A Perspective from Within the White Coat

Abstract

One can easily generate a noisy and angry discussion in any physicians' dining room in the United States by bringing up the subject of managed care systems and their use of financial incentives to control physicians' behavior. Generally, the reaction will range from a palpable frustration among the younger physicians to a feeling of resignation in the senior colleagues. The latter group will then reflect back on the era before managed care, when compensation was on a per diem basis. The more vocal younger generation will continue to vent their spleens about the illogical and unfair nature of their compensation systems, and then realize that they must quickly return to their respective offices, less their productivity be undermined. Having entered clinical practice during the adolescence of managed care, I can provide one clinician's perspective, but cannot pretend to speak for all physicians. There are many of my colleagues who have taken to arms, securing M.B.A. degrees and reviewing HMO contracts every evening before bed. It is easy to discern who these people are: They talk about covered lives, contractual withholds, and capitation systems. I am not among their number. Naive as it is to say, I chose to enter medicine to take care of patients, and I assumed that I would be compensated fairly and live comfortably. If indeed, I had wanted to maximize my future income, I would have sought my fortune in the business world, or failing that, the legal profession.