US Docs' Pay Higher Than Other Nations: Really?
US Docs' Pay Higher Than Other Nations: Really?
This is Jeffrey Berns from the University Of Pennsylvania School Of Medicine in Philadelphia, and Editor-in-Chief of Medscape Nephrology.
I am going to step out of my comfort zone today and talk about something that is not directly related to nephrology, but because it has to do with physician compensation, it relates to all physicians, including nephrologists.
There was a recent article in The New York Times titled: "Doctor's Fees Major Factor in Healthcare Costs Study Says" that has been discussed around the country. This newspaper article refers to an article that was recently published in the journal Health Affairs, titled Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries. One of the authors of this article is an Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, so obviously, this person potentially has the ear of the White House administration.
The study tried to compare costs, fees, activities, and so forth, of primary care physicians and orthopaedic surgeons in the United States with those in Australia, the United Kingdom, Germany, France, and Canada. When they address primary care physicians, which will be the focus of my comments rather than orthopaedic surgeons, they comment that in the United States the term "primary care provider" includes family practice, general practice, internal medicine, obstetrics and gynecology, and pediatrics. That was not mentioned at all in The New York Times article or in other editorials that have come out in response to this study. It was not clear what was considered to be a primary care provider in any of these other countries, but obviously there is a huge spectrum, even in this country, between pediatricians, family practitioners, internists, and obstetricians and gynecologists. It's a little bit dubious to lump all of them together in a single category.
The authors of the Health Affairs article state that they recognize that "full comparability is close to impossible" when comparing fees, incomes, services, and so forth. They also refer to some of their analysis as "imprecise." They looked at fees, and then tried to get a handle on the costs of training, running an office, and so forth. We all recognize that in the United States, the money for healthcare that is spent per capita and the percentage of the gross domestic product is higher than in these other countries. The issue is whether physicians' fees account for that difference and to what extent. Obviously, the focus then becomes whether healthcare reform will involve substantial ratcheting down of physicians' fees.
In terms of primary care practices, as defined, the authors of the Health Affairs study conclude that in the United States, primary care physicians are paid about one third more than in other countries, but what is interesting, if I read their analysis correctly (and how they do that analysis and the assumptions they make are not always very clear) about 80% of the difference in pretax income (fees paid to physicians) seems to be attributable just to the cost of education, both undergraduate and medical, in the United States compared with these other countries. I'm not sure all the assumptions about the type of care provided during the physician encounter, the quality of that care, the length of the office visit, and the extent of services are comparable across these countries. It is also not clear whether the geographic variabilities within the United States are accounted for, nor does it appear that malpractice expenses, expenses of running an office, and so forth, are fully and appropriately accounted for. Malpractice is a significant issue in the United States with which the other countries don't need to deal to the same extent.
We are going to be hearing a lot about this study, in part because of the authorship, and physicians seem to be an easy target for healthcare reform and reducing healthcare costs. I have serious concerns about the validity of the findings in this study, and I think it would be worth the time to become more aware of some of the details of this particular study, because I think this issue is going to be facing all of us as physicians over the coming year. This was published in the most recent issue of Health Affairs, by Laugesen and Glied.
This is Jeffrey Berns from the University Of Pennsylvania School Of Medicine, Editor-in-Chief of Medscape Nephrology.
This is Jeffrey Berns from the University Of Pennsylvania School Of Medicine in Philadelphia, and Editor-in-Chief of Medscape Nephrology.
I am going to step out of my comfort zone today and talk about something that is not directly related to nephrology, but because it has to do with physician compensation, it relates to all physicians, including nephrologists.
There was a recent article in The New York Times titled: "Doctor's Fees Major Factor in Healthcare Costs Study Says" that has been discussed around the country. This newspaper article refers to an article that was recently published in the journal Health Affairs, titled Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries. One of the authors of this article is an Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, so obviously, this person potentially has the ear of the White House administration.
The study tried to compare costs, fees, activities, and so forth, of primary care physicians and orthopaedic surgeons in the United States with those in Australia, the United Kingdom, Germany, France, and Canada. When they address primary care physicians, which will be the focus of my comments rather than orthopaedic surgeons, they comment that in the United States the term "primary care provider" includes family practice, general practice, internal medicine, obstetrics and gynecology, and pediatrics. That was not mentioned at all in The New York Times article or in other editorials that have come out in response to this study. It was not clear what was considered to be a primary care provider in any of these other countries, but obviously there is a huge spectrum, even in this country, between pediatricians, family practitioners, internists, and obstetricians and gynecologists. It's a little bit dubious to lump all of them together in a single category.
The authors of the Health Affairs article state that they recognize that "full comparability is close to impossible" when comparing fees, incomes, services, and so forth. They also refer to some of their analysis as "imprecise." They looked at fees, and then tried to get a handle on the costs of training, running an office, and so forth. We all recognize that in the United States, the money for healthcare that is spent per capita and the percentage of the gross domestic product is higher than in these other countries. The issue is whether physicians' fees account for that difference and to what extent. Obviously, the focus then becomes whether healthcare reform will involve substantial ratcheting down of physicians' fees.
In terms of primary care practices, as defined, the authors of the Health Affairs study conclude that in the United States, primary care physicians are paid about one third more than in other countries, but what is interesting, if I read their analysis correctly (and how they do that analysis and the assumptions they make are not always very clear) about 80% of the difference in pretax income (fees paid to physicians) seems to be attributable just to the cost of education, both undergraduate and medical, in the United States compared with these other countries. I'm not sure all the assumptions about the type of care provided during the physician encounter, the quality of that care, the length of the office visit, and the extent of services are comparable across these countries. It is also not clear whether the geographic variabilities within the United States are accounted for, nor does it appear that malpractice expenses, expenses of running an office, and so forth, are fully and appropriately accounted for. Malpractice is a significant issue in the United States with which the other countries don't need to deal to the same extent.
We are going to be hearing a lot about this study, in part because of the authorship, and physicians seem to be an easy target for healthcare reform and reducing healthcare costs. I have serious concerns about the validity of the findings in this study, and I think it would be worth the time to become more aware of some of the details of this particular study, because I think this issue is going to be facing all of us as physicians over the coming year. This was published in the most recent issue of Health Affairs, by Laugesen and Glied.
This is Jeffrey Berns from the University Of Pennsylvania School Of Medicine, Editor-in-Chief of Medscape Nephrology.
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