Doctors Don’t Get Paid to Practice Good Medicine

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Did you know that? Does it surprise you? Oh, sure, there are many doctors who practice good medicine (myself included, I hope). I’m just saying that’s not how they get paid.

For the most part doctors get reimbursed based on how many patients they can quickly get through their office, clinic, ER, etc. They also get paid, usually very well, to do procedures, so the more procedures they do… well, you get the picture. Some physicians work for an hourly wage, no matter how many patients they see or don’t see. For example, in the emergency room, I work for an hourly rate but I must be productive enough or I could find myself out of a job. Doctors who work for a specific rate, regardless of how many patients they see per hour, are probably still in the minority. Certainly most office practices are numbers driven.

Let me give you an example.

Dr. Smith and Dr. Jones practice next door to each other on Main St. Dr. Smith prides himself on communicating with his patients, explaining things, educating them, helping them find non-pharmacological ways to deal with their various problems. He believes that natural methods of dealing with health problems can often be more beneficial than taking pills. He takes time to listen to the dad who’s stressed out at work, to the teenager who feels left out at school, to the four year old having nightmares and to the working mom who is trying to maintain her sanity. Because his approach to medicine takes time and effort, though he is efficient and experienced, Dr. Smith sees, on average, twenty-five patients a day in the office.

Dr. Jones has a different approach. She figured out a long time ago that the more patients she could see in one day, the more money she’d make. In fact she has become so quick that she is able to see fifty patients a day. Her office is the epitome of speed and organization. Dr. Jones realizes that her practice approach is not exactly what she envisioned when she was an idealistic medical student but she knows it is much more lucrative to just give people what they think they want, usually a prescription of one kind or another, and then get them out the door. It saves all that time trying to council and teach patients about their health. Her patients have become accustomed to the fact that they will be in and out of the office in a hurry but they are willing to accept feeling rushed in exchange for getting prescriptions for antibiotics, tranquilizers, sleeping pills, antidepressants or anything else they might request.

Please understand that I am not saying that speed and efficiency are undesirable qualities for an office practice to have, or that there is never a good indication for writing prescriptions. What I am saying is that what most people could benefit from is a physician who listens, educates and includes the patient in the treatment of the patient’s condition. We all want to be listened to. We all want to be valued. We are all capable of learning how to have optimal health.

Now which of the two doctors above, makes more money? Which one would you like to have for your doctor?

Marlene Buckler, MD, FACEP
A Doctor’s Guide To Avoiding The Emergency Room

Dr Buckler is an emergency room doctor and a Fellow in the American College of Emergency Physicians (ACEP). She has been practicing emergency medicine for more than fifteen years. Learn more about a healthy lifestyle and how to keep yourself out of the emergency room at

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