On My Mind...

A Pay Cut?

I love the idea of a healthy, Ivy League-educated, unmarried, childless, white guy with time on his hands to write terrorism novels based on his whopping three months as an "embedded reporter" for the New York Times pontificating about runaway physician salaries as a cause of our nation's health care crisis.

Alex Berenson's NY Times Op-Ed last week suggesting that doctors get paid too much is, simply put, ridiculous. It would be easy for me to be snarky--after all, it is awfully simple to suggest other people's salaries should be lower when one comes from a family that has enough expendable income to send their children to tony prep schools and pack them off to Ivy League colleges and then subsidize their Manhattan lifestyle. But the notion that doctor pay is too high is fundamentally flawed. First, doctors’ salaries have been shrinking for the past twenty to thirty years for a variety of reasons. One, malpractice insurance eats up a huge portion of physician salaries; and two, the rise of private, for-profit insurance companies siphon money out of the system in order to pay their shareholders and (let's be honest, grotesquely overpaid) CEOs. Let's just think about that for a minute--CEOs of big health insurance companies take home dinosaur-sized salaries--and not because they provide better or more insurance coverage--but primarily because they provide less. But Berenson never suggests that the Fat Cats in the health insurance industry or Big Pharma get a pay cut. He doesn't even fall back on the tired tort reform argument. Instead he goes after the hardest working men and women in the business--men and women who, for the most part, sacrificed huge portions of their lives to get educated and then spend their days helping ordinary people feel better.

So is physician income too high? Well, too high for what? Is their income outsized compared to their education and expertise? Are the services they provide worth less today than they were twenty years ago? Are they easily replaceable by someone willing to work for less? I think a reasoned and reasonable answer to these questions is NO. What should someone make if they spend four years of college, four years of medical school, three to five years as a resident (working for minimum wage or less), plus added years for specialty training and fellowships? What is the value of a limb salvaged? A life saved? A disease found early? A dignified death? What is the value of knowing the results of a test, an x-ray, or MRI? How much is health care worth?

Just one last snarky comment. When Berenson was an embedded reporter in Iraq, did he tell those military doctors, whose skill and expertise has kept the body count lower than in any previous war, that they should consider a pay cut? And if he had been (and thankfully wasn't) hit by an IED, I bet he would have paid anything to have a doctor keep him alive

So, when you're ready to cut corners, Alex, or you're the first in line to see the discount physician or get all your health care needs from a tech at the WalMart clinic, let me know. Until then, maybe it's time to write that second novel....

Oh--and another idea--since you pointed to the idea of physician pay being linked to patient outcome, I think you should try it first. How about journalists only get paid when their readers' IQ goes up? That way we'll know you're doing your job of educating the citizenry.

"On My Mind" is a column designed to encourage discussion within the medical community about politics and health issues. The writer of this column is a professor of American history and has an unhealthy obsession for politics.

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