Friday, January 02, 2009

Health Care Utopia's First Great Challenge

Welcome to Health Care Utopia, young doctor-to-be!

Now that you've completed medical school and post-graduate training, we've decided that you'll be the perfect candidate to join in our government-directed social experiment. You see, we've decided that all doctors straight out of medical training (irrespective of subspecialty) should make the same Perfect Starting Salary of $200,000. No need to fuss over medical specialty, no. We've taken those discussions out of the picture, because irrespective of the speciality you decided to pursue, everyone in Health Care Utopia makes the same starting salary!

Now, to keep it simple, you only have two choices about where to practice after you've completed your training: (1) Socialist Hospital in lovely city of Mount Pleasant or (2) Capitalist Hospital in the thriving city of Prosperity. To keep your decisions simple, every state in the Utopian Union has only these two cities. Also, we mean no offense, but you're just too green-around-the-gills to be subjected to the challenges of private practice and have no money to buy our required electronic medical record that holds the key to all health care payments in Health Care Utopia).

Now, the only difference between the two hospitals in which you will be an employee is their compensation model. These, we have learned, can be very sensitive subjects for our doctor-employees. Since we're not quite sure which model to impose nationally, young doctor, we're going to insist you become part of our Great National Experiment.

So here's the deal: Socialist Hospital pays all their doctors the same amount by pooling all their revenues and dividing them up at the end of the year evenly. This way, everyone is happy. Well, at least at first. If all the doctors work harder each year, we'll pool those earnings for them, divide it up evenly, and everyone makes more money! Isn't that great? No more fuss and muss with productivity bonus earnings here. If everyone keeps working hard, you'll all make a bit more money year after year. If someone is a slacker, well, you all might not get paid more even though YOU worked harder, but hey, this is Socialist Hospital! It's how they work. They'll be able to follow each and every one of your work schedules because they follow our perfect Work Unit measures and eventually fire the slacker-doctor, really they will. Now you might not make as much money as those guys at Capitalist Hospital, but you might have a life outside the hospital here. And you know what's great? I've heard some doctors in this model can even work really hard four days a week and sometimes just take the fifth day off (although some of their colleagues seem a bit perturbed by this, since they have to be at work when you're not).

Capitalist hospital, on the other hand, works on a slightly different model. At Capitalist, the harder you work, the more you'll make, irrespective of what your colleagues do. If you want to make a lot of money, just work harder! The sky's the limit! It's really simple at Capitalist: more Work Units means more money. So if you work really hard, take call as often as you want (even ever other night, if you want), and keep your clinic visits to just 5 minutes instead of seven, you can see more patients and see a TON of income! Be careful not to give too much work to your colleagues, though, or you might not make as much money since they'll earn those Work Unit points instead of you. The challenge at Capitalist will be if you want a life outside the hospital. In that case, your Work Units are likely drop quite a bit, a so too, your salary. I mean, that's the way it goes. But that's how things work at Capitalist Hospital: every man for himself.

So tell me, young doctor-recruit, which will it be?



The Happy Hospitalist said...

Doc. You know the most important aspect of the job is which hospital has better free food.

Come on now.

DrWes said...

Dr. Happy-

For now, both hospitals provide free food, but depending on their profits year-to-year, we may or may not be able to continue providing this benefit. It will be up to you and your colleagues since either way, we'll have "shared destinies."

Best of luck chosing!

-Your Health Care Utopia Team

Anonymous said...


Does this nirvana called socialist hospital really exist? And how exactly do they measure my work output? If it is all based on this wonderful RVU system, then I as a primary care doc get screwed again, since your specialty colleugues will generate much more work product by this model making me look like a total slacker under this system. How about work as a measure of hours actually worked, which is how most of the working world is compensated vs. this arbitrary system of physician compensation that has been corrupted by the influences of special interest groups allied to protect their piece of the pie.

Finally, we can measure the work output, but how do we measure the quality of the work performed? If you injudiciously perform EP studies on everyone who throws a PVC, then should you be rewarded under the capitilistic model for this behavior?

I know I have gotten off the subject, but the devil is in the detail, and I wouldlike to know how you are going to conduct this measure of work before signing on to one or the other.

#1 Dinosaur said...

Perfect Starting Salary of $200,000

Hey! That's more than twice what I made this year. Can I get in on that deal?

DrWes said...

Here in Health Care Utopia, we have carefully balanced all Work Units for national norms where 1.0 unit equals 1 hour of work, If you can do things faster, good for you. We don't care how well you do things, but rest assured that legal penalties can be applied if problems occur. We do not care how much experience you have, since those who suffer legal circumstances on a recurrent basis will soon be left destitute. Your colleagues will also complain if you do not produce and keep your patients happy. Best of luck in your choice.

#1 Dino-
Isn't Utopia great? Sorry you have seen so little income for all you hours working. Oh, we forgot to mention that malpractice is paid from your income, but tort reform has been enacted in Health Care Utopia, so your expense annually will only be $25,000 per year!
We look forward to you joining our team of quality innovators!

Grumpy, M.D. said...

I used to work for Large Socialist Group, and got sick of the fact that I could bust my butt and watch the slackers in the group see half as many patients, or go to coferences often, or whatever. So basically, I was working to support them.

