Here's an interesting article from Medscape:
(abstract)
What is the number one reason why physicians leave their practice group?
Discontent over their compensation.
There are many ways to structure a compensation plan, and each has its pros and cons. A group may compensate its partners on the basis of productivity measured by relative value units generated, bonuses that are based on productivity and patient satisfaction, equal pay model in single-specialty groups, achievement quality and efficiency measures, or a number of other plans.
Unfortunately, many groups rush to create the compensation plan design before they bother to develop clear-cut strategies that would guide the building of the plan. They also neglect to reevaluate the plan on a periodic basis and to pay closer attention to critical signs of dissatisfaction with the plan.
For example, the compensation plan was a real sticking point for one 27-physician orthopaedic surgery group. They had a long-standing income- and expense-sharing plan in which expenses were shared on the basis of revenues. The 3 spinal surgeons produced more revenue, and so their expense allocation was greater than that of their partners.
However, because those 3 surgeons saw fewer patients in the office than the other partners, they used the staff (the major expense item) much less than their colleagues did. In addition, because those 3 surgeons' fees were higher than any of their fellow orthopaedists, the billing staff devoted much less time to billing and collecting those revenues.
The 3 spine surgeons wanted to change the expense-sharing arrangements and were ready to quit the group if the changes weren't made. The other surgeons didn't want to make the change.
The outcome? We recommended a minor variation in the expense-sharing formula that resulted in modest decreases in the incomes of 24 partners but in measurable increases in the spine surgeons' take-home pay.
The article refers to a private group practice in US, but I think it's just an example of human nature at work and that the experience is universal and applies not only to medical practices, but any other profession where contribution and renumeration are not consciously and regularly managed, and of course society at large.
"Why Physician Compensation Plans Fail"
Wednesday, May 25, 2011 | Labels: healthcare policy private practice
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42 comments:
Seems like the accountant there does not know what is activity based costing.
In the end, charge the portion of the cost to who is using that. Revenue allocation is the quick and dirty way, but left much to be desired.
What is the number one reason why physicians leave PUBLIC service?
Discontent over their compensation.
And why the physicians' discontent over their compensation ?
Maybe these days it is becoming fashionable to use tons and tons of money instead, to "help to maintain some dignity" ? (or perhaps ones feeling of self-worth ?)
Instead of what, Anon?
instead of peanuts? Reforming doctors, from monkeys to mercenaries =)
instead of anything under the sun other than "tons and tons of money (or its equivalent)" !!
So what are you offering out of this "anything under the sun"?
How much money is considered too much to pay a doctor?
How much do you think I make?
yes, anonymous. How much do you think government doctors make? Think carefully before you answer -- are you ready to have the rug pulled out from under your feet? Are you ready for the red pill? (...or was it blue)
2 to 3 times of a policeman or SCDF officer?, 4 or 5 times that of a NTUC aunty?
How much exactly? Give us a number.
http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=852
50-60 percentile still not enough? How much do you want?
3 meals in hawker centre, food court or restaurant?
Beyond the 5 years of initial service, the Ministry will benchmark MOs' salaries to private sector general practitioners in the same age group. The MO salary scale is also applied to doctors still undergoing specialist training, as there are no private sector counterparts for this group. The MO salary structure must therefore be competitive in order that a significant proportion of each cohort is prepared to undertake the rigours of specialist training. The majority of MOs in the public sector can thus expect to earn around the 50th to 60th percentile of private sector earnings. The better performers would similarly be paid the upper end of private sector salaries. Doctors performing more onerous night duties, will receive an additional allowance.
That press release is 11 years old, and does not provide any figure.
Stop avoiding the question: how much do you think I should make? Give us an exact figure.
http://www.geraldtan.com/premed/Doctor_salaries.html
It depends on how old you are (experience), which field you are in and the number of hours you worked.
GP
Assuming u work 40 hours a week and locum at $60/hr, that is 9.6k a month which is a reasonable amount for newly graduated doctors.
Specialists
Using the same assumption of 40 hours, specialists should make a premium so the actual rates depend on your speciality and how much you charge.
http://www.medscape.com/viewarticle/731131
so
$100/Hour and More
Neurologic surgery: $132.33 (P = .01 - .05 compared with general surgery)
Radiation oncology: $126 (P ≤ .01 compared with primary care, broad category)
Medical oncology: $114.21
Plastic surgery: $113.78
Dermatology: $102.68 (P = .05 - .10 compared with general surgery)
$80 to $93/hour
Cardiovascular diseases: $93.74
Gastroenterology: $93.27
Neurology: $92.52
Emergency medicine: $87.47
Obstetrics and gynecology: $83.40
$66 to $75/hour
Neonatal and perinatal medicine: $75.86
Psychiatry: $72.24 (P =.01 - .05 compared with general surgery)
Pulmonary diseases $71.67 (P = .05 - .10 compared with general surgery)
Pediatrics $69.24 (P =.01 to .05 compared with general surgery)
Child and adolescent psychiatry: $67.36 (P =.01 to .05 compared with general surgery)
$58/hour and less (P ≤ .01 compared with primary care, broad category, for all)
Family practice: $58.25
Internal medicine: $58.18
General practice: $57.55
Other pediatric subspecialties: $51.62
Internal medicine and pediatrics: $49.90
"It depends on how old you are (experience), which field you are in and the number of hours you worked."
