I am someone who is very much in favor of transparency in medicine. In fact I recently pitched the idea of increasing hospital transparency to a state representative. (I highly recommend this book about that very topic.) However, the way that CMS released the Medicare data was ignorant and potentially damaging to physicians.
One of the biggest issues for healthcare right now, especially physicians, is its public image. For years doctors have been pegged as greedy, rich, and negligent. Our own president has not-so-subtly hinted at physician greed as a driver of healthcare costs. While there are few broke doctors, I believe the public’s belief about a doctor’s earnings is ill-informed.
Below is a slide from the MedScape Physician Compensation Report
Those do look like rather large salaries. But, like the CMS data, this is out of context. For example, we have no information about hours worked, debt load, etc. A survey of over 3,000 doctors suggest that 50% work 9-11 hours per day. Almost 20% of respondents work 12 hours or more per day.
Then there is debt accrued during medical school and residency, an expense not included in salary figures. Physicians actually start out in the negative, by hundreds of thousands of dollars. Dr. Benjamin Brown has crafted a great synopsis of this issue with a nifty graphic to explain. He isn’t the only one to cite this fallacy of medicine being a financially advantageous investment. CBS News reported on it as well.
The public’s view of physician earnings is not improved by the recent CMS data release. CMS has opted to release Medicare payment data with no interpretation. This means that patients are going to see raw numbers without the context of what they mean. This is problematic for many reasons. First, there will be inherent differences between private and group practices. The latter often share single billing accounts so that one individual will bill for all procedures with his or her billing code. The money is then divided up amongst all providers in the practice. This data also does not adequately represent the patient population serviced, how much of the payment goes back into overhead, etc. You can imagine that a hospice and palliative care doctor will have many more Medicare payments than an surgeon who does elective procedures. To read more about this check this New York Times Article.
Somehow the government has turned healthcare reform into patients vs doctors, and no one is winning. I am not sure if this is premeditated, but as physicians get dragged through the mud it becomes harder and harder to do their job. For example, my father has become convinced that many of the recommended tests and medications prescribed by his doctor are money making schemes, even though they are actually based in very sound medical evidence (in fact, the preventative care is now free under the ACA).
Meaningful healthcare reform requires us all to work as a team: patients, physicians, and the regulatory bodies. Pitting one against another undermines our goals of delivering safe, effective care at a reasonable price. Hopefully the government catches on to this notion in the days ahead.
You can find the New York Times’s How Much Does Medicare Pay Your Doctor App here.