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It’s definitely been more than the last few years. Physicians have been experiencing the same decrease in relative salary compared to executives that pretty much every other job has for the past 40-50 years. Seems like maybe physicians are falling behind at a slower rate than other professions, but it’s a long-running problem.

https://img.grepmed.com/uploads/2589/administrators-physicians-comparison-timeline-spending-original.png

On the topic of mail, what was your favorite fan mail segment on the show? Follow up, what was your favorite fan mail overall, on the show or otherwise?

Thanks for bringing so many laughs and good times into the world.

I already replied with a clarifying question to the person you’re asking, but if I’m guessing what they’re saying correctly… yes.

There’re laws (mainly regarding “waste” and “abuse” of Medicare, self-referrals, other stuff) that were made in response to physicians who have a financial stake in a hospital, lab, surgical center, whatever, referring pts from a system where they practice to a system they have a financial stake in when there was no necessity to do so.

For example, suppose I’m a cardiologist. I just do general cardiology, and don’t do things like heart catheterizations, stents, pacemaker placement. But… I know people who do. I open a cardiac procedure center that does those things and contract my colleagues to work there. Then I start to send my patients there for those procedures. Some of that money comes back into my pocket. Maybe I see a guy who maybe needs a stent, maybe not. You poll 100 cardiologists, and they’re split 50:50 on whether or not to stent the guy. But if you show me 100 patients identical to that guy, maybe I recommend 60 of them for stents… a little more money comes back into my pocket, and 60:40 isn’t that far off from 50:50. But maybe I have a bad year, get divorced and have to pay alimony and child support, maybe my 401k took a big hit, or maybe I just want to buy a new corvette. All the sudden I’m sending 70:30 for stents, maybe even 75:25, and a little more money comes back into my pocket. Now all the sudden I’m send 20-25 more people for stents than probably would’ve needed it b/c, whether subconsciously or intentionally, my medical decision making is influenced very directly by my stake in that procedure center. How many of those 25 people suffer complications of a procedure they never needed but got b/c… a little more money in my pocket.

What if someone else opens up a competing procedure center? Maybe they have some new equipment? Different, better, safer techniques? Or what if they’re just cheaper? Am I gonna start sending all my patients there? Probably not, b/c… a little money out of my pocket.

I’m not saying disconnected CEOs with no medical training or knowledge are better. But there’s a clear motivation and potential (as well as tons of actual documents cases) of the sort of abuse I’m describing that ultimately leads to inappropriate care and patient harm.

For my money, I’d think a hospital owned/managed by docs who are disconnected from the literal patient care decision process would probably be better. I’m not aware that there’s any laws preventing that, but maybe the person you were asking the question to knows something I don’t.