Sunday, July 19, 2009

Planet Doctor Rules Say Professor Reinhardt Is Only Partly Correct on a 'Just' Physician's Income

The Disease Management Care Blog spent over 25 earth-years on Planet Doctor. Located in Earth orbit on the other side of our sun, it is oxygen starved and the surface temperature can vary from absolute zero to blistering. Only when you know the serpentine thinking of its kooky inhabitants, can you survive. Armed with this expertise, the DMCB would like to share some truth about primary care physicians (PCP), courtesy of Planet Doctor logic.

PCP numbers in the North American continent are decreasing and, as a result, a cadre of Significant Earth Leader (SELs) is giving them considerable attention. These SELs have observed in their pronouncements to their underlings that, compared to other specialties, the PCPs’ average income is considerably lower. Using the linear input-output logic typical of this class of human species, the SELs have calculated that income -> incents medical students to -> select more remunerative specialties which will -> lead to a shortage of generalists. To correct this trend, the ELs have decided to increase the income of PCPs.

We of Planet Doctor ask you to consider the following ‘thought experiment,’ of Robert Frank. He stole his counterfeit invention from us when he visited us via spaceship decades ago. While the relative income and lifestyle of our denizens compared to your Earth is indeed higher, the relative status of PCPs, compared to specialists, is at the low end of our world's socioeconomic scale. It is hard for Earthlings to comprehend this, what with incomes > $100K, but it is true.

This is why Professor Reinhardt’s assessment of a just physician’s income focuses on the wrong earthbound standard. While PCPs certainly appreciate the status conferred on them by Earth society and their patients, the rules of Planet Doctor are what really count. For example, your RBRVS system was really invented here and beamed to your CMS headquarters by our satellite radar array. That and specialist physicians’ words and deeds reinforce the second class citizenship status of PCPs (see p. 5) on a daily basis. Even patients, even if they savvy about health care policy, still want to see a specialist instead of relying on the training and judgment of their PCP.

Silly Earthlings. You think money and percentiles are what is important to PCPs? Whether you consider it in relative or absolute terms vs. other professions or society at large, income and status are insufficient windows on the many dimensions of professional status and the impact on the number of PCPs. The truth is far more complicated. More money courtesy of SELs is not the fix and simplistic economic notions of status fall short of the real truth.

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