Medicine
The widening income gap between primary care and other types of physicians is one of many reasons that fewer medical students have been choosing careers in family medicine, general internal medicine, or general pediatrics. So it stands to reason that if any doctors will be paid less money in a reformed U.S. health care system, it ought to be the specialists. Up to this point, however, no physican organizations have offered to reduce their members' incomes in order to help control health care costs. In an editorial in last week's New England Journal of Medicine, medical ethicist Howard Brody points out the ethical problem with this uncompromising stance:
Early in 2009, insurance companies, pharmaceutical manufacturers, medical device makers, and hospitals all agreed to forgo some future profits to show support for the Obama administration's health care reform efforts. ... Physicians have, in effect, sworn an oath to place the interests of the patient ahead of their own interests - including their financial interests. None of the for-profit health care industries that have promised cost savings have taken such an oath. How can physicians, alone among the "special interests" affected by health care reform, justify demanding protection from revenue losses?
Brody goes on to assert that physicians could lower health care costs simply by paying more attention to evidence-based care guidelines, since studies have shown that areas of the U.S. which use more health resources (e.g., diagnostic scans, surgical procedures) do not have better health outcomes. He then challenges each medical specialty society to draw up a "Top Five" list of expensive tests or treatments that provide little or no health benefit and to develop a plan to discourage its members from ordering items on this list.
Unfortunately, I would be shocked if any physician groups actually stepped up to the plate to do this. In our current health system, all of the incentives - financial and psychological (see my previous post on reform "scare stories") - are aligned so that physicians provide more wasteful care, not less. But just as we all make difficult-to-attain resolutions every New Year - "I'll start an exercise program" or "I'll lose ten pounds" or "I'll be nicer to people who get on my nerves" - all doctors, regardless of specialty, should resolve to set aside self-interest and order fewer tests, treatments, and procedures that are not supported by good evidence in 2010. And in 2011. And in every year after that, until it actually happens.
- Health Care Industry Pledge To Cut Costs: No News At All
The big news on health care reform last week, when at a press conference, President Obama announced that the “Health care industry is said to promise to hold down costs voluntarily” (New York Times, Monday May 11, 2009, p. A11; p. 1 in the Kansas...
- Will Choosing Wisely Change The Way Family Physicians Practice?
As phase 3 of the Choosing Wisely campaign draws to a close, it's time to start assessing its impact. Family physicians have been at the forefront of this clinician-led movement to reduce waste and prevent harm from unnecessary medical interventions,...
- Cost-conscious Medicine: A Movement That's Gathering Steam
The past few months have offered encouraging signs that physicians and physician organizations are belatedly recognizing the need to take an active role in controlling health care costs by emphasizing "high-value" care and minimizing the use of low-value...
- The Cost-conscious Physician: An Oxymoron?
Several years ago, when my wife directed the third-year Family Medicine clinical clerkship at a highly ranked medical school, she developed a popular workshop on the cost of health care that presented students with scenarios of patients who were either...
- Reform Primary Care First, And Health Care Will Follow
I mentioned in an earlier posting that fewer medical students each year are choosing to pursue careers in the primary care specialties (family medicine, general pediatrics, and general internal medicine). The reasons for the decline have been documented...
Medicine
New Year's resolutions for physicians
The widening income gap between primary care and other types of physicians is one of many reasons that fewer medical students have been choosing careers in family medicine, general internal medicine, or general pediatrics. So it stands to reason that if any doctors will be paid less money in a reformed U.S. health care system, it ought to be the specialists. Up to this point, however, no physican organizations have offered to reduce their members' incomes in order to help control health care costs. In an editorial in last week's New England Journal of Medicine, medical ethicist Howard Brody points out the ethical problem with this uncompromising stance:
Early in 2009, insurance companies, pharmaceutical manufacturers, medical device makers, and hospitals all agreed to forgo some future profits to show support for the Obama administration's health care reform efforts. ... Physicians have, in effect, sworn an oath to place the interests of the patient ahead of their own interests - including their financial interests. None of the for-profit health care industries that have promised cost savings have taken such an oath. How can physicians, alone among the "special interests" affected by health care reform, justify demanding protection from revenue losses?
Brody goes on to assert that physicians could lower health care costs simply by paying more attention to evidence-based care guidelines, since studies have shown that areas of the U.S. which use more health resources (e.g., diagnostic scans, surgical procedures) do not have better health outcomes. He then challenges each medical specialty society to draw up a "Top Five" list of expensive tests or treatments that provide little or no health benefit and to develop a plan to discourage its members from ordering items on this list.
Unfortunately, I would be shocked if any physician groups actually stepped up to the plate to do this. In our current health system, all of the incentives - financial and psychological (see my previous post on reform "scare stories") - are aligned so that physicians provide more wasteful care, not less. But just as we all make difficult-to-attain resolutions every New Year - "I'll start an exercise program" or "I'll lose ten pounds" or "I'll be nicer to people who get on my nerves" - all doctors, regardless of specialty, should resolve to set aside self-interest and order fewer tests, treatments, and procedures that are not supported by good evidence in 2010. And in 2011. And in every year after that, until it actually happens.
- Health Care Industry Pledge To Cut Costs: No News At All
The big news on health care reform last week, when at a press conference, President Obama announced that the “Health care industry is said to promise to hold down costs voluntarily” (New York Times, Monday May 11, 2009, p. A11; p. 1 in the Kansas...
- Will Choosing Wisely Change The Way Family Physicians Practice?
As phase 3 of the Choosing Wisely campaign draws to a close, it's time to start assessing its impact. Family physicians have been at the forefront of this clinician-led movement to reduce waste and prevent harm from unnecessary medical interventions,...
- Cost-conscious Medicine: A Movement That's Gathering Steam
The past few months have offered encouraging signs that physicians and physician organizations are belatedly recognizing the need to take an active role in controlling health care costs by emphasizing "high-value" care and minimizing the use of low-value...
- The Cost-conscious Physician: An Oxymoron?
Several years ago, when my wife directed the third-year Family Medicine clinical clerkship at a highly ranked medical school, she developed a popular workshop on the cost of health care that presented students with scenarios of patients who were either...
- Reform Primary Care First, And Health Care Will Follow
I mentioned in an earlier posting that fewer medical students each year are choosing to pursue careers in the primary care specialties (family medicine, general pediatrics, and general internal medicine). The reasons for the decline have been documented...