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Would You Trade Salary Upside For Security?

February 14, 2014
Written by: , Filed in: Diagnostic Imaging, Medical Ethics, Practice Management
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For physicians, the shift is on from private practices to salaried positions at hospitals—from, among other things, autonomy and upside earnings potential to security.

Is that good or bad? Here’s one radiologist’s take:

I think it’s pretty clear that sooner or later we’re all going to be on salary. I think there’ll be a radical decrease in imaging, but that’s OK because there’s incredible waste in the current system.

That’s Kirk Moon Jr., MD, a radiologist in private practice in San Francisco. He was quoted in a New York Times article (online Thursday, in print today) headlined “Apprehensive, Many Doctors Shift to Jobs With Salaries.”

The article says 64 percent of the job offers filled last year through the physician placement company Merritt Hawkins were for hospital employment. In 2004, it was only 11 percent. The American Medical Association says 60 percent of family doctors and pediatricians, 50 percent of surgeons, and 25 percent of surgical subspecialists are employees.

But the move to employment status may actually increase health-care costs overall, the article says. Most hospitals are for-profit entities. Often, maybe even usually, they reward employees for generating extra revenue—for ordering more imaging tests, for example. Tests performed at a hospital rather than a freestanding clinic or doctor’s office can also carry an added “facility fee.”

The Times article quotes economist Robert Mechanic about the shift to salaried employment:

In many places, the trend will almost certainly lead to more expensive care in the short run.

Mechanic is senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Health Industry Forum.

The article is worth a read—as are the hundreds of online comments it has generated.

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