Physician compensation still out of balance


Sometimes, I think those who have to pay physicians must feel like Hamlet did when forced to cope with his situation:

"The time is out of joint-O cursed spite,
That ever I was born to set it right!"

Hamlet, Act 1, scene 5, 186-190

OK, maybe the physician situation isn't quite as serious as having to promise your father's ghost that you will kill your stepdad...but we've still got some major problems. If you look at data from the MGMA, it's hard to escape the idea that there are some trends in motion that just can't continue.

Twenty years ago, at the beginning of my career, everyone was all up in arms over the fact that specialist pay was higher than primary care pay. They argued, rightly, that such a pay structure created questionable incentives. Despite the heated words, however, things didn't change much.

Today, talk of a "medical home" and the importance of primary care is enjoying a renaissance, but the raw fact remains that physician pay is still out of joint. 

MGMA data, for example, suggests that while primary care doctors worked even harder last year, their pay didn't keep up. Meanwhile, for reasons that--as far as I can tell--have little to do with differences in inherent value, some specialists are seeing meaningful pay increases and others less so.

OK, I admit that as long as we have a capitalist system, physician pay and the needs of the broader healthcare system will never be aligned exactly. There will always be winners and losers. But if PCP pay doesn't keep up with production, and specialist pay increases are all over the map, the disparities will remain too dramatic.

Until compensation models that emphasize value to the clinical process become more prevalent (including better pay for primary care), things are going to stay topsy turvy. Here's hoping that in the next year or two, our industry begins to get its hands around the notion of normalizing physician pay. And in the meantime, if you can share any stories of how you've worked this issue out, or if you have any suggestions, please feel free to be in touch. We'd love to hear from you. - Anne

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