Editorial: Making doctor pay healthy

Monday, Aug. 6, 2007 | 7:09 a.m.

Lost in the debate on health care reform is the issue of doctor pay - not necessarily how much they make but how they make it.

The New York Times reported last week that one of the rarely discussed issues in health care is how the system compensates doctors and whether it lends itself to unnecessary care and rising health care costs.

"The problem is the way they earn their money. They have to do stuff. They have to do procedures," said Dr. Peter Bach, a former senior adviser to Medicare and Medicaid and a physician at Memorial Sloan-Kettering Cancer Center in New York.

Bach told the Times that doctors, in some cases, are rewarded for ordering more expensive tests when cheaper and comparable tests are available. He also said the system rewards tasks, not success and not preventive care.

"This is a highly inefficient way to pay doctors," he said.

Specialists make the most money because they do the most complex - and lucrative - procedures. General practitioners and pediatricians, who handle day-to-day patient care, are among the lowest-paid physicians in the country because they perform relatively few tests and procedures. As a result, a smaller percentage of medical school students are opting to go into primary care or pediatrics.

To pay the bills, general practitioners have to treat a large volume of patients because insurance companies pay little for basic examinations, for researching treatment options or for consulting with patients on their health. In other words, there is not much financial incentive for doctors to take the time to explore a patient's life and find other treatment options than costly tests.

The issue of doctor pay should not lessen scrutiny of prescription drug prices or insurance company practices and profits in the health care debate. However, the way doctors are paid should be addressed.

Doctors should be paid well and paid for what they do. For that matter, there should be more compensation for doctors who spend time with their patients practicing medicine, not just performing procedures.