A version of this op-ed was published on June 18th, 2009 in The New York Times’ Room for Debate blog.
In his recent address to the American Medical Association, President Obama noted that our health care system “rewards the quantity of care rather than the quality of care.” This perverse incentive leads to unnecessary and potentially harmful medicine, while also being a major contributor to spiraling health care costs.
Doctors enter the profession to care for patients, and most are not trained, or have the inclination, to run a business. But our health system’s incentives provide a strong motivation to do just that. In fact, doctors often find themselves in a position where the pressure to generate revenue becomes as important as how they practice medicine, and those who do not pay close attention to the financial bottom line are at a competitive disadvantage. It is no wonder that both physicians and patients are growing disenchanted with the current direction of American health care.
Some health policy analysts entirely blame the medical profession for the role they play in rising health care spending. And indeed, doctors have tremendous influence in the tests being ordered and treatments prescribed. But singling out physicians would be like wholly blaming the players for a proverbial game’s flawed rules. More important than focusing on the players, we need to change the rules.
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That means re-aligning incentives to best serve the interests of patients. Physician payments need to be divorced from the volume of care, and associated with evidence-based patient quality measures and a reduction in medical errors.
Furthermore, we need to value the time doctors spend with patients. Instead of being encouraged to squeeze in appointments and rush through office visits, doctors should be incentivized to take the time to counsel and guide, along with improving their communication with patients, not only in person, but over the phone and on the Internet.
Clearly, successful health reform depends on modifying physician behavior. Doing so requires that we change the incentives that motivate doctors.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
