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Thursday, April 27, 2006

Another argument against pay for performance (P4P) Should doctors be tipped?

Dr. Faith Fitzgerald,professor of Medicine at UC Davis,speaks out against P4P in the April 13,2006 issue of Internal Medicine News.(www.internalmedicinenews.com)

She makes two major points.

1)recommendations by "expert"panels are subject to reversal due to the fragile and provisional nature of medical conventional wisdom. Physicians feel bad when they make certain recommendations ( e.g. HRT for postmenopausal women) and later learn they may have harmed their patients, but at least they thought they were doing the right thing based on the information available at the time. However, with P4P, " Shall we have the same solace if we make these decisions,not because we think they are right but for money?

2"...the very concept of pay for performance for doctors,especially we when collaborate in the creating of the concept:Pay for performance embodies the tacit assumption that if we are not delivering it, it is because we are not being paid enough."...it[P4P] corrodes the conception of self-governance and correction that is part of the definition of professional. ...We must not servilely accept gratuities for doing our duty."

I believe P4P is wrong on so many levels. Thanks to Dr. Fitzgerald for emphasizing the aspect of how P4P is antithetical to physicians' professional identity.

1 comment:

ismd said...

"I would encourage all proud physicians and their representative groups to refuse cooperation with those who would institute pay for performance. It corrodes the concept of self-governance and correction that is part of the definition of professional. It would be unnecessary were it not for our ongoing capitulation to the directives of external agencies for cheap, algorithmic, rapid-throughput, one-size-for-all medical care with diminishing returns for increasing mandates."

If there ever was a call for revolution, this is it. I, for one, abhor the concept of P4P, and have vowed to drop out of Medicare and any other insurance plan that institutes this degrading measure. Kudos to the good doctor for her statement.