A frequent topic on other medical blogs is the relative compensation of various physician specialties/practice types: proceduralists vs. cognitivists, primary care vs. specialists, surgeons vs internists, hospitalists vs. officists. Should the healthcare pie be recut, enlarged, both, or neither?
Here are some of my preliminary thoughts on the matter:
1. Emergency/urgent services: When I develop heart problems, the cardiologist treating my heart attack is going to have a lot more leverage than the primary care doc who later manages cardiac risk factors.
As a society, we need to ensure that certain emergency services- such as neurosurgical treatment of brain bleeds, is available on a timely basis. If there is a shortage of dermatologists, neurologists, psychiatrists etc in an area, a majority of Americans can afford to travel elsewhere to seek these services. If you have just been in a car accident, the lack of nearby neurosurgical care can mean you're dead or permanently disabled.
I feel that those who provide emergency services deserve higher compensation than doctors who don't.
2. After Hour Services: Over-useage of ER's would decline if more docs had evening/weekend hours. Doctors should be able to charge patients extra for seeing them outside of the normal work week. I would personally be willing to pay my doctor more out-of-pocket for the convenience of evening hours. If doctors were allowed to charge surcharges for after-hour services, busy professionals would benefit. Retired persons and the unemployed could continue to go to physicians during normal daytime hours. The only group that wouldn't benefit is the working poor.
More to come on this topic later- maybe.