Listening to Your Doctor's Advice
One of the things I feel is great is that physicians are starting to be evaluated and compensated on quality that they provide versus just being paid “piece rate.” Since I became a doctor in 1992 my salary has been based on the number of patient office visits. When I practiced in Canada I was “called on the carpet” for ordering too many thyroid tests by the Manitoba government. Other than that they did not care about the care that I provided for my patients.
When I moved to the US in 1996, I was paid a salary for my first two years followed by a 100% productivity based salary. That is, the more patients I saw per day the more income I made. The last two years has been a gradual transition to 10% of my income dependent on quality measures.
I think that this is great, but I do have a concern: how is quality measured? Part of quality is based on patient satisfaction scores. Some is based on whether my patient decides to get a colonoscopy (colon cancer screening) test. Other potential outcomes are diabetes test measures, smoking rates, and body mass Index levels.
My problem is that I alone am not powerful enough to force these changes. I cannot help if my patients cannot execute my suggestions. They may have extenuating circumstances in their lives such as lack of funds to buy the food I suggest, or lack of time to exercise, or just a severe addiction to smoking. I as their physician cannot change these circumstances or give them the will to execute change. I can inspire, and provide the information and support, but that is all. I can’t be by their side at all times making sure they do the things that I suggest.
I see parallels to this type of evaluation and how teachers are evaluated. The teacher can provide instruction, inspiration, and guidance, but they can’t make the student execute. They can’t influence their home environment.
I think doctors should also be evaluated based on the instruction and support they are providing. Are we offering the support and advice patients need? I am afraid that rewarding physicians on the results of lab tests, patient weights, or the completion of lab tests will promote the discharge of some patients from a physician’s practice. Maybe this is a good thing because patients will have added incentive to listen to what their physician suggests. I just don’t know yet. I do know that I am happy that I am not being purely rewarded on how many patients I see in a day. Patients, please listen and act on your doctor’s advice It will benefit you and your doctor.