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...truth is, we pay them all wrong...
Doctors themselves could tell you that - particularly primary-care providers (PCPs), the foot soldiers of the U.S. medical system. New doctors graduate from medical school lugging up to $200,000 in student loans. Paying that off takes a big bite out of even a low-six-figure salary. Add to that the high costs, long days and billing headaches involved in running a practice, and it's no wonder so many family docs are trading up to specialties like orthopedics, where the pay can be three times as great and the hours a whole lot shorter. Only...
...themselves but also from the ones they farm out. Others buy state-of-the-art diagnostic hardware and charge state-of-the-art fees to use it. "Focus on your bottom line," urges a brochure for in-office CT-scan machines from one manufacturer. And as long as insurers pay the bills, patients don't ask what things cost. "A colonoscopy used to take 45 minutes to perform," says Ted Epperly, board chairman of the American Academy of Family Physicians. "Now it takes 15, but the cost hasn't come down." (See how to prevent illness...
Less Is Much More In the years since the reviled health-maintenance organizations (HMOs) were at their peak, all manner of fixes have been proposed to the health-care system, from small tweaks to wholesale overhauls. There's pay-for-performance: compensation depending on doctors' success in keeping costs down and getting patients well. There's episode care: a fixed price for a procedure like a heart bypass that covers everything from pre-op to surgery to full recuperation. Most broadly, there's global care, which provides access to a diverse team of caregivers who cover all of a patient...
...doctor's pay is not fixed in advance. Salaries are pegged so that they stay within 80% of the national average, but up to 20% of income is based on teams' achieving performance goals. If the cardiac group keeps its complication and readmission rates below a certain level, paychecks get fatter because costs decrease. Ditto for the pediatric orthopedic team, which must successfully treat kids for, say, spinal curvature without being too quick with the knife for those who don't need surgery or too slow for those who do. "We keep cash compensation flexible and incentivized," Steele says. "That...