Dr. Linda Brodsky: 5 Major Issues With Physician Compensation

The factors surrounding physician compensation are both numerous and complex. Hospital-employed versus independent setting, primary care physicians versus physician specialists, the fate of the Medicare sustainable growth rate — these are but a few issues at the tip of the iceberg.

Linda Brodsky, MD, a pediatric otolaryngologist and founder of Expediting the Inevitable, shares five issues that specifically deal with physician compensation and why they are hot topics in today's healthcare climate.

1. Compensating physicians on their ability to manage risk is difficult.
The accountable care organization model is now coming into focus, but Dr. Brodsky says the risk management portion of ACOs will disproportionately affect physician pay. She says most diseases that people have cannot be controlled by physicians. Diabetes, cancer and heart disease may have genetic causes or lifestyle and eating habits that contribute to the problems. "Linking physician pay to their ability to manage patients with diseases and risk factors that physicians have no control over is foolish," Dr. Brodsky says. "Patient care can't be standardized for most medical problems. Most people don't fit into care protocols."

2. Physicians are not paid for every task completed. Dr. Brodsky carries a pager with her one of every five nights and all day Mondays through Fridays. Every time it goes off, she makes sure to take care of her patient or a patient of one of the physicians whom she covers. Several physician compensation models, like hers, do not factor in that availability. Additionally, she says physicians are spending more time reading over consultants' reports, checking lab reports and returning patient, pharmacy and other phone calls but are likewise not always compensated for those tasks. Dr. Brodsky says serving on teams to manage complex patients in hospital settings is another non-reimbursable service, one that women physicians find themselves in more often.

3. Tort reform, which impacts physician pay, is not being considered. Dr. Brodsky says the thought of a malpractice lawsuit hangs over the head of any physician, and this affects his or her behavior. She said she deeply contemplates the options of her medical decisions, such as whether a child should receive a CT scan. She puts the "cost risk" of the procedures at the bottom of her priorities because she wants to get the diagnosis right, and sometimes the tests need to be ordered to avoid the ramifications of a lawsuit. Numerous tests are also driving up costs, and that could directly impact a physician's pay. "How quick are we to send a child to the [emergency room] just in case instead of using good sense?" Dr. Brodsky says. "Just-in-case medicine is driving up costs of healthcare."

4. Generalists are underpaid, but specialists are not overpaid. The conventional wisdom that family physicians, primary care physicians and other generalists are underpaid while specialists, specifically surgeons, are overpaid is only half true, Dr. Brodsky says. She says generalists are the front line of preventive care and need to be paid more, but surgeons are not overpaid because of their expanded skill sets. "To develop a surgeon's skills of being able to think, treat and perform surgery — that takes a lot of inner strength, thinking creatively in new and changing circumstances and many extra years to develop," she says.

5. Female physicians are compensated significantly less than their male counterparts.
Female physicians have consistently earned less than male physicians, and according to a Health Affairs study published in Feb. 2011, the gender gap appears to be expanding.

Several researchers looked at the starting salaries by gender of all residents graduating New York state training programs from 1999 to 2008. After controlling for specialty choice, practice setting, work hours and other factors, a significant gender gap in starting pay still existed. In 2008, male physicians in New York made on average $16,819 more per year in starting salary than female physicians. "There is a real gender bias in how women are being paid in medicine," Dr. Brodsky says. "This is not healthy for a healthcare system. Women are going in with a disadvantage, and it's leading to problems with women dropping out of the workforce. What will result is a physician shortage and a tremendous societal burden."

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