Why Your Doctor Needs a Raise


Let’s assume state leaders come to agree that a pay increase is the only way to stock Boston with the primary care docs we need. How to put that into practice? The danger is that policymakers will do too little, too late. Though there are proposals on Beacon Hill to forgive med school debt if doctors become primary care providers in underserved areas, they are unlikely to make much of a dent. South Carolina, for instance, has tried a similar policy to increase its number of geriatricians. While commendable, this kind of effort has been "inadequate in both scope and consistency," according to a report by the Institute of Medicine, a national think tank.

What if those specialist-dominated committees just raised reimbursement rates for primary care? Sounds like a simple solution. But it probably wouldn’t be an effective one. Two years ago, for example, the Centers for Medicare and Medicaid Services announced with great fanfare that it would seek to increase by 37 percent the reimbursement rate for the most common type of office visit that primary care docs handle. Alas, because of the labyrinthine way the policy was written, the increase actually worked out to about 5 percent by the time it hit doctors’ bottom lines.

Ultimately, what’s needed may be a wholesale makeover of how primary care is delivered and paid for. Goroll, the MGH doc, has helped design one such plan that’s garnering interest. Instead of reimbursing doctors per visit, it pays them a set amount per patient, shelling out more for those with serious health problems and less for the relatively healthy. Built into those payouts are the costs of running a practice: salaries for assistants, funding for efficient electronic record-keeping, and performance bonuses to ensure docs don’t get complacent. Meanwhile, the happier patients created by such a system would be more loyal (although they’d be free to change practices easily if they want to), getting all their care from a doctor with whom they have a steady relationship. It sounds like a dream—and for now, well, it still is. Goroll’s plan is in the testing phase; he’s raising money for a trial beginning in January to see if it will really work.

Goroll says he’s wary of the fact that his model will be "viewed as a giveaway to primary care physicians," and admits that high costs will be a concern. But he’s got one thing working for him: the desperation of patients anxious for a solution to this mess. It’s a feeling I myself have become all too familiar with.