Which is what it is.
And if I happen to have patients/employers who think that my work deserves more that the figures given above? What is that to you?
Then they will pay more loh but I seriously doubt any patients think that doctors deserve to be paid more (unless they have a vested interest) since medical costs will rise even further if doctors are paid more.
http://www.straitstimes.com/STForum/Story/STIStory_673980.html
Even Dr Woffles Wu think that way.
Do we want GPs to be doing surgical cosmetic procedures when they should really be concentrating on providing much- needed primary health care?
If you think patients are willing to pay more, raise your consult fees and see whether you have more patients or less patients.
A specialist once said in the distant past that he don't understand why there can be overcrowding. If he feels that he is seeing too many patients, he will simply raise his consult fees and the number of patients will drop.
Whether this is still applicable in today competitive market is debatable but the concept remains.
"Do we want GPs to be doing surgical cosmetic procedures when they should really be concentrating on providing much- needed primary health care?"
If we want GPs to concentrate on providing much-needed primary health care, then why won't we pay them more?
If we don't want GPs to be doing aesthetics, why are we paying them so much to do aesthetics?
The last i heard.
There are polyclinics providing subsidised primary care but I have not heard of subsidised aesthetics care.
Exactly.
People are able and willing to pay for aesthetics, without subsidy. And we wonder why GPs do aesthetics instead of primary care?
That's why we should ban unqualified GP from doing aesthetics so they can concentrate on primary care.
Leave the aesthetic business to the specialists. They have longer training and are qualified.
GP just see cough and cold and compete with TCM/nurse practitioners.
Banning unqualified GPs from doing aesthetics only bans them from doing aesthetics - it doesn't mean they will concentrate on primary care.
If you want them to do something, you have to incentivise them to do so, not just disincentivise them from doing other things.
How much (incentive) exactly? Give us a number.
I can't give you a number, and I don't know someone who can, but I can tell you how we get know: start improving the renumeration for GPs (not just in terms of monetary rewards, but also in terms of work conditions and having a stake in those practising in groups) for doing primary care work. When you see GPs stop doing aesthetics and returning to primary care, then you know you are there. Make sense?
to the anonymous who posted this : 2 to 3 times of a policeman or SCDF officer?, 4 or 5 times that of a NTUC aunty?
... I don't know what to say.
How about: why don't you take your money and go to NTUC and ask 4 or 5 aunties and diagnose and treat you instead?
Then how many times the pay of a NTUC aunty or policeman or fireman, before you, the doctor, would consider doing the diagnostic and treatment instead?
I don't know. I don't know how much an NTUC Aunty or a policeman or a fireman makes.
I'll do what I do for what I am being paid now, thank you very much.
I'm actually getting tired of enlightening these people. I'm getting tired of having to prove to people what we do for them, and for how little. I wonder if I'm actually getting tired of helping... people like this.
I don't blog to "enlighten" them, Remi, but to expose the absurdity of their "it's a valuable service, so I should not pay so much for it" mentality.
Take heart. The fact that they whine so much about healthcare shows that they realise its importance, but are just unwilling to pay for it. As long as you have the knowledge and skills to provide healthcare, and as long as you dont fall into the trap of believing that your duty is to "serve" such people regardless of what you receive in return, you will be all right.
And yet there are Singaporean who “serve” to protect you, your family, your property and your wealth, regardless of what they received in return, but it is alright to tell some of them and their family, to “go to NTUC and ask 4 or 5 aunties and diagnose and treat (them) instead” when the sin is their hope of “not pay so much” for the “valuable service” for which you simply only wanted more money out of it ? mercy! mercenaries…..
And do I not "serve" to protect them, their familiy, their property and wealth too?
Maybe when I buy your wares or employ your services, I should ask to "not pay so much" because I serve too?
Going by your logic, anyone who "serves" or their family are entitled to "not pay so much" for everything in Singapore, aren't they?
