California Road Trip, Day 19, Davis

Our Davis audience, listening to their Mayor

Fall is upon us and the OSU Beavers are now 2-0 in Pac-10 play.  Sitting at a coffee shop in Bike City, USA (Davis) with a leaf blower wailing in the background, I ponder how to present my thoughts without sounding overly judgmental…

Before our evening presentation, we dined with our hosts who had also invited a skeptical third year medical student.  Ryan seemed primarily concerned that the “single payer” would dictate reimbursement levels, leaving physicians with little recourse to find another payer.   Let’s bluntly talk about physician income.  Generalizations are dangerous, but by all accounts, using the metric of net income,  primary care providers in other countries do “better” and specialists do “worse” than ours.   That said, the foreign doctors have higher job satisfaction than in the USA.  Unarguably, without minimizing the stresses unique to each different specialty,  our committed primary care providers are significantly underpaid compared to a number of the specialists who expect to bring in net incomes well in excess of $400,000/year.

Without minimizing financial incentives, medical students gravitate to particular specialties largely to find a niche that meets their particular interest, skill sets and temperament.   Some fine orthopedic doctors and radiologists would be unhappy, marginal primary care doctors (and vice-versa).   For the extra training and on-call responsibilities, they should should receive extra reimbursement, but how much is enough?   It is important to note that primary care has its unique set of stressors that some specialists would find intolerable.  Dr. Mike Huntington has yet another aphorism to capture this conundrum.  “Maybe the extra training that specialist receive should be the cost they pay for NOT going into primary care.”   In any case, our dire and worsening primary care shortage substantially contributes to our poor health care outcomes.  If our goal to provide value for the all the money we are spending on health care,  we need more primary care providers.  Or is our goal to sustain high, sometimes obscenely high, physician income?  Ouch.

I am confident that whatever flavor of single payer health care we ultimately embrace will reimburse physicians fairly. We will never lack for bright, competent, motivated young people who are willing to work diligently for the privilege of becoming a physicians.

As we departed our evening venue, a primary care doctor, now working for UC Davis Student Health, asked, “How are you ever going to get the specialists to sign on to this?”   Indeed, the physician community has been sadly MIA (missing in action) during the great health care reform debate.  Primary care docs, who are predominantly supportive of a single payer solution,  are buried in patients and paperwork, struggling to pay for the health care benefits of their employees.  Specialist are, for the most part, making a pretty darn good living, working in the heart of our Health Care Dragon… that costs us twice as much as most of the rest of the industrialized world and, by almost any measure of community health, yields very poor results.

It’s a lot less painful to think about football.  Go Beaves!

–paul hochfeld

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