Opinion

First step to fairer pay is determining your value

A message to all physicians from the chair of the AMA Board of Trustees, William G. Plested III, MD.

By William G. Plested III, MDis a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07. Posted April 5, 2004.

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Judging by the responses to some of my previous articles, I can't help but believe that my concerns about the shocking state of physician reimbursement are widely shared. I certainly appreciate the fact that so many have sent letters and e-mails. The question asked most frequently -- almost universally, in fact -- is, "What do you recommend that we do?"

In general, I studiously avoid making such recommendations -- and will continue to do so. This is simply because of the peculiarly oppressive legal system that controls every facet of our professional lives. Today it is considered brilliant business strategy for giant insurers to merge to form what by any definition would constitute a monopoly. And then -- surprise -- they seem to adopt uniformly strict reimbursement policies.

By such maneuvers they can -- and do -- bludgeon physicians with any number of abusive practices. Yet at the same time, physician attempts to integrate their practices to achieve economic leverage have been met with universal hostility by the federal agencies charged with enforcing antitrust laws. These antitrust regulators have a misguided understanding of where marketplace power really resides in today's workplace.

Even the smallest evidence of concerted action by a group of physicians who are not legally affiliated would be met with immediate and crushing retaliation by federal regulators -- simply to send a message. Especially when that concerted action is one that demands fair reimbursement for physicians. This has actually been occurring on an increasing scale over this last year.

So with this in mind, I am understandably reluctant to suggest solutions that might even hint at concerted action. However, I am perfectly willing to describe in detail the inequities of the system under which we toil -- and present my opinions about how we got here.

The bad news is that we haven't yet succeeded in convincing the antitrust regulators that their attitudes are not reflective of the marketplace. But we're not giving up the fight!

The good news is that physicians are extremely bright, capable, goal-oriented individuals. When physicians are confronted with a problem and provided with examples of the cause of that problem, we can expect them to arrive at workable solutions.

Therefore, the most basic requirement for changing the reimbursement climate for physicians is for physicians themselves to perform a very personal and careful review of the subject.

An honest appraisal of the true value of one's efforts is essential to one's overall happiness. Without a careful personal evaluation, how can anyone hope to understand if they truly are fairly paid or not? And, how could one ever make such a reasonable decision to continue or cease an activity based upon compensation received for that activity?

It is certainly quite possible that many physicians will feel that their level of compensation corresponds with their own perceived value -- if this is the case, this is obviously extremely valuable information.

On the other hand, if one feels that he or she is significantly underpaid, that should be carefully and calmly approached with special attention to all possible solutions that can be imagined.

Believe it or not, that list of possible solutions can be surprisingly long and may provide a very workable answer. Again, an organized approach is fundamental -- and this must include a careful listing and evaluation of risk as well as benefit. Only by a conscientious evaluation of possible risks can one devise tactics to mitigate those risks.

I know this all sounds a bit negative and fatalistic. But nothing could be further from the truth. It is extremely difficult -- if not impossible -- for anyone to perform their job or profession to the highest level of their capabilities if they have a constant sense of oppression -- or if they feel that their efforts are not truly valued. Happiness indeed does affect performance -- even that of conscientious physicians.

The first step on the road to regaining control over our profession -- and our lives -- is to understand that we really do have the ability to regain that control.

So if any of you are truly unhappy with your professional lives, accept my challenge and do a very personal evaluation of your practice. Involve your family, since no one in the world cares more or is more affected by your happiness.

To paraphrase the words of baseball's resident philosopher Yogi Berra, if we don't know where we're going, we might not get there.

William G. Plested III, MD is a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07.

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