It’s become widely accepted that primary care physicians are underpaid, and I would suggest that many specialties are overpaid. The basis for this situation lies in the RVU system which measures what it measures, but was not intended as the basis for a reimbursement scheme. What RVUs do not account for sufficiently is time, and time is what a physician has as their limited and scarce resource. RVUs are weighted towards the resource inputs: work effort, practice expense and malpractice expense.
While this is not “unfair” per se, time enters in to the equation, as physicians are limited in only being able to do one thing at a time. There are some opportunities for simultaneous income, such as diagnostic testing. An experienced surgeon does not have the practice expense of a primary care office and support staff – the expense ratio for surgical practices are much lower than office based practices.
The result is that specialists earn more per hour than can a primary care physician, based on the conclusion that “actively doing” something requires more work effort than does the “actively thinking/listening” work effort in primary care.
We know – although the specifics may be fuzzy – that we in the
By putting “time” into the equation, we will redefine physician “work effort”. That’s what is needed to put more money – and value – on primary care physicians. By doing so, we also shift and broaden our definition of what is meant by “medical care”, and, most importantly, can return primary care physicians to their rightful role of truly managing and coordinating the health care for their patients. In this new model, EHR becomes a critical component enabling this to happen – the ability to manage, analyze, share and move data is critical.
The debate is just heating up, and there will be action in the next two years. Physician organizations are at the table in this debate, and individual physicians and practices should be making plans for a renewed sense of purpose as the “Captain of the Team”.