It's very simple really. All medical work is "challenging" in intellectual terms, i.e., we all have to use our brains and think about what we do (albeit about different specific things depending on specialty). I will grant that some of us have more physically demanding jobs (I don't think I could stand up for 12 hours doing some crazy microneurosurgical procedure). And some of us, granted, spend more or less time than others in fellowship, residency, etc. Regardless, in the end, all of us, as physicians, use essentially the same basic tool: our intellect.
Thus, since we are really all using the same ultimate skill set, I would propose that we all be paid the same.
NOT in the manner of everyone being paid the exact same salary, but rather an arrangement whereby everyone makes the
same hourly rate. I'm arrogant enough to propose that an hour of my brainpower is worth the same as that of a cardiologist or a dermatologist or a pathologist or an ENT surgeon, or you name it.
That, to me, makes much more sense than trying to put different values on different services and procedures. It's pretty hard, in my mind, to decide that the professional fee for reading an MRI should be $X and for reading a sleep study should be $Y. They both require the MD to draw on their training and experience to think and interpret. How do you say that the radiologist's thinking is worth more or less than the neurologists? (No smart-ass comments from either specialty, please!
) But it's very easy to simply say "an hour of
any physician's time is worth $X" and go from there depending on how much time he works.
That way, we all start off even. And if you're a lazy-ass neurologist who only wants to work 35 hours a week, fine. You'll make less than the ortho surgeon who spends 100 hours in the OR. But you bust your butt for 100 hours, you'll do better than the ortho surgeon who only works 80 hours. You'll also make more if you do more call, so you can trade off money for lifestyle if that's your preference.
That all seems very fair to me. Or am I missing something?
The only problem with this, of course, is setting the basic hourly rate. Maybe we should just base that off a typical FP doc with no hospital work and no call, and go from there.
Thoughts?