Wednesday, February 27, 2013

Divergent Physician Worlds, One Future

At a dinner recently two physicians were talking about money. This is a rarity and I was all ears. Both were academics working for salary at different academic institutions. Both were married to physicians. Both were bright. Both were bitter.

The general opinion was that the average academic physician made as income considerably less than their private physician counterparts. One stated her income was about 100 thousand dollars a year, as was her husband's. Both were surgeons; she had better hours than her husband who frequently started his day at seven and came home around two in the morning. She had a student loan from medical school that totalled 460 thousand dollars. She had decided she could not afford children.

I suggested that husband and wife physicians had more negotiating room and could work fewer hours and both said that was not possible in the academic community. The rules were tight, productivity was closely monitored and there was no room for part time service. More, referrals within the system were closely observed; Relative Value Units (RVU) where physicians are given numerical grades for referring to the hospital for services that can be billed by the institution determines employment and contracts. (This is a particularly interesting twist. It seems that academic institutions have turned the history of medical practice on its head. Now the physicians are working for fixed salaries and the hospitals are plumping up fee-for-service.)

There were some worthwhile generalities that came out of this meeting. Academics are oppressed and unhappy. The rise of Industrial Medicine will make the physician in the system as insignificant as possible. And most surprising, the academics resent their independent private practice colleagues immensely and want to have them share their pain.

As academics tend to be published, quoted and deferred to in public by everybody but their employers, this bodes ill for the future of the profession.

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