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Merit pay goes under the stethoscope


November 19, 2021 Jonathan Teghtmeyer, ATA News Editor-in-Chief

My wife is six seasons into rewatching the entire 90s medical drama ER, and as a result, I have caught a few episodes and parts of episodes while passively watching.

It happened that a particularly sad episode about a child with cancer was unfolding on TV when I came across news that the United Conservative Party AGM would feature debate over merit pay for teachers — an issue that continually and periodically rears its head.

Upon reading this resolution, I became so enthralled by the prospect of using outcome-based measures to determine teacher pay that I felt it should be applied to all professions. Given my newfound status as a medical expert — having watched at least five cumulative hours of medically-related television, here and there, over the past few weeks — I decided to direct my energy toward evaluating merit pay for doctors.

So I got out my pen and paper and pieced together a rationale for this fantastic idea.

“We need to create a system where excellence is rewarded, and where consequences are expected when performance is poor,” my rationale began, borrowing the inspirational words that supported the merit-pay-for-teachers argument advanced by UCPers in Edmonton-Manning.

Much like the Manningite United Conservatives, I then turned to definitive objective evidence produced by the completely unbiased Fraser Institute.

“Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions,” says their recent report comparing health-care performance among countries. “After adjustment for age, it has significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average of OECD countries included in the study.”

“While Canada does well on five indicators of clinical performance and quality (such as rates of survival for breast, colon and rectal cancers), its performance on the seven others examined in this study are either no different from the average or in some cases—particularly obstetric traumas and diabetes-related amputations—worse.”

From this I came to one clear and undeniable conclusion: Alberta’s health-care system is a complete mess and that must be blamed on no other factors except the poor performance of doctors. At this point, my pen became a blur moving across the paper as brilliant rationale positively flowed from my fingertips.

“We need a system based on the idea that the feelings of medical professionals should never come before the needs of patients.”

Given my desire to pass this resolution based on misinformation as opposed to facts, I continued writing.

“This is only achievable if the Union is reeled in by allowing Alberta Health Services to evaluate their doctors rather than the Union.”

That ought to work.

When you’re on a roll, you’re on a roll. I came up with criteria.

Let’s base physician-evaluation criteria on a number of outcomes related to each physician’s patients: life expectancy, incidence rates of various diseases, levels of obesity, heart-attack survival, blood pressure, medication utilisation, return visits. What could go wrong?

Sure, the American College of Physician Ethics may express concern. They may say that such pay-for-performance schemes related to specific conditions may lead to “neglect of other, potentially more important elements of care for that condition or a comorbid condition.” They may say that, “the elderly patient with multiple chronic conditions is especially vulnerable to this unwanted effect of powerful incentives.”

But who are they? Just some special interest group — pffffft!

Some argue these programs could result in the deselection of patients, physicians who play to the measures, or increasing distrust between patients and doctors, but these are minor side effects compared to the incredible advantