What other major medical institutions, besides Johns Hopkins, salary their doctors rather than pay on a fee for service basis?

Mayo is also salary-based.

There is an argument (and a strong one) that salary-ing doctors is a good, good idea, because if you pay them by patients seen or by tests/etc proscribed, they will do things that are financially good for them, but wasteful or even unhelpful to health, live over-proscribe testing, not spend enough time to really understand a patient’s problem, etc.

Mayo can afford to pay large salaries to its doctors because it saves a lot of money by not running millions of needless tests.

I understand that the VA hospital system is salaried – I am going to Brooklyn VA hospital next Friday for the Shwartz series as part of my training for my new job – my supervisor who is just as into socialized medicine as myself was talking about salaried physicians today and how it works there in the VA system…how the system just works better…as I understand it Kaiser Permanante Medical Group is also salaried and works great

I would have assumed VA is salaried. I grew up in military care, which is salaried, and I think it is MUCH better. That is part of the reason I prefer that type of system. The docs I know who left the military to go to the private sector all say they felt like they were able to be better doctors in the military.

The entire Kaiser system is salaried. Also, many major medical centers have salaried doctors, to a degree (those that do more procedural medicine still get paid more, however). That said, in many cases the person’s salary may still be augmented based on how much they work (i.e. your base salary is X: see 500 patients, get an additional Y, see 1000 patients, get 2Y).

Most hospitals that I have seen, if they have stall physicians they are salaried. Some services at salaried hospitals may be outsourced (thats why you may get a bill from 1-x number of people when you hvae a hospital visit) ie. radiology, anestheology, a few others are common.

Ah, @shilolo beat me to it. Kaiser-Permanente has had salaried doctors since before I was born, back in the dark ages of the early 1950’s. I still remember that when I was a kid an office visit for Kaiser subscribers cost $2.00.

I know that hospitals have salaried doctors, but are they salaried when they see a patient outpatientI think of most in-houose doctors at hospitals as not doing the follow-up with a pt after discharge, or even seeing patients that do not need to go to the hospital. What’s the scoop on that?

Almost all closed-end HMOs are set up like this.

@JLeslie – Im a little confused on your question, if in the event say someone sees a specialist like a cardiologist while they are hospitalized after they are discharged they dont follow up with the same cardiologist in the hospital?

Some hospitals (at least Mayo and a couple of others are set up this way) have 2 services for everything, inpatient and outpatient, but either MD gets paid the same as long as the hospital is salaried and they are employees of the hospital (not contracted out).

@rottenit Well, I am learning, this is part of the reason I ask the question.

If I am sick with some mysterious thing and decide to go to Johns Hopkins for medical care, I would not go to the ER, I would make an appointment with a doctor associated with Johns Hopkins, so when I see him, from what I understand, he gets paid the same whether he performs a scope on me or not, just as an example of a procedure.

But, if I go to the doc down the street from me, he gets more money for perforing the scope.

I am guessing that my insurance gets billed for the scope either way, but the doctor is not given financial incentive to order the scope. However, the information @shilolo provided is very interesting.

@JLeslie I don’t quite know how Hopkins works its billing, to be honest. However, lots of doctors, especially specialists will manage both inpatients and outpatients. A cardiologist may be “on service” (meaning seeing inpatients) for 2–3 months a year, and also would also have an outpatient clinic as well. Whether you are seen by the same cardiologist if you have a heart attack and are admitted and then later need outpatient follow-up is purely determined by who you follow up with.

As far as the procedural thing, the answer is probably a firm maybe. It is possible that the specialist has part of their salary tied to how much revenue they generate, and thus they may still be motivated to do more procedures. However, my experience is that academic physicians hue much more closely to established “guidelines” than private practice doctors, for whom their entire salary is driven by billing concerns.

@shilolo when you say “academic” physicians, do you mean docs in hospitals? Docs in teaching hospitals?

@JLeslie Yes. Doctors in teaching hospitals, not doctors at small community hospitals. So, the Hopkins, Harvard, Cleveland Clinics of the world….

@shilolo At Navy in Bethesda we used to say that they love to put you on the table because it was a teaching hospital. Meanwhile, I think the best care I ever had was there, partly because of one particular doctor. I had a primary who specialized in adolescent care, they should expand that specialty. Especially for girls.