By John A. Wilson, MD
Originally posted on Neurosurgery Blog on June 28, 2013
As one neurosurgeon put it, “After finishing my last day of seven, 24-hour days, on-call, removing a brain tumor, stabilizing a fractured spine, and finally spending hours with a grieving family to help them grapple with the difficult decisions surrounding a locked-in syndrome for a brain stem hemorrhage, I arrived home to read a National Journal article by Ms. Sanger-Katz entitled, ‘Doctors Already Make More Than Enough Money.’ I have no words to describe my emotions.”
Well, the AANS and CNS have some words in response.
Ms. Sanger-Katz is clearly misinformed. As such, we invite her to come spend a week on-call with a neurosurgeon to see if we are really in this profession for the wrong reason. Maybe then she will have a better understanding of why we don’t consider ourselves to be “actors in health care”’ as she suggests in her article. We don’t pretend to save lives every day as if we were in a movie, and it’s insulting to even suggest such a thing.
Ms. Sanger-Katz is quick to dismiss the potential access to healthcare problems that patients may experience. She even goes so far to suggest that it would be impossible for doctors to stop taking Medicare patients because it would be bad for “business.”
Maybe she missed the memo, but it is well established that the country faces a severe physician manpower shortage, which will be exacerbated as health insurance coverage is expanded to an additional 30 million Americans and the baby boomers continue to reach retirement age. Overall, the shortage will approximate 130,600 physicians by the year 2025 — 64,800 specialty physicians and 65,800 primary care physicians.
There are about 3,689 practicing board certified neurosurgeons for over 5,700 hospitals in the U.S., serving a population of more than 311 million people. As the population ages and more of our citizens face debilitating and life threatening neurological problems such as stroke, degenerative spine disease, and Parkinson’s, this supply-demand mismatch will become even more acute. Add to this supply-demand imbalance the concept of cutting federal reimbursement rates below what it costs to deliver the care, and access issues will only worsen. Just look what happened to Medicaid in California.
Because our country is facing a ballooning federal national debt, it is obvious that everyone will take a “haircut,” including the Medicare provider community, which, by the way, will be absorbing a $415 billion hit over the next decade. Perhaps, Ms. Sanger-Katz should take another long hard look at who makes “more than enough” in the healthcare system, as it certainly isn’t primary care physicians. Earlier this month, it was reported that compensation “for the top management teams – the five-highest paid executives at each company – ranged from $21 million at Humana to $47 million at United Health.” And just last week, Kaiser Health News and ABC released a report containing compensation details for CEOs at dozens of top nonprofit and government-supported hospital systems.
Physicians who are giving care are certainly contributing to the health of American. Can these executives say the same thing? Perhaps evaluating the value added by these administrators would produce a “‘salubrious’ affect.” Seems to us, Ms. Sanger-Katz has some bigger fish to fry.