Thursday, January 3, 2008
Do Doctors Make Too Much Money - Volume II
I am truly amazed that the #1 most read post I have ever written was (read the link after!) "Do Doctors Make too Much Money?". Thousands of people from around the world have "googled" that phrase and found EverythingHealth. Every day there are several visits to that one old piece. I am amazed because I wouldn't have thought there was that much interest in Doctor's incomes. Apparently there is A LOT of interest and many have strong opinions if you read the comments.
I think some doctors are probably paid too much. But the other 99.99% deserve what they get or, if they are primary care physicians...they deserve A LOT more. The doctor group I know the most about is primary care and general Internal Medicine. I can tell you that, on average, these doctors are underpaid and overworked. Now don't write back and compare it to a teacher or a fireman and tell me how underpaid they are too. This is not a comparison...it is a fact.
If you have been reading EverythingHealth or any number of other health blogs, you know that we are facing a huge primary care crisis in the U.S. because less than 15% of all doctors in training will chose this specialty due to low reimbursement and heavy workloads. Why should you care?
You should care because your body is complex and there is no textbook or computer that can replace the thinking, intuition and training of a doctor. You should care because you are getting older along with everyone else, and the body is less forgiving with age. The Happy Hospitalist an Internist who practices in a hospital setting, describes just another decision making day at the office.
It isn't worth much, unless it is you, or your mother or wife.
You should care about primary care because your average specialist (cardiologist, transplant surgeon, gynecologist, dermatologist, ophthalmologist, pathologist, ENT, orthopedic surgeon and on and on) is not going to concern themselve with the complexities of multi organ disease and granny's alzheimers. They are not going to follow up on that abnormal mammogram or care about your cholesterol level. They are not going to care if you can't sleep, pee or poop...unless it involves an expensive test or procedure. Specialists are trained to deal with one part of your body. That is what they are interested in and that is where their expertise resides.
A primary care Internist has broad knowledge about every organ you own. They think in a comprehensive way and form differential diagnoses that let them process information to come up with the best diagnosis, testing and plan. Some are gifted healers and bring even more to the table.
Many people who follow health care policy believe it may already be too late to save primary care medicine. At the very least we will have two tiers of medicine. Retainer or concierge practices that cater to the wealthy and nurse practitioners who deal with routine health matters. Emergency rooms will be filled with everyone else. Patients will shuffle from specialist to specialist with no coordination, and costs will soar. Then we will see if we paid them too much back in the "good ole' days".
Posted by Toni Brayer, MD at 6:57 PM