What is your point? Is your point that ntuc aunties and Scdf personnel are not paid enough? Or that doctors should be paid less because they earn so much more than ntuc aunties? Why are you comparing blue collar to white collar workers? Are you arguing for communism where everyone gets the same pay? Doctors earn ten times a road sweeper does. What about lawyers? They earn twenty times the amount of a road sweeper. How about bankers - they earn thirty times a road sweeper. What about a minister who earns two thousand times the amount of a road sweeper? How do you compare payscales across different vocations? Should you use skill level? Are doctors more skilled than ntuc aunties? Can an ntuc auntie do a heart bypass? How about working hours? Who works
Longer hours? Do you even know what a doctors daily schedule entails?
Rising medical costs has very little to do with how much doctors are paid. We are a small part in the health care economy. In the US, physician salaries account for less than 10% of the health care budget!
Politicians will have you believe the nonsense that doctors salaries are the reason for raising health costs because policies that target doctor salaries have a lot of emotional value(votes). N it is far easier to implement.
GP / hospital based docs salaries in S'pore have been largely stagnant for years; have health care costs been stagnant ? No. Where is the correlation?
N comparing us to policemen/SCDF/ NTUC auntie is frankly ridiculous. None of them had to go through 5-6 years of university in one of the most rigorous courses. They also do not have to pay 15-40K a year in university tuition.
If you have to make comparisons, why not compare us to the guys who helm the services that protect Singapore? After all we have similar skills and education levels with many of these top brasses in the SPF/SAF/SCDF. Our salaries are COMPARABLE ! We do not make 2-3X more than them.
Why compare to SPF / SAF / SCDF? Oranges and apples. Compare to dentists, lawyers, civil service right?
No lah, Towkay, don’t be Angry … Ipad no need discount, Iphone no need “not pay so much”, 3DTV also no need, entry fee to Integrated Resorts no need, French cooking lesson in French lagi no need….just basic “entry level” modern days needs and aspiration, eg education, housing, medical care, safe living environment, water & electricity ….
If the “guys who helm the services that protect Singapore” are the only ones needed to protect Singapore, then can save breath already lah; at that level of salary, it can comfortably afford these services which in turn can pay COMPARABLE salaries – the eco-system is balance and “self-sustaining”
But in SG, the guys that really / actually doing the protecting are the same lot ?, do they even make nearly comparable salary ?, and are both groups not equally susceptible to falling sick ? or needing the same gamut of medical services?
So are GP / Hospital based docs servicing more the guys who helm or the guys that are been helmed?
The comparison is just a quick take (did not search net thoroughly, sorry hor) which goes like this; doctors practise (ie doing their job) by taking risk on other people (and other people’s family), SPF/SAF/SCDF “practise” by taking risk onto themselves (and their own family) … and the latter group should have been in first, doing it well and continuously doing it; the by product of which is a kind of protective “sphere” to enable the former but smaller group to even begin to focus on their rigorous 72 months courses…. no? not even close?
:\ weak premise, weak argument carried far beyond common sense - and you know it.
We do not "practise by taking risks on other people". We weigh benefits against risks, and employ our clinical judgement to call in favour of risk only when benefits outweigh the risks. We keep up to date with current specialist knowledge to keep our clinical judgement sound. It is precisely the combination of specialist knowledge, skills and clinical judgement that makes medicine a "profession" rather than a vocation - in Singapore and all around the world.
There is also the question of the huge university tuition loan incurred from med school (which you conveniently forgot to cut and paste from Gerald Tan's website because it doesn't suit your argument.) which needs to be repaid after graduation.
And you are continuing to ignore the rigorous schedule that lasts for life for many of us - not just 72 months. The 24 months immediately after - housemanship -- are possibly more taxing than NS! Beyond that we have a six day working week to look forward to, on some weeks. On other weeks when we go on call we effectively go beyond six days. On-call for many doctors means staying in hospital on our feet, seeing patients and doing procedures / operations, and getting an hour's... or two if we are lucky of sleep within 36-48 hours.
We also do not get much in the way of bonuses. I believe for Medical Officers the annual bonus ranged from $4 (I kid you not) to $94 last year. Civil servants can expect bonuses up to - and sometimes in excess of half a year's salary. We rarely even get a month's bonus, and it appears to be shrinking with time.
Pharmaceutical reps sometimes earn in excess of our salary because of their sales bonuses. A hospital pharma rep starts work at 8 and ends by 2-3pm. A GP rep can start at 10 and end by 4. Most hospital doctors start work at 6.30 am and end by 7.30 pm; sometimes 9.30 to even midnight depending on the daily schedule. Non private GPs work long hours to balance their books when they are starting out too. The salaries you picked out are senior consultant salaries at the "end of life". Consider that a senior surgeon in his fifties draws a pay of $20k -- then consider his peers who are senior partners in law firms, or senior pilots, or CEOs who are all drawing $50k to $100k a month. Consider that even a senior surgeon isn't eligible for the premier services at HSBC -- which demand a monthly salary greater than 20k... and then consider going out there and looking at the figures for ALL professions instead of fixating on doctors.
