Your Performance Will Be Ranked Based on Financial, Policy and Political Goals, Not on How Good of a Doctor You Are
Just take a step back and think about the entire concept of "pay for performance" when applied to medicine. How do you objectively measure performance? It's almost impossible. How do you truly grade your own doctor? Patients rank their doctors on bedside manner, appearance, how much time they spent with them, how much they listened, and mostly based on personality, ie, "I just seemed to like him." There are some terrible doctors that are loved by patients, and excellent doctors that have crappy beside manner and therefore aren't "ranked" as well by their patients.
Then think of how
you would rate the performance of a doctor as a medical student, resident, attending or whatever level you're at. I'm an attending physician, and I could certainly rank the performance of the doctors I work side by with. That is after working
side by side with them, for a
long time. But it's not easy. And even doctors will have different opinions of other doctors as to their performance. When you get out of your own specialty, it gets even harder. If you're an ER doctor, you are going to rank the performance of a surgeon, for example, based on certain, factors, ie, "When I call him, does he respond quickly, offer valid help, or is he a total work avoidant jerk that hates taking call?" You don't really know how good the guy is tying off a bleeder in the OR, do you? No. You don't know his success rate on his top 3 most performed surgeries. Even if you did, you don't know if his success rate is lower because he has the best reputation and gets sent the toughest cases because he is the best (or at least perceived as such).
Likewise, if you're a surgeon, are you going to know which ER doctor is consistently most likely to diagnose bacterial meningitis in a 4 month old when it's still treatable and presents just like the flu, or the heart attack in the 41 yr old female who is convinced it's just heart burn, who has a normal EKG? No. You'll have no idea. You're going to rate the "performance" the highest on the guy or gal that calls you the least when on call, or when they call the conversation is concise and to the point, or who orders up a bunch of pre-op labs for you to make your admission go easier. Absolutely none of that really has much to do with "who's the best" or has the best "performance." Each of us, the government and insurance companies included,
Rank Physician Performance In A Self-Serving Manner.
This often has little, if anything to do with patient health as a result of physician performance, considering true physician performance is incredibly difficult, if not impossible to truly rank. You can objectively rank the failures, the bottom and outlier 1% such as the dangerous doctors with the frequent sentinel events gone wrong, ie, wrong leg amputated, came to work drunk, sees half the patients as the average doctor, etc. But to truly rank who is top quarter, second quarter, third and fourth, is nearly impossible. So what does that mean?
It means that you will have to get used to being judged in a way that is very, very different than how you were judged before. You will not be judged by your knowledge base, how smart you are, how much you know or don't know about medicine. You will be judged if a patient likes you, not necessarily whether you treated them by following best practice. You will be judged by the government and insurance companies by how much money you either cost, or save them, and not necessarily whether you are best at diagnosing, treating, or caring for patients. You will judged for how many boxes you check or don't check on your electronic medical record. You will be judged based on how much money you can make for your hospital department. In some cases, you may be ranked as a better performer if you are willing to practice worse medicine, do what's worse for your patients, and make more money for your hospital. Your performance will be ranked based on your helping them achieve their financial, policy and political goals. It's unfortunate, it's not the way it should be, and I don't agree with it. But this is the way your, and my leaders, are saying it is, should be, has to be, and "Will be," across all medical specialties. If you can help us change things as you move along in your careers, and make them better for patients and doctors alike, we'd all sure appreciate it.
http://www.kevinmd.com/blog/2013/11/focus-patient-satisfaction-sick.html