I went solo in 2000, and have no regrets. I still work the same amount, but make more money, and nobody argues with me when I want to take time off.

Robin said...

Hi, Dr. Wes.... Now, I, as *the patient* want to know where I'll get the best treatment. Utopia hospital worries me a tad 'cause I'm afraid it won't matter how I'm treated if the all get paid anyhow. Is that how it works?

DrWes said...

Great to hear from you! Here in Health Care Utopia rest assured the quality of your care is our first priority. We have found, however, that measuring quality is difficult, since quality to one person means something different to another. Therefore, we continually expand our ever-expanding Performance Measures to assure a minimum of quality for you. It's the best we've come up with so far as a means to evaluate "quality."
Your doctors will be eager to take care of you, too, since if they decide to cut back, they lose revenue - that's how we've designed it. Don't you feel better now? So look for the ads to each hospital on the expressway. This, too, will help you become a more "educated" consumer!
The Utopia Health Care Team

Anonymous said...

Gee I respect you so much DrWes. Its like I am talking to Rush Limbaugh.

I certainly want happy Hospitalist to get the best free food. He deserves it.

Here's a couple thoughts:

1. Who owns the hospitals and actually employs the physicians at Utopia Hospital? BOD of doctors, corporations that exist in other states or the government?

2. Will the patient's admitting (clinic) doctor have privileges at the Utopia Hospital?

3. Will the patient's admitting/clinic doctor being able to call the shots at Utopia Hospital? The clinic doctor would be paid by his clinic and so I do not know how he or she MD would fit into the $ mix.

4. Who will monitor patient safety and continuity of care at Utopia Hospital?

5. The Utopia for me (a patient and care-giver for sick dad), the Utopia would be cooperation, communication and coordination between clinic specialty or PCP docs and the hospital doctors.

I may not always agree with your But, sincerely, I appreciate and respect your good work.

All the best for a happy and healthy and prosperous 2009.


Anonymous said...

I currently work for the Air Force, the greatest socialist hospital in Utopia where you get paid based on rank (with some additional pay for docs to help offset this some). Since the nurses tend to stay in much longer than the docs they also tend to have (much) higher rank. I can tell you that in a system where everyone gets paid about the same does not get things done and only leads to laziness. There is no incentive to work harder (or even work at all, depending on the size of the hospital) and one thing that is abundantly clear: the less work you do the less work you want to do.

Give me Capitalist hospital any day, where you get paid for your hard work and motivation! Oh yeah, that is where I will be as soon as my time in the barrel is up.

DrWes said...

Grumpy MD-
Congrats on your prosperity, but in the new Utopian model, you must use the master Electronic Medical Record to order your tests. This is because we must be sure your test requests match our pre-determined criteria for ordering. We go not test willy-nilly in Health Care Utopia. In order to qualify to use the master EMR, you MUST sign up for one of our hospital models. Our team of helpful advisors can assist you with the transition.

All physicians, both in and outpatient, are employed by their respective hospital group. As such they are welcome to refer patients to their hospital, but cannot, by contract, refer to the other hospital. If they want to come to see in THEIR hospital, that's fine, but they are barred from seeing you if you go to the other hospital. Hope that helps!

Gas Passer-
We understand your point, so Capitalist Hospital sounds like your best bet. But we know that many in the military system like their friendly atmosphere and like the team approach and friendly work-together feel, so the Socialist Hospital might work best for them. Hence why there's two choices! Best of luck to you!

Anonymous said...

I chose the capitalist model! But only because as a primary care doc I can finally get paid for all the stuff I have to do for free under your rules, rather than having specialists dump their patients on me after they have gotten done with their very expensive 30 minute procedure. Do I get paid for taking call and answering phone calls for free at 2 AM as well? Is there any pay differential for after hours work? Where do I sign up!!!

Lisa G said...

My questions is this--over at Capitalist Hospital, you're paying for productivity. The statement about dropping clinic visits to 5 min. vs 7 min for example made me wonder--

Who would I want taking care of me--the 5 minute guy, or the other guy who isn't under such constraints. I'm thinking the other guy.

I wonder what others will think about that point.

Fantastic post, I'm going to be following...

DrWes said...

Congrats on your decision. Our helpful advisors will give you all details regarding your transition to Capitalist Hospital. They have been busy simplifying the pay model and getting rid of the term "Work Unit" and are instead just going to call it "Hourly Wage!" Smart folks, huh? Now, since people are eager to join this model, and because giving preference to night shift might be socially incorrect, we do not supplement pay during the evenings. Just look at it as another chance to earn more money!

All the best to you-
The Hesth Care Utopia Team

Anonymous said...

Doc Wes,

I am awaiting my contract and am anxious to begin work. By the way, where exactly is the town of prosperity located. Is the insurance mix adequate and is there a need for primary care services? Are all comers allowed on staff at prosperity hospital or is it basically a closed shop like many hospitals? Does the hospital in the town of Prosperity have any competition, or, contrary to the capitilist model, is it the only game in town? These are important factors since my income will depend largely on the volume of services I deliver, so I would prefer to have little competition and a great need for my services. Does the FTC exist still in th evirtual town of Prosperity?