Furthermore, SPF do not "practise risk on themselves or their families." They enforce the law. In certain select instances they come under threat and must respond in an appropriate way that MINIMIZES risk to the people around them, and to themselves. They are supposed to AVOID risk. I suspect an SPF member would be horrified at the way you describe their job.
Likewise with the SCDF. (Incidentally you forget that some of us doctors ARE from SCDF, and know what the "work" entails on a daily basis.) We do not leap into burning buildings or shifting rubble because we enjoy the risk. We shore up and reinforce, and undergo training to MINIMIZE risk to the casualty and to ourselves. The SCDF is primarily about risk avoidance. Such risk activities only make up a small proportion of what the SCDF does.
Doctors risk needlestick injuries and contracting Hep C and HIV too whenever they take your blood. We take out insurance to cover the risk - we don't clamour for higher pay. :\
Arguing that the SAF / SCDF / police (home team?) provide the "security bubble" that enables the rest of the country to function as a basis for payscale is silly and bordering on the justifications military juntas make for staying in power and paying themselves well. By the same flawed logic these vocations should be paid better than politicians, since without law and order politicians would be ineffective. Legal services would fail with anarchy - so perhaps SPF should be paid better than lawyers and judges too? The SPF, SAF and SCDF - like doctors - have a job to do. And we all just get on with it.
Salaries are pegged to skillsets, knowledge and workload.
I submit to you that in truth, doctors are not paid ENOUGH - when compared to their PEERS. (people of similar academic ability / overall calibre, who were our classmates in school and went on to become bankers, lawyers, politicians, pilots, businessmen etc) The thing about doctors is we take it lying down - we don't clamour for higher pay like lawyers, or pilots do. Most of us feel some visceral need to help our patients, and can see the conflict between help and payment. The GPs of old used to accept remuneration in kind - home cooked food! Even amongst doctors payscales can vary greatly depending on specialty - and often unfairly so. We bitch about it but largely take it lying down.
Your argument is frankly so ludicrous that your persistence is becoming slightly offensive. If you are merely interested in arguing a point - no matter how illogical or worthless it is - then I submit that you would do better on a collective blog of lawyers. Please go and tell them they are paid too much because they earn more than 8 times the salary of an NTUC aunty, and 2 times the salary of a doctor, although they only work a 5 day work week. You can try your luck on a pilot's blog too. While you're at it consider doing the same to Khaw Boon Wan, I hear he is very approachable on his blog. It would be interesting to know what his take on earning more than two thousand times a cleaning aunty's salary is.
Kindly report back to us what they say after that.
"...doctors practise (ie doing their job) by taking risk on other people..."
How horrible!
I suggest you don't take this risk or allow your family to take this risk at all!
"If you are merely interested in arguing a point - no matter how illogical or worthless it is - then I submit that you would do better on a collective blog of lawyers."
Yes, those vultures! If I commit a crime and they screw up my defence, it is *I* who go to jail, not them! They are practising by taking risk on me!
Ok, how about this; with best plan and intention, a doctor minimise risk to the patients. SAF, SPF, SCDF people minimise risk to themselves! If risk prevails, doctors get to learn from it, say would do better next time, move on. On the other hand, the latter might “get” a medal and/or a “promotion” and leave the “learning” to his/her families to “move on”…. (lawyer example spot on)
(To build a sleepy fishing village into a repository of billion dollars investments, in SIM City SEA edition; should you start with 100 top rate politicians/civil servants + 10,000 conscripts or 100 conscripts + 10,000 top rate politicians/civil servants? (try recruiting these 10,000 instead!))
If a bankers, lawyers, politicians, pilots, businessmen want more (multiple of NTUC aunties’ pay) or cried “why don't you take your (little) money and go ….!” or “How horrible! (so little money) I suggest you don't take this risk or allow your family to take this risk at all!” …ok walk loh, no bank loans (children go do Arts instead of Med), pay damages and apologise (but there really was a gold tap!), 9 hours sitting trip instead of 40 min, or forgo elevators that stop at every floor..
Now why would anyone want to bug doctors? can go JB buy cheap pills what ….mercy!
Maybe forget this lot all together, cut them loose!, they can go see all the Chinese Sinseh they want "instead". Since so many of them (and getting more by the day) are needed to afford just 1 GP, lets service only bankers, lawyers, politician, pilots, businessmen - earning many “…times the salary of a doctor…only work a 5 day work…”, it would be cold hard cash and not “instead of peanuts? Reforming doctors, from monkeys to mercenaries” wouldn’t it?
Is he writing in English?
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