The 4.5%

On the heels of the COVID-19 pandemic, physicians are faced with yet another barrier to providing care- pay cuts.

Medicare has already approved a 4.5% pay cut in physician payment. While to some this may seem like a small percentage, the fact that this conversation is even on the table in the first place should be highly concerning.

Physicians are facing a serious problem- one that extends beyond pay. There is an unspoken understanding that primary care physicians, and perhaps all physicians, are at the mercy of the corporate agenda. Rather than focusing on promoting physician wellness and satisfaction, physicians are met with increasing patient loads, less autonomy, pressure to meet demands of patient -centered care, lack of advocacy in government, ROI’s, UDS measures, and competition from healthcare professionals with fewer years of training.

On the latter point, let me be very clear. Do not get me wrong, there is a need for health care providers from all fields- specifically physician assistants (PAs) and nurse practitioners (NPs). They offer a unique perspective, and many are well-qualified to provide high-quality care to patients from all demographics. However, while the doors are open for them to increasingly work autonomously, it should not come at the cost of the well-being and compensation of primary care physicians. Additionally, hiring PAs and NPs should not serve as grounds to pay primary care physicians less or to replace them.

But, alas, I digress.

What does the Medicare pay-cut really mean?

Well, it depends on who you ask. For me, it reflects the boldness of American government as they express their perception of the value of physicians. It isn’t enough to subtly pay physicians gradually less and less over time as years pass on; in fact, physicians are unknowingly and knowingly pitted against each other for the benefit of the capitalistic and corporate structure. Physicians are finding it more difficult to pay off loans quickly and feel adequately compensated for their work- which extends beyond just “getting paid more”. But for the sake of this topic, let’s temporarily focus on “just money”. Ever wonder how no one thinks twice when providing a credit card, albeit sometimes begrudgingly, to the mechanic to repay him or her for his or her service? Yet, many expect physicians to be unrealistically altruistic- offering care without the expectation of adequate compensation after years of studying and sacrifice that extend well beyond the time it takes for a certification and apprenticeship.

Another layer to the conversation is this- with the increasing power of patient-centered care and litigious culture in the setting of rising inflation and economic strain, well-meaning physicians have their hands tied when patient demands conflict with established scientific/evidence-based practice- i.e antibiotics to treat viral infections.

Many primary care providers to some degree have altruistic intent and genuinely work hard to provide excellent care for their patients. We also need to eat, pay our loans, rest, and provide for both ourselves and our loved ones (many of which we sacrifice so much time away from). We also desire to serve out communities, not just with funds, but with time, energy, and effort to help everyone achieve their health goals. And despite not receiving the compensation we have earned, many of us try our best to show up anyway- even at the expense of our own wellbeing and the wellbeing of those we hold close to our hearts.

The need for healthcare providers continues to increase, yet the number of physicians leaving the practice (sometimes tragically) is beginning to reach new heights due to some of the reasons listed above and to the growing burden physicians have with the demands of their career. It is important for all of us (patients, nurses, PAs, NPs, lobbyist, senators, governors, residents, attendings, mayors, corporate leaders, and anyone with a vested interest in helping others) to work together to bridge the glaring gaps in healthcare starting with advocating on behalf of physicians who were giving all they have long before an epidemic revealed their long established value to the temporary fame of the world’s stage.