How Doctors Are Paid

Why do doctors so rarely talk to patients by phone or e-mail?  When use of the computer is ubiquitous among other professionals (accountants, lawyers, architects, etc.), why do so few doctors maintain their patient records that way?  Why do so many doctors prescribe medicines without knowing what they cost?  And even when they know about generic substitutes, why don't they know those costs, or where patients might shop for drugs to get the lowest price?

My recent article, published online by Health Affairs, explains all these problems are a direct result of the way doctors are paid. 

Doctors are not paid to talk to you on the phone or by email. Blue Cross doesn't pay for consultations that aren't face-to-face, in the doctor's office. Neither does Medicare, nor do most employers.

Lawyers are paid by the hour; but doctors get paid by the task.  There are many things doctors could do to improve quality and enhance patient satisfaction, not to mention control overall costs, but these things are not done because doctors get no compensation for doing them.

The bottom line is if we want more patient-pleasing, higher-quality medicine, we have to change the way we pay doctors.

Comments (4)

Trackback URL | Comments RSS Feed

  1. John Goodman once again offers us clarity and insight to the complicated challenges of improving our healthcare system. The accepted perspective is that our current healthcare system is broken and yet concise perspectives on the steps we have to take to correct it are difficult to find. In this most recent article from John, he offers excellent thoughts on what could and should be done; bringing consumer market forces to the delivery of healthcare will be a key element of high quality, affordable care.

    Michael C. Howe, Chief Executive Officer

  2. Anonymous says:

    I have been preaching this for years. Dr Anderson Hedberg, past Pres of ACP authored the seminal paper on the need for doctors to be reimbursed for phone consults, published in 2003. Reprints are available.

    Dr. Bob Kramer

  3. Jay Montgomery says:

    No, Dr. Bob, paying physicians to make phone calls would be exactly the wrong thing to do. When we pay physicians to ‘do things’, thats what they do. And then they are not satisfied, so they ‘do more things’. The last I saw, 50% of patients were not taking their medications properly or at all. Paying for phone calls would surely dry up the last of those consceintious patients who call their doctor to ask questions pertinent to their health.

    No, Dr. Bob, what we need to find ways to pay physicians for the costs they avoid by providing better care. That approach might encourage physicians to make that call to a recently diagnosed patient to make sure their questions are answered and that they are taking their medications properly. Phone calls like that just might strengthen the trust relationship with the physician and avoid unnecessary visits to ER/Urgent care.

    If that sounds like a plug for P4P (pay for performance), it is not. P4P programs universally provide miserly small financial incentives when what we need are significant incentives that trigger that switch in the brain that begins to ask, “How can I reduce patient costs?” rather than “What do I have to do to increase revenues?” Important change will require that we do things differently if we are to do them better. And that almost always means new investment. Let’s offer physicians an investment opportunity where they invest their money to institute new care systems that will provide better (and therefore less costly) care.

  4. David Burke says:

    Yes Dr. Bob
    If a patient has the right to sue a doctor, than the doctor has the right to get paid.
    Medicine is the only field where anything that a Doctor does he or she becomes liable. Even phone calls could lead to further liability.
    It seems that again everyone wants the “best” care but no one wants to pay for it.