“(anybody ever think of doing formal change management for patient care? I just made it up, but why not?) The list idea isn’t anti-IT, either. Why couldn’t systems link to Web pages on which lists (with visuals) are maintained to provide just-in-time advice and reminders? There’s an HIStalk interview slot waiting on Peter if he’s interested.”

uh, yup. CPOE forcing functions. cannot sign an electronic d/c summary without clicking through Halten Zie splash screens. enforced guideline compliance at the point of care. eg pt w CHF listed as diagnosis (either present on admission or final) in health record data base cannot be discharged unless/until the clinician rectifies with ACE/ARB prompt, LV FX prompt, d/c education prompt, etc. it’s so brazil. coming soon to a CPOE system near you.

/hospitalist
//haven’t seen peter in months. suspect i will see plenty of his handiwork.
///survivor submassive CPOE install and continuous web 2.0 upgrades. oy veh.

Linux used on the floors: actually I think this is a GREAT idea, so long as the vendor’s software runs on Linux. Floor computers should be treated as appliances, and Linux is a perfect fit for this (the price is right).

Mac: the shoes analogy is fine. Let’s build on it: you’re wearing shoes now, but shoelaces cost $400. And to walk on all the muddy roads to which you’re accustomed, you’ll have to take the shoes off anyway, or run Parallels (oops, there went the metaphor).

Still, it really frustrates me to hear physicians cry poverty when the average PCP cleared $165k last year (just go to Medical Economics for recent survey on physician compenesation) and most specialists are clearing at $200k-$300k a year. It is kind of like the CEO who laments his $10 million in stock options when his golf buddy CEO has $20 million. Hard to have much compassion there.

Plus, I would liek to interject some reality to Ian Morrison’s piece that is very biased and potential misleading:

“Let’s start at home. Consultants and futurists are paid four to five times what they would be in other countries; hospital CEOs, three to four times; administrators of all types, two to three times; and so on. CEOs of health plans who rack up $100 million-plus in compensation over the course of a career are well ahead of the cumulative earnings of all the ministers of health in the developed world.”

Funny, but he doesn’t mention U.S. physician compensation in comparison to their internation peers. According to the most recent figures from the OECD, PCPs in the U.S. earned on average $173,000 a year or 4.2 times gross domestic product (GDP) per capita. In other OECD countries, PCPs earn roughly half as much – or $94,000 on average – based on purchase power parity dollars.

The gap for specialists is even much wider. Specialists in the U.S. earn on average $274,000 a year or 6.5 times GDP per capita. In other OECD countries, specialists earn on average less than half that at $129,000 or 4 times GDP per capita. So even adjusted for higher wealth and earnings in the United States, the gap between what physicians earn here and elsewhere in the developed world is large, as is the gap between physician earnings and average American earnings.

So basically, physicians in the U.S. are paid much more than their international brothen and are a part of the reason why U.S. healthcare is so expensive.

I loved this quote though, “I want my son to be a salesman because America rewards sales more than almost any other profession.” Another reality check here by going to the Bureau of Labor Statistics and looking at some recent figures on the median income figures.

Here is a quick breakdown of select annual salaries fromthe BLS:

1. Sales Representatives, Wholesale and Manufacturing, Technical and Scientific Products – $72,700
2. Sales Representatives, Wholesale and Manufacturing, Except Technical and Scientific Products – $58,540
3. Front-line supervisors/managers of non-retail sales workers- $76,840
4. Insurance sales agent – $58,450

That contrast that to the annual salaries of select physician specialties from the BLS:
1. Family Practitioners and GPs – $149,850
2. Peds – $141,440
3. Internists – $160,860
4. Surgeons – $184,150

Obviously this doesn’t hold for every individual salesperson but I hope that high school guidance counselors aren’t telling students to follow Ian Morrion’s advice. Just for a final comparison, CEOs according the BLS made only $144,600. So even the average CEO isn’t making as much as a PCP.