Tuesday, September 20, 2011

Are doctors treated worse than everyone else?

Many physicians, and especially primary care physicians, aren’t happy campers. Why should they be? They feel disrespected, overworked, over-managed, and underpaid. They tell me they wouldn’t advise their children to go into medicine. Some feel that physicians are singularly beset upon. “Our government acts toward the medical profession in an abusive fashion. No other industry or profession is humiliated in this way,” writes RyanJo, a frequent commentator to this blog.

I can appreciate why many physicians are upset. They’ve had a decade where the Medicare SGR formula repeatedly has threatened to cut their fees, only to have Congress enact last minute reprieves that replace the cut with a small token increase that has not kept pace with their costs. Last year, Congress actually allowed the cut to go into effect and then retroactively restored it, creating havoc in physicians’ offices during the four weeks when they weren’t being paid. Like Charlie Brown and Lucy’s football, they are told each year by their members of Congress that that “this will be the year when the SGR will finally get repealed, really, for sure, we promise, this time will be different”--only to see it pulled away at the last minute.

In the meantime, they are constantly hounded to be more accountable for the care they deliver, to fill out just another form, to document their encounters, to get permission before they order a test, to double-check on whether their patient really needs that motorized wheelchair peddled on late night TV, to report on their performance, to e-prescribe (or else!), to buy an electronic health record and make damn sure that it is complies with “meaningful use” rules (or else!), to spend thousands of dollars to convert to new diagnosis codes (or else!) just because someone in government says they must . . .can we blame them for being unhappy?

Surely not. Health care payers, government and private sector alike, have a responsibility to stop piling on more paperwork and rules. Congress has a responsibility to fix the problem it created with the SGR, and ensure that physicians are paid fairly for their services. Primary care physicians have the right to expect that their services will be valued appropriately and sufficiently. And organized medicine has a responsibility to show its members that it is fighting against such intrusions and for fair payment policies.

But as we make the case that physicians deserve better, we also need to be aware that much of the rest of America has it much worse. Just read Robert Samuelson’s column in Monday’s Washington Post, documenting the economic devastation created by the Great Recession and lost decade of stagnation. He writes that the Census Bureau has found that “Median household income (the income precisely in the middle of the distribution) was $49,445, down 6.4 percent from 2007 ($52,823), the recent peak, and the lowest since 1996 ($49,112).” About 10 million more people have fallen below the official poverty line since 2006. The jobless rate remains stuck at over 9 percent.

But things are actually much worse than these numbers suggest, he argues:

“Even for millions of Americans with jobs, there’s a palpable sense of loss and anxiety. One reason is the devastating housing slump, subtracting huge amounts from people’s wealth. About half of households also own stocks through retirement accounts, mutual funds or ordinary brokerage accounts. The market’s daily gyrations inflict a feeling of endless vulnerability.

Perhaps as powerful are parents’ fears for their children. The jobless rate for young workers (ages 20 to 24) is always high — the young are restless and move between school and jobs — but now it is an astronomical 14.8 percent. Getting started is hard; studies suggest that young workers who experience intermittent work and low wages in a harsh economy may suffer permanently depressed lifetime earnings.”

Physicians have a lot to be unhappy about, but they almost never have to worry about being laid off from work, they are still relatively well-compensated, and they are trusted and respected by the public. Internists on average earned $189,000 in 2009, according to the Bureau of Labor Statistics; surgeons earned a bit more than $225,000. (Yes, I know that some internists make much less than the average, but some also make more—that’s how it works with averages.) For all occupations, the average income was $44,410.

I also know that there is much more to career satisfaction than having a job and a good income, and the country should pay attention to the physicians’ grievances. We should want physicians to be happy in their work. We should want smart young people feel that there is a future in medicine, including primary care. We should want to join with physicians to protest government actions that abuse and humiliate them. We should want to pay doctors fairly for their services and eliminate much of the paperwork that is driving them (and their patients) crazy.

At the same time, the medical profession won’t garner much public sympathy if it acts unaware that it remains a stable and highly compensated profession, at a time when wages for most Americans have been stagnant for a decade, one out of ten of us is out-of-work, millions more have become officially poor, many who have jobs fear losing them or worry that their kids won’t find them, creating what Samuelson calls a “fatalistic sense that the economic slump will never end.” Let’s remember that even as physicians have legitimate complaints about how they are treated, tens of millions of Americans have it far, far worse.

Today’s question: Do you think physicians have it worse than the rest of the country?


Harrison said...

Of couse physicians don't have it worse than the rest of the country. That was always my concern when we go to Congress to argue for a fix to the SGR formula. If we argue this point as compromising our revenue stream without explaining it, then we lose. We have to explain what decisions will be needed to keep the businesses we represent open if such cuts are allowed to proceed. Staff layoffs, loss of staff benefits, decreased access for Medicare patients, delays in upgrading offices from paper to EHR, etc....
Physician income losses can be used to argue these points, but not easily. Those arguments have to do more with the debt burden of new physicians, and the choices they are likely to make in order to pay for that debt. If we want to have patients move into primary care so that our system is healthier then we have to make the physician reimbursement in primary care attractive for young physicians.

We should also be very big advocates for the health of our economy. Fiscal policy that moves money into the hands of our patients so they have more power as consumers will be good. We are very much plugged into the the economy. If the economy is doing well with more people employed and insured then we have patients who can afford to pay for our services.

We need the economy to improve as much as any other group offering services.

ryanjo said...

The US economy is a slow motion train wreck, created and sustained by corporate greed and government incompetence. So of course, let's invite both into patient-physician relationship.

As Bob comments, I have a job as a physician. Many others do not have any means to support themselves; they are very obviously worse off.

Whether physicians should be mindful of their own incomes and employment when asking for wrongs to be corrected -- this misses the point. How much more degraded will US society be facing a physician shortage, or even worse, the advent of a physician workforce bought and paid for by large corporate entities.

Imagine the failure of a large corporation (like GM) employing thousands of medical personnel. Or a battle between politicians over funding the entities created by the ACA, such we have witnessed over the debt ceiling. This is not only a battle over paperwork and incomes. This is about who makes the decisions for our healthcare. We should remember recent events and choose wisely.

Robert E. Jackson said...

"God and the Doctor we alike adore. But only when in danger, not before; The danger o'er, both are alike requited, God is forgotten, and the Doctor is slighted"

Russell W. Fitzgerald said...

Thank you Robert E. Jackson for your concise, truthful, playful quotation.

skatha said...

Love it-the government is paid to be incompetent. That way, the oligarchs who push for more privatization have the full support of the people least able to protect themselves from downward wage pressures, increasing costs of living, and persistently high unemployment!
Are doctors worse off? Seriously? I work as a locum tenens doc. My income has gone up every year since I decided to do it full time. My husband is an architect. His pay got cut 10% in 2009. He does the work of 3 people now and worries if his company is going to let him go once his current client's work is done. What is it with this culture of victimization in this country where the people least likely to be actually victimized-mostly white, upper middle class males who usually identify as conservative-are the ones to complain loudest about being victimized?