I'm not a doctor. And I don't even want to play one on TV. A scan of the major healthcare headlines over the past two weeks reveals a national obsession with how physicians make their money and spend their time. If you think you're overregulated and micromanaged, check this out.
Who'd answer this job ad?
Seeking someone to work long hours, take a pay cut and deal with regulation
As Shawn Rhea reports in this issue's cover story (p. 6), the Association of American Medical Colleges released new guidelines for teaching hospitals targeted at financial ties between doctors and medical vendors, suppliers and manufacturers. As the AAMC says in a news release, “The presence of individual or institutional financial interests in these relationships sometimes creates perceived or real conflicts of interests in patient care.” In other words, physicians will make care decisions based on what's best for their wallets rather than what's best for their patients when they're under the thumb of the medical industrial complex. Among its many recommendations, the AAMC says teaching hospitals should create internal systems to uncover, monitor and evaluate doctor-industry financial connections and make information about those connections publicly available to patients and consumers.
Also in this issue, Maureen McKinney reports on proposed regulations from the CMS that would greatly expand the Physician Quality Reporting Initiative, or PQRI (p. 8). Despite the many technical problems that have plagued the voluntary program since its inception in 2007, the government is pushing forward with plans to expand the number of participating doctors. For example, to induce more doctors to participate, the feds are lowering the number of patient records that have to be submitted in order to qualify for bonus Medicare payments. Yet, at the same time, the proposed regulations would add 20 new quality measures that doctors would have to report to the government, bringing the total number of measures to an incredible 198 starting in 2011.
Another way the government is pushing doctors into the PQRI program is by cutting their regular pay to make any bonus program, no matter how onerous, look attractive. As Jennifer Lubell reports, the CMS issued proposed regulations that would reduce Medicare payment rates to physicians by 6.1% starting on Jan. 1, 2011 (p. 10). That would be on top of the 23.5% pay cut that will take effect on Dec. 1, absent congressional action.
Lubell also reported in our June 28 issue (p. 6) that the first target of the new Independent Payment Advisory Board, which is charged with making Medicare payment recommendations by the new healthcare reform law, may be physician reimbursement.
And, of course, late last month the Accreditation Council for Graduate Medical Education issued its proposed set of new rules governing how many hours medical residents can work without falling asleep standing up (June 28, p. 8). As Andis Robeznieks reported, the rules would set an 80-hour maximum on work hours per week, averaged over a four-week period. First-year residents would be subject to a 16-hour maximum on consecutive work hours. And senior residents would have a 24-hour cap on consecutive work hours. And the proposed rules were viewed as going easy on medical residents.
So, the next time you go home after a long day at work and complain to your spouse, significant other or dog about working longer hours for less pay and having someone constantly telling you how to do your job, it could be worse. If the same rules that apply to physicians applied to you, you couldn't supplement your income on the side; you'd have to publicly report your job performance; you'd take another cut in pay now and likely in the future; and if you didn't put in 16-hour days, five days in a row, you'd be considered a slacker.
Better to be a hospital administrator or an insurance executive.
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