Imagine you were in control of healthcare spending. How much would you pay a doctor a year? Write that number down.
Now let me rephrase that question. Let’s say you were in a terrible motor vehicle accident, and you and a loved one suffered life-threatening injuries. The doctor at the hospital (which is on the ready 24/7 for you), who has spent over 9 years of post-graduate training to ensure you get appropriate care, saves both your lives. How much would you pay that doctor a year? Write that number down.
How much does Jason Spezza get paid a year to try and push a puck into a net? $7-million a year.
There has been an increasing trend in the media to throw the spotlight on the “cost” of physicians – and even more so in the past month given the recent Drummond Report, as well as the government’s re-negotiation with the Ontario Medical Association that’s happening before the current physician remuneration contract expires at the end of the month.
And rightly so, since physicians are one of the most costly components of our government’s expenditure. Check out this article I came across this morning. While I may not agree with everything the author proposes, I think he hit a key point: “controlling” physician costs is not the answer. It is not just how much physicians are paid, but also how they dictate the utilization of everything from diagnostics to therapeutics.
There is an interesting concept of physician induced demand in health economics. The idea is that there is financial incentive for doctors to over-investigate and over-treat, with no check in the system given that patients lack the intricate medical knowledge to discern whether they are appropriate. This phenomenon is present in varying degrees depending on the funding structure of the healthcare system; the most drastic example of this is none other than the United States, which spends the greatest % of its GDP on healthcare in the world by a large margin, while arguably providing the same level of healthcare as similar countries.
Ann Intern Med. 2005;142:847-854
One of the proposed methods of addressing this problem is to play around with the way physicians are funded, moving away from a fee-for-service model towards others such as capitation, salary, or a combination of them. They all of course have their own disadvantages (which I will explore in a later post), but what’s even more interesting is the new idea of pay-for-performance. Linking financial reward to actual end results at the workplace has been the backbone of most professions since the beginning of time, although somehow the idea is a novel one in the field of healthcare delivery. Doctors are paid for doing things, and nurses are paid by seniority…regardless of how good or how efficient they are. None of it is tied to actual patient outcomes.
Maybe it’s time we stop asking ourselves how much a physician or nurse is worth – but instead, explore how we should link our healthcare dollars to the achievement of the healthcare outcomes we want.