PHYSICIANS/POLICY: Brian Klepper on the end of life as we know it, or something like that

Brian Klepper was recently up at Medscape bemoaning the lack of physician leadership in righting the troubled ship of our health care system, and challenging physicians to do better.

He got lots of feedback, not all of it as negative as you’d think, and he had his own response. All well worth reading.

On the other hand, HSC says that in real terms we’re paying physicians substantially less than in 1995. I suspect that most of that pay "cut" was in the 1990s, and things seem to be picking up again, but — as one reader asked me — there is not that much good data on physician incomes, and in real terms they did very well between 1960 and 1990.

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  1. Canadian docs make more money than american docs, because unlike the USA, CAnada actually pays their primary care doctors a much closer wage to the specialists.
    In America, specialists make 5X as much money as PCPs. Canada got it right, and up there specialists only make 2X the amount of PCPs.
    American doctors should be happy about switchign to a Canadian system. Most of them will actually make MORE money under that system. Some of hte specialists will make less, but PCPs outnumber specialists so the bulk of docs would benefit.

  2. I found this on:
    “I have identified five clear global trends now facing individual physicians:
    (1) the inability of public sector health care systems worldwide to cope with demand for health care services and in response to that, the expansion of the private health care sector;
    (2) a movement towards preventive health, where, because physicians are reluctant to take the lead, nurse practitioners and pharmacists are being offered an opportunity to expand their professions;
    (3) a definite shift towards measurable quality. Driven by patient-demand for outcomes-measurement, especially in the USA and UK, there has been an increase in sophisticated systems of professional self-regulation. If doctors do not get their own act together, somebody else will;
    (4) a significant shift from an unmanaged fee-for-service system, where private health care services are provided, to one where costs are managed.
    (5) the increasing role of technology in medical practice.”
    “Unless phyisicians face up to these pressures, I believe that they will begin to lose the battle. The threat to the medical profession and to the patient is that clinical decision-making will eventually be forced into a situation of financial decision-making, which could cause irreparable damage to the patient-physician relationship. My concern is that the medical profession might not be focused enough on its core duties to be able to be effective medical and social leaders.”
    “Physicians will increasingly be more subject to international political influences in health care. Governments will manipulate change with the emphasis on universal access to health care, cross-subsidised funding and the additional emphasis on the preventive and promotional elements of primary health care.”
    “My warning to doctors is to guard against being branded as a self-serving profession. If physicians worldwide do not stay on the high road of being the patient’s best advocate and partner in health, they will suffer.”
    I think a lack of leadership is exactly what physicians are suffering from. They are going to be dragged kicking and screaming into a new world as the rest of us have painfully had to understand and adjust to. Will Walmart’s entry into primary care be the start of a major shift? They certainly changed the landscape of retail, like it or not.

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