The comments on my recent post Fighting Chaos are some of the most interesting ones I have had. One which particularly sparked my thoughts (not an easy thing to do, mind you) was one that compared being a physician to being a barber. It states:
I’m a licensed barber. Does this mean I get to give you a buzz cut because I can do those faster, and make more money in an hour, or am I suppose to take the time needed to give you the kind of haircut you want, and expect, even when you wait until the very end to to say, “Take it just a little bit shorter all over!”?
You see, being a barber is a public service, but so is being a physician. A patient is a customer, paying for your service, just like you are the patron, paying for a haircut. Sure you don’t get all of the money, but neither does a barber. We have fees, supplies, chair rent, taxes, etc., just like you. If my profits are eaten up because you require twice the time that a normal haircut would, it doesn’t mean I have a right to give you a rotten haircut. Consider this, you probably wouldn’t even pay for it, and if you did, you would never come back! Should doctors expect more from their patients for shabby service?
I pay around $300 a month just to have insurance coverage for my husband and I. On top of that, I also have my co-pays, and my portion of the bill, that insurance doesn’t cover. I have max out of pockets and deductibles, which also run into the thousands! Doctors don’t see all of that money, but I’m sure paying for it! I expect my doctor to spend as much time with me as needed! I’m not out to take up extra time from my doctor, but when I have a valid problem, I expect to be taken care of appropriately. No short cuts!
This is interesting because I take care of some hair stylists and have commented how similar our jobs are. Here are the similarities I see:
- You are your own source of income
- Reputation brings business
- A full schedule is the norm if you are good
- People will wait if you are worth it
- You get to hear people's secrets
- You deal with sharp objects
- You have out-of-date magazines in your office
- Doctors' offices and barbershops both smell funny
- Little kids hate going to both
- "Doctor" and "Barber" both have six letters
- In the middle ages, barbers were doctors...or was it the other way around?
- There are llama barbers and llama doctors (although the llama does not do the doctoring or barbering).
There is a good point to what the commenter says, and it does seem to make sense. These similarities seem to imply that physicians should just accept a lower income. It is our desire for higher salaries, not the system itself that is making things bad.
But here are some very important differences:
- Physicians train for 7-8 years before earning significant income.
- Physicians generally incur over $100,000 in debt - I am 14 years out and still paying student loans.
- Neither should use a flamethrower in caring for their customer.
- Barbers can set how much they charge, but doctors can't. Others (Medicare, insurers) set how much physicians can earn. A high-quality physician with excellent customer service can't charge more. A bad physician with poor service earns the same, if not more.
- Third-parties pay for medicine, not hair care. This means that patients are often not aware how much (or little) a doctor is paid for the visit. The rising insurance rates have not gone into the pockets of doctors - in fact, the salaries of doctors have dropped while insurance costs go up.
- A baseball can be "doctored," but cannot be "barbered."
- There is not a shortage of barbers, but there is a shortage of primary care doctors. This means that to serve the entire population, PCP's must see high volume.
- Physicians have an enormous amount of unpaid work, whereas barbers do not. Barbers are not called many times a day with people asking for free haircuts. Physicians get patients calling for medical advice and wanting it done over the phone to avoid paying.
- Barbers' malpractice is not quite the same as doctors'.
- Doctors are not as good at Foosball.
- There are no subspecialty barbers making 4-5 times the income of regular barbers. Some stylists command more, but that is based on reputation and quality of work. Reputation and quality have no influence on how much a physician can charge.
- Obviously, the responsibility of a doctor is at a different level than that of a barber. This is no disrespect to barbers; but nobody would suggest that barbers should earn what physicians earn (although some primary care physicians actually are earning what some barbers earn).
I must also mention that I am also a small-business owner, being stung by the high cost of health insurance just as much as any other business owner. I do understand the cost to the consumer because I am a consumer too.
This is not to defend the shabby service that some physicians give. My purpose in the post was to point out that a system that is not sensitive to the quality (both the quality of service and care) but instead is only sensitive to volume, will produce bad care.
Quality must be recognized. It is for barbers, but not for physicians. It's not surprising that things are so messed up.