit the amount of surgeries they perform, which translates into less surgery opportunities for the patient.
Some people wielding pitchforks and torches at the insurance companies may point to socialized medicine or the health care systems of other countries as a remedy for both physician financial need and insurance company bureaucracy. But from my conversations with physicians from other countries, this lack of compensation and physician autonomy leads to doctors checking out at 4pm every day without any feelings of obligation to the patients and patients waiting weeks or months to see specialists or undergo tests.
Another reason to pay doctors more is there simply isn't a big enough army of physicians, especially primary care doctors, to deal with the health care needs of this country. The difference in income between specialists and family or primary care doctors is staggering and large enough to push most medical students away from primary care and into a sub-specialty. I remember as a young college student speaking to older doctors (who by the way likely made more than I will) warning me against the evils of the health care field and how little money I would make. The truth is, they are somewhat right. Despite being a doctor, my family still lands firmly in the middle class. And retirement savings are a joke since we have so many loans to pay. Saving for retirement as a physician is like showing up to the retirement race ten hours late, starting 50 feet behind the other racers, and running with a parachute behind your back.
All of these scenarios come together to form a very bleak picture of our health care system. Physicians, the very source of aid for the patients in our system, are being forced out in droves. Sure, physicians usually have a job for life, but this hasn't stopped many of them from burning out and leaving the practice of medicine. After all, we went to medical school to help people, not to become accountants. Isn't the health of our patients and the stability of our health care system worth paying doctors a little more?