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Wednesday, June 9, 2010

800 pound mooses and the American College of Physicians

The American College of Physicians has created an initiative to reduce costs and increase quality.  It is called the High-Value, Cost-Conscious Care Initiative, and was launched at the annual meeting in April.  They plan to focus on overuse and misuse of ineffective tests and treatments, of which there are many.  The congressional budget office estimates that 700 billion dollars yearly is spent on tests and treatments that do not improve health.  I suspect they underestimate that significantly. At the same meeting the college revealed plans to lobby for changes in health care policy not quite adequately addressed in the health care reform package, including prolonging salary bonus for primary care doctors treating patients on medicare and medicaid.

This is good! Even great. Why did this take so long?

I expect that part of the problem has been that it is difficult to find consensus in changing a system when there is considerable concern about loss of income and loss of respect. 

Issues not mentioned in the articles I have read about the meeting which are difficult to address include the fact that the present 10% bonus for primary care physicians doesn't come close to making the salaries of specialists and family practice or internal medicine doctors equal.  Providing adequate numbers of high quality primary care doctors is absolutely necessary to raise the quality of health care and health in general, and the oversupply of specialty physicians pretty much guarantees that too much expensive and unnecessary specialty care will be delivered.

Also, addressing the large and irritable moose sitting in the corner of the room during this discussion, some physicians really do make too much money.

I don't think that physicians should have to take extra jobs as cab drivers to support their families, as happens in Cuba, and there are many issues suggesting that physicians' salaries should be higher than average salaries, but a starting salary of $500,000 for a neuroradiologist is just plain out of balance. A full time primary care doctor can expect to pull in $150,000 at the height of his or her career, and in small towns or if the physician is female, that number is significantly smaller.

It is difficult to address this issue in a group like the American College of Physicians, because most people don't want to see their salaries shrink, and these large organizations are responsible for representing all of their members.

(Note: the 500 pound gorilla has been replaced with an 800 pound moose due to regional differences in fauna. i.e I'm from Idaho.)

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