by Linda M. Girgis, M.D., Family Practitioner
Several recent articles called for increased transparency in doctors’ earnings and in their conflict of interests. Those calling for this transparency think this revelation will suddenly drive the free market and make patients informed consumers.
Many believe physicians and medical groups will lower healthcare costs in an attempt to win patients under a more transparent system. Here’s why their arguments are flawed.
When Medicare published the earnings of doctors earlier this year, few people got a true picture of what these numbers mean. The numbers did not reflect any overhead expenses. Much of the public falsely believed this represented pure profits for physicians. However, this was gross earnings not not net profit. Overhead expenses easily reach 50% or more in many practices. This newly released transparency was more misleading more than helpful.
The notion that we should compete for business by cost altering is also a false assumption. I do not get to set the amount that I get paid. I get paid only what the insurance company says that I am allowed to get paid. I can change my fees all I want, up or down, but I will be earning the same regardless. [This needs clarity, doctors do not set prices, but insurance companies do, asking physicians to adjust their fees is pointless because we only get paid what the insurance companies are willing to pay]
Creating a “rate sheet” of services based on competitive pricing at the doctor’s office will only affect self-pay patients. With the passage of the ACA (Obamacare), this truly represents only a tiny fraction of all patients.
Transparency in earnings will not drive any change in the healthcare system because it’s out of physicians’ hands. Perhaps a more revealing transparency would be the earnings of executives at healthcare insurance companies. Their incomes, after all, are directly proportional to the amount of money the insurance companies profit and the costs of services they keep contained.
Transparency in how services are covered and denied would drive a true improvement in healthcare but perhaps at a loss of income for some executives.
Revealing Conflicts of Interest
While transparent billing is an issue, physicians are also facing a call for transparency with conflict of interest issues. Many of these are talking specifically about relationships with pharmaceutical companies. The vast majority of physicians have no relationship whatsoever.
Many doctors, myself included, no longer even talk to pharmaceutical representatives in our offices. There are some who say something as small as the gift of a pen is enough to influence us and our prescription pads. The introduction of the Sunshine Act greatly curtailed pharma activities in this regard.
But even drug prescriptions frequently are dictated by insurance companies more than physicians. More often than not, we are prescribing medications for a patient based on their insurance formularies. A prior authorization can no more influence my prescribing habits than a pen with a medication logo on it. It comes down to cost savings for the insurance plans and, since most patients can’t afford the exorbitant costs of so many medications, the choice of medications is left in the hands of the insurance companies pharmaceutical committees.
Physicians are frequently up against a bureaucratic wall as we seek the best medication for our patients only to be turned down by an uncaring person sitting at a phone bank miles away from us.
It’s flat out ridiculous to think even the nicest pen in the world can over-ride the realities of insurance or our calling to help improve the lives of our patients.
Are They Keynote Speakers or Shills for Pharma?
Doctors who give lectures often are paid by pharmaceutical companies. There is no other profession where the experts are expected to be keynote speakers for free. Many of the abuses that did occur over the years have been remedied by the Sunshine Act, if doctors don’t fill these roles, who will give these valuable teaching lectures? Nurses, medical students, others?
Surely educational lectures should be given by the experts who best understand the issues. Only when other professions offer up their experts for free should physicians be expected to do the same. There is no shame to be compensated for time and expertise. Sure, a speaker should disclose if they are working for any companies. But, that should not pre-judge their content as biased. We are physicians afterall, we know how to listen for information that can best help our patients.
Pharma and Research
Critics also challenge transparency of Pharma funded research. Again, if they don’t support development and clinical trials, who will? There is a real need for proper oversight by agencies such as the Food & Drug Administration, but pharma is uniquely posititioned to support research. They are the ones developing new and novel medications. They also have the scientists on hand who can vet the safety of new medications. The last thing a pharmaceutical company wants is a drug recall. No one wants to see Phen-Fen again! Pharma is highly incented by market forces to keep drugs safe and effective.
Transparency has a place in the healthcare industry but it needs to focus across the breadth of medicine, not just on physicians. Any patient who reads their EOBs (Explanation of Benefits) knows that physicians have been transparent for decades on their fees. We have never attempted to hide any of this. Even if we wanted to, it has been decided for others to put it out there on our behalf. Those of us practicing on the front lines lost that war long ago.
Let’s Look at the Big Picture
Transparency in medicine is a big issue, if you want a free market and true competition, reform all the third parties who are profiting from medicine. And let medical decisions return to the ones in the exam rooms treating the patients.
Do we want the most cost effective healthcare system driven by big corporations that profit by denying care? Or do we want healthcare workers who are free to provide the best medical care to all patients?
credit: Linda Girgis, MD
Bio: Dr. Linda Girgis MD, FAAFP is a family physician that treats patients in South River, New Jersey and its surrounding communities. She holds board certification from the American Board of Family Medicine and is affiliated with both St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis also collaborates closely with Rutgers University, University of Medicine and Dentistry of New Jersey (UMDNJ), and other universities and medical schools where she teaches medical students and residents. She recently completed a medical mission in Egypt.
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