Tuesday, July 08, 2014

Do Healthcare CEOs Deserve More Money Than Doctors?

This was the interesting article I read on Medscape recently.
It's certainly a timely article, when many of us in the frontlines of seeing patients, who really abhor the politics, business and economics of things and really just want to play the role of the healer, is being caught between a system that is cutting down costs and reimbursing doctors less, versus trying to provide quality care without being restricted by policies.
Some excerpts from the article:
When politicians and government officials talk about high healthcare costs, physician earnings and salary tend to be at the heart of those discussions. And yet, there are other players in the healthcare arena who earn much more than physicians- in particular, much more than primary care physicians.
At a lot of health insurance companies, hospital systems, and large academic hospitals, many chief executive officers (CEOs) earn millions of dollars per year, far exceeding what any practicing physician makes.
This wide gap is troubling to some doctors. They wonder what it says about the importance of clinical work, the stress of patient care, and the training needed to become a physician.
Researchers have pinned the average income for a CEO at a nonprofit hospital at almost $600,000, with CEOs at large networks and large teaching hospitals making much more than that. In California, for example, no fewer than 32 CEOs at nonprofit hospitals made more than $1 million per year in 2013. In addition to base pay, healthcare CEOs can make a great deal more in bonuses- and, at for-profit organizations, in stock options.
Does the amount of CEO pay have anything to do with raising quality of care, or even improving the hospital's bottom line? Not according to a recent study in JAMA Internal Medicine, which examined pay for CEOs at not-for-profit hospitals. The study found no significant association between CEO compensation and the hospitals' finances or these organizations' quality, mortality, or readmission rates
At the 11 largest for-profit insurers, CEOs earned an average of $11.3 million in compensation in 2013.
Hospitals, by contrast, haven't done as well financially as insurers have, owing to stagnant reimbursements and lower volume of inpatient services. But CEOs at the largest hospital systems, especially the for-profits, nevertheless managed to make good money- in some cases up to about $12 million
That kind of compensation raises the ire of many physicians. "An insurance company is only interested in the bottom line," said Richard M. Dupee, MD, a primary care internist in Wellesley, Massachusetts. "When I'm not paid $30 for an electrocardiogram because it's supposedly not indicated, I think of the insurance company CEO who is making millions of dollars a year."

That bitter statement is something I can relate to, when I think about the 5-20 minutes my CMA or I spend on the telephone per patient when we are trying to obtain approval from the insurance company to do a scan, even if it's something as simple and as textbook as a thyroid I123 scan in working up hyperthyroidism- needing to be passed from one person to another over the phone. Or, having some nonmedical person on the phone deny my request for a Thyrogen-stimulated radioiodine whole-body scan in a thyroid cancer patient with an unstimulated thyroglobulin of 30, because the levels were not "increasing compared to the previous". Yes, I'm referring to you, United Healthcare- of all the insurors, you disgust me the most- clearly, patient health is not your priority. But the others are just as stupid. I can't even keep track if I'm allowed to check a lipid panel every 365 days, every 335 days, every 90 days, or whatever (all of the above are different restrictions for the different health insurance companies!). So if I have a pancreatitis patient with serum triglycerides of 1200 mg/dL and I put him on insulin and a fibrate, if this was Company X, I'd have to wait a fucking year to retest him, or have him pay for the test out of pocket???
Another doozy- having to contact the thousands of patients of our clinics when the new year comes along and the stupid insurance decides this year to cover Novolog, and not Humalog, or that the preferred Testosterone medication is now Androderm, and not Androgel. And the fun part is the formulary often changes yearly.

All these for what reason? To "save money"- but does it lower premiums for patients? Hell no. Saving money probably gives the CEO or VP-this-or-that a higher year-end bonus.
It does make you bitter, feeling like you can't really do your job as a doctor, but yet someone way up there is getting paid millions, with little direct knowledge (and probably concern) of your patient and his welfare.
Even at a local level, to have policymakers force clinics to adopt a certain defective EHR (electronic health record), only to make sure the 'Go-live' dates was on track- never mind that the system was flawed. Or to be forced to use a certain lab for tests, even if that lab frequently messes up the test, even as simple as getting the damn gender wrong, and issuing the wrong reference ranges. Just for the sake of 'uniformity'. Not patient care or safety.
It's true that we always judge our self-worth to be more than what it really is; and so my personal bias when I read that article was that CEOs of healthcare systems are getting paid too much. But then again, it probably has something do to with that envy that I'm getting paid 2-5% of what the CEO is. And they say envy is a sin, no?
So, the option is to 1) Get an MBA and hope on the bandwagon- but I'm not smart enough, or 2) Find a new job.
And there are days when I'm REALLY tempted to go to option 2.