Health reformers would like to push America toward evidence-based medicine where doctors typically treated ailments in the optimal way, based on prior successes. But the prescriptions they offer often fail to meet this standard of proof.
An example is the widely held belief that paying primary care physicians more would somehow make our health system more efficient and, ultimately, even save money. But how?
We know that specialists are taking an increasing role and that fewer new doctors are becoming general practitioners (or family doctors, or even internists, who often play the same role) and that such generalists often earn much less money (primary care physicians, internists and pediatricians average less than $200,000 annually) than a superstar specialist neurosurgeon (who often earn more than $500,000 a year).
The theory is that general practitioners are giving their patients something of a bum's rush, hastily referring them to a specialist for any apparent problem, because they're paid so little for a patient visit.
So instead of spending 40 minutes with a patient, teasing out what the real problem is, determining whether it requires immediate medical intervention and deftly counseling the patient about the need for a healthier lifestyle (exercise more, eat less), the primary care physician simply listens to the superficial complaint and quickly shunts the patient to the specialist who deals with the relevant body part.
There's wide agreement that it would be nice if a growing segment of new doctors became family physicians, but there's no certainty on how to make that happen (short of simply drastically shrinking specialist training programs, an option too draconian for most involved to consider).
And while its true that a primary care physician makes less, there's no assurance that upping income by a third - which would put her in the $250,000 range - would discourage new doctors from going into surgery where income can be double that. Even the big spenders aren't suggesting equalizing pay.
Money talks, but we don't know when it speaks loudly enough to distort career choices. Doctors who become specialists say they do so because it allows them to explore a medical problem more deeply (reflecting a specialization we see in society generally) and often promises a more structured lifestyle.
If that's so, a bit of extra money won't make a lot of difference. This, of course, is the long-run perspective. But the potential immediate impact isn't any more positive.
That's because primary care physicians are working full time now. If they spent twice as much time with each patient, it appears they'd only be able to see half as many patients. Thus waits for a doctor's appointment would grow longer than they are now, at a time when patients are already growing restless.
I'm not unsympathetic with primary care physicians who'd like to make more money and they can make an equity argument that some find convincing. But anyone who argues that raising their pay would improve our system should be asked to produce plausible proof that would happen.
That hasn't happened yet.