Someone asks Dr. Rob: “Why do doctors fight universal care so hard when they get a worse deal from the insurance companies than European doctors get from the governments?”

He gives a few good reasons, but this one probably resonates with most doctors:

If I am lazy, I earn less money. If I work hard, I earn more money.

Ah, the American way. Of course, this cuts both ways as the current system encourages physicians to do more, despite evidence that more medicine isn’t necessary better care.

Putting doctors on strict salary won’t work. Like Dr. Rob, I’ve worked at the VA as well, and patients suffer if there is little motivation for doctors to be productive.

I’m not sure what works the best. Probably a base salary with bonuses for both outcomes and productivity. The performance measures would have to be implemented thoughtfully and carefully, or else a whole new can of problems will arise.