Doctors achieving individual success. Why can’t doctors work for a salary … like most Americans

Following is the text of a letter to the editor of the Wall Street Journal. The original article by Schnapp talks about new payment schemes being tested for doctors, and asks the question; should we consider society accepting the cost of physician education as opposed to physicians having to seek compensation levels necessary to discharge their considerable debt, especially given the growing percentage of their income from Medicaid and Medicare payments. The original article is well worth reading.

I call your attention to the words below I have placed in bold. I’m not sure government funding physician education or a major portion of it degrades future physicians to the level of serf, but let’s explore that highlighted sentence. Can anyone argue with that simple logic that physicians should have the same opportunities as anyone else, I surely can’t.

In response to the letters of July 25 responding to John Schnapp’s “Doctor Pay and Social Priorities” (op-ed, July 20), I suggest that the government not socialize the cost of medical education and begin to extract itself from the socialization of physician compensation. Who are these independent, free-thinking, talented physicians of the future who would commit their lives to the status of civil servant after college and trust their careers to the whims and largess of their political masters?

Physicians should have the same opportunity as the rest of society to achieve individual success and the accompanying rewards. The health, vitality and care of our citizens are at risk. Regrettably, this progressive socialization of doctors will result in more and better MBA applicants at the expense of fewer and lesser physician candidates.

Allan Dobzyniak, M.D.

Eastport, Mich.

On the other hand, where do those rewards come from? They come from fees for treating sick people, from income through investing in medical facilities where sick people are tested and treated and sometimes from fees paid by companies for evaluating their products. In other words, those rewards come from you, mostly through your insurance company. There is nothing unusual about that of course, most rewards anyone receives all ultimately come from what consumers pay for goods and services.

There is one big difference though. Health care is not something we voluntarily purchase, generally our bodies push us to that frequently unpleasant decision. At the same time unlike other purchases, we have little practical control over subsequent purchases once we enter the system. So, a physician’s individual success and resulting rewards are based in large measure on a system where the physician controls both pricing and demand accompanied by reward incentives to increase the demand. And no, I am not saying all doctors are greedy and self-serving at our expense, but I am questioning whether we can apply the same reward structure to health care as we do to selling cars.

We can also raise the question whether salaried physicians are somehow less talented or less motivated to provide the best health care possible to their patients than entrepreneurial physicians. Again I rely on my simple logic; there is no reason for that to be so. Rewards come in many forms other than monetary.

So the debate rages on. Government and some private insurers are trying new payment methodologies based on other than fee-for-service with the goal of higher quality at lower cost, many physicians want the status quo or better, patients want more and better health care, but also within that ever illusive “affordable” status. Unlocking the right acceptable balance is the goal, but who has the key? One thing is clear to me; patients (consumers) must be involved in driving and supporting change. Merely complaining about high insurance premiums is not the answer.