Doctors say they deserve high compensation because they have at least five years of post-college training, they often leave medical school with hundreds of thousands of dollars of debt, and they provide a vital service to the community. The Physician Compensation Report was conducted earlier this year and it was posted on the Medscape website.
In all, 19, physicians from 25 specialties responded. Of the doctors who responded, more than 60 percent said they were employed by an institution of some sort while about a third said they were in private practice. They added that there seem to be a number of reasons for their discontentment. One is the number of years physicians spend in college, medical school, and then in training. By that time, other college graduates have been earning salaries for eight years or so.
Wergin pointed to his son, who is just getting his first job in the medical field at the age of Changes in the medical field may be fueling some of the discontent, too.
Specialists who used to work on their own and garner percent of their fees may now work for a medical group or hospital and only get a portion of that. Many doctors are also being asked to perform more administrative tasks and perhaps see more patients.
Both Wergin and Jamieson said compensation might start to climb in the near future. One reason is the emerging emphasis on quality care over quantity of care.
Jamieson said some medical institutions are starting to add bonuses and other enhancements for doctors who do good work. Waszul argues that high salaries for doctors are part of the problem of high medical costs for Americans, but Gary Price, MD, and Tim Norbeck wrote a rebuttal for Forbes that argues the following:. What are these salaries, anyway? Salaries for doctors tend to be affected by the same things that affect salaries for other industries: location, education, specialty level, experience, and demand.
Network-employed doctors do not have as much freedom as their colleagues who are independently employed, but they also have more job security. With all other factors being equal, independent doctors get paid more than their salaried, group-employed colleagues. However, doctors who own their own practices often have to work longer hours in order to see enough patients to make their offices profitable.
For doctors who have families, children, or important social and community commitments, this can be an unlivable arrangement. That is part of the reason why doctors are moving towards salaried employment with a hospital, network, or group. Doctors can decide whether or not to participate in Medicare.
Most eligible providers are in this category. This creates a fine balance of quality care delivery with the understanding that patient volume loads and compensating for the same may not soon recede. As these compensation plans evolve, systems must make sure that their plans pass fair market value FMV review to ensure that the system is not overpaying the provider, which may draw the ire of the federal government.
I stipulate that this is not cut and dried. Figure 7 is a hypothetical example delineating the modus of compensation plan design, in broad strokes. Of course, systems will continue to reward for the number of patients seen but also place a measurable value on quality and efficiency driving the compensation to realize the value care models. That is, physicians will receive a component piece of their compensation based on care delivery, as evidenced in Figure 7.
Using our Dr. X example, Hospital Y is deep into quality measures and has determined that its efforts require physician input into quality improvement. In Figure 7, Dr. X retains his nominal base pay and his wRVU production compensation that he had established in Figure 5. Combining Dr. All of this said, doctor pay is driven, in large part, by production. But that may shift as care value is measured, monitored, and reported, and revenue is more closely aligned with quality of care.
The crux of evolving compensation models revolves around the idea that compensation and quality will be woven into a tight tapestry where, at some point, there may exist a shift of a greater level of compensation from production to quality. As with most things in healthcare, there is no one right answer to compensation. Even with provider compensation, some things are local.
This is a BETA experience. You may opt-out by clicking here. More From Forbes. Nov 11, , pm EST. Under fee-for-service FFS the insurance payer pays whatever the physician, hospital or other health care provider charges, without prearrangement of fees, once the provider of care submits an insurance claim. This simply means that providers agree to provide health services at prearranged discounts off their regular fee-for-service fees.
This is the usual arrangement for PPOs Preferred Provider Organizations , which are essentially a group of available providers joined together into a network. Fee-for-service reimbursement is potentially on its way out, which means more complex payment models are continuing to emerge.
Given that the majority of people enrolled in a health plan will never use health care services within any given month, capitation arrangements should naturally balance out the high utilizers in health plans with those who use little or no health care every month.
With this model, the actual care provided by the physician is the driving force of compensation more so than the number of visits. With this pay structure, a physician caring for a handful of high-profile patients has the ability to earn more than a physician working with very general patient cases.
This is because a basic checkup would be assigned a lower RVU than a specialist procedure. The RVU model focuses on value-based healthcare, rather than the fee-for-service volume-based model. A payment model where physician and hospital expenses are joined to make a single payment for an episode of care. A quick example would be an outpatient surgery.
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