By Roy Benaroch, MD
Here it is, folks: the annual Physician Compensation survey from Medscape/WebMD. Pediatricians made it to number one!
Number one, that is, for the least paid doctors. We’re right on top when it comes to making less than other physicians. The top three lowest paid docs are the three primary care physicians: pediatricians, family medicine, and internal medicine.
The highest paid doctors are radiologists, orthopedic surgeons, and cardiologists. Why the big difference? The top-paid docs are the ones who do the procedures. They catheterize things and poke scopes into you. They line up their patients and cut and poke and cash the checks. Radiologists don’t even have to talk to their patients—they just mumble a dictation and move on to the next film.
I’m not sure that this system works out the best for patients. I talk, and explain, and discuss, and explain some more. I spend most of my time talking. All of that time, to the insurance company, is just yapping. Hopefully, my patients and their parents leave my office better-educated, reassured, and able to handle things. What they don’t leave with is a big bill from a procedure.
Over the last few weeks I’ve had one patient, a teenager, who has missed a lot of school because of belly aches. I’ve spoken to him, and his mom, and the GI specialist, and the ER doc multiple times to coordinate care and make sure nothing was missed. I’ve talked to the school, I’ve written letters to the guidance counselor. All of this helped my patient get back into his usual routine. None of it paid me a dime. Here’s the thing: the financial incentives in place don’t reward doctors who talk and explain and coordinate. I could have made more money freezing off a single wart than I did for about three hours of phone calls.
Don’t get me wrong: I love my job, and I’d do it for even less money. But the American penchant for action—for doing something—is part of the reason our health care system is so expensive. Paying doctors for keeping people healthy, rather than doing things to them, might be one way to reduce health care costs while improving our wellbeing.