In today's Wall Street Journal, Dr. Benjamin Brewer gives as succinct a statement of the morass of treatement incentives in the practice of medicine as you will find:
One of the problems with our medical system is the bias to pay doctors more for performing a test or procedure than for using our heads to make a diagnosis or manage a disease.
Obtaining a thorough history and physical exam and reviewing tests to make a challenging diagnosis pay much less than conducting a battery of tests or performing a diagnostic procedure.
If I spend 30 minutes in an extended office call for a patient with diabetes, high blood pressure and heart disease, I get paid an average of $69. If I remove a skin cyst off the patient's back in that same time, the minor surgery would bring $110.
If I do a screening colonoscopy at the hospital to check for colon cancer for the same patient in the same time, my average reimbursement is $478 with essentially no office overhead. It's no wonder that medical students want to go into procedural specialties like gastroenterology and fewer want to pursue cognitive specialties such as general medicine.
Fascinating. As always, there are tradeoffs involved. There are two types of errors that can be made with respect to procedures: they can be implemented when they were not medically necessary or they can be not implemented when they were medically necessary. As a society, we put a lot of weight on avoiding the latter type of error. The field of medical malpractice exacerbates this. So it is not surprising that we have poor safeguards against the first type of error given the high fees. But if we tried to improve them, we should expect to have more of the second type of error.
Brewer's point about choice of specialty is also a good one. After we had the VoxSon, it became very clear to me that the medical industry tremendously undervalues and undercompensates pediatricians, who epitomize the need for using their heads rather than tests.