Tom and others,
I was musing about this last night, and remembering years ago when I was in a group. There would be the monthly meetings to discuss production. The envy of the lower producers, the anger of the higher producers that the low producers were not pulling their weight. And, always, the subtle and not so subtle pressure to produce more. Practicing better or more cost effective medicine never came up.
That group also had its own lab and x-ray (much like hospital employed MD's). So, imagine what would happen if you were a lower producer, trying to good medicine, and you came out of that meeting feeling like you let your partners, your wife and your kids down. The next patient you saw with a cough for two weeks; why, it isn't tough to justify a CBC and 2 view chest. Maybe even an EKG if their BP is a little up. Maybe spirometry. Chest percussion from physical therapy? Sure, why not. Can't hurt. Sputum culture for sure, even if it is just saliva they're bringing up. No reason not to be creative. Certainly no one will criticize you next month if your numbers come up.
The point, Tom, is that you and I are free to do the most effective, compassionate, and cost-effective medicine we know how. Yes, our reward may only be in heaven. Yes, I resent all those who flaunt their greater income. But, I no longer go home feeling slightly sick to my stomach.
