It's part of the social contract: doctors accept limited salaries in exchange for limited liability; patients accept that they cannot sue doctors for millions of dollars in exchange for a guarantee of access to decent health care.
True or not (certainly not true if you ask internists and family practice docs) the perception in our country is that doctors are "rich". We represent some sort of elite class of Americans who send their kids to private schools, drive Lexuses and Audis, join country clubs, and spend summers in the Hamptons. It's absurd, of course, as the majority of docs in the trenches can attest. But perception is king. Therefore, it seems that meaningful tort reform is unlikely until we do something to alter that perception. I have no problem with decreased salaries and lowered reimbursements. But the reason physicians make what they do in this country goes way beyond malpractice insurance. You want to transform the physician class into civil servants, fine. But do something about the exorbitant cost of medical school. Address the threats of frivolous lawsuits. Ease the burdens of running an office by subsidizing EMR. It's a package deal. As physicians we need to be a little more flexible. The roar from the primary care sector comes off sometimes as a whiny demand for more money (take it from the specialists if you have to!) and less work. And the more lucrative specialties (neurosurgeons/dermatologists) need to consider a world in the very near future where they earn 50-70% of what they make now. But it has to be a two way street. The social contract in the United States has always been tilted in favor of the entrepreneur, the capital man, the Wall St trader. We don't compensate individuals in this country based on the moral value they provide to a community. Few would argue that teachers and firemen and pediatricians and social workers are paid commensurate with the effect they have on local citizens. And we're fine with that. We're a country that has thrown in its lot with free enterprise and open market capitalism. That will never change. Doctors are now finding themselves marginalized financially in much the same way as the kindergarten teacher, the social worker at the battered women's shelter. I see the inevitability of it. But there has to be a reasonable compromise. You can't ask doctors of the future to earn less and work more without subsidizing the training and schooling, without addressing the med mal crisis. I'm willing to sit down at the bargaining table. But as the recent attempts at HCR demonstrate (no mention of tort reform or medical school subsidization in either bill), too often no one is willing to sit down across from us to negotiate....
I enjoyed this thoughtful post. I don't see a 'package deal' in the offing. And if one did materialize, and were forced upon us, would it be progress? I suspect that once we opened the package, we might not be celebrating. Let's be careful what we wish for.
As you say, America has -for the most part - a market economy. There is a competitive market for talented young people. Nobody has to go into medicine, and when the rewards are significantly reduced you will see some number of talented young people choosing to go into other fields instead of medicine. You get what you pay for.
Any tort reform should have to take into account not only the financial status of the primary health care provider, but also the quality of life and financial status of the consumer who was harmed by the neglect of that health care provider who did not refer on to a specialist before the patient reached endstage disease, a disease that most likely could have been treated successfully if caught earlier. Specifically I speak of my husband who was finally referred to a nephrologist in December of 2009 at the bottom of Stage IV Renal Disease at that initial visit, with dialysis looming in the VERY NEAR future. Kidney Disease, the silent disease that is diagnosed through lab results that often are difficult to decipher by the patient. It seems unconscionable to me that the medical professional who read the lab results on a regular basis either could not or would not put the pieces of medical evidence together three or four years ago and tell us that he may have kidney disease... NOT ONE WORD that kidney disease was even a possibility, even when all the symptom signposts pointed that direction. Costs of medical school??!! Compare that to the costs of DIALYSIS. Even if covered by insurance, the co-pays and deductibles are horrendous to someone who earns a fraction of what doctors make. REAL harm is done to REAL people by the negligence of primary care providers. Some harm cannot be corrected or undone. So what type of "package deal" does tort reform hold for us??? And what, exactly, do they teach in med school? How to avoid giving a patient an explanation of the hieroglyphics contained in lab results so the patient remains ignorant until the absolute end? And how to avoid the legal tort traps after they bury their mistakes?? How about having a bit more transparency about a doctor's qualifications, past success rate, and past mistakes? It seems that you owe us that, if you are going to put so much more of the burden of correct medical diagnosis on the shoulders of the patient. I really doubt that you will post this, given that it comes from the "other side of the fence." And yes, we are in the process of consulting with a lawyer, but even that will probably prove to be a mine field for us. Our lives are ruined.
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