Blog | Wednesday, October 21, 2009

Is the evidence piling up everywhere or just around me?


First, there was the session advising primary care docs to start making money off MRIs. Then, there was a big TIME magazine article about the success of the Geisinger model. Now, today I attended a seminar on coordinated diabetes care, and heard over and over again--from docs and other experts--that the reason doctors don't do more care coordination is because they're not getting paid specifically for it.

One alternative to motivate coordination is to pay for outcomes, but of course, that brings up concerns about gaming the system and general fairness (as Zeke Emanuel put it, the reverse-Lake-Wobegone effect, where everyone thinks their patients are sicker than average).

It's beginning to seem more likely, to me at least, that doctors may have to be provided the same incentives that the rest of us are. Why do I write obits and answer phone calls from PR people instead of just crafting snide blog posts all day? Because it's my job and I'm paid a--here comes the dirty word--salary to do it. I know, the loss of independence and entrepreneurship and all that, but when more and more medical students are deciding that they don't want to get involved in the primary care business, maybe it's time to change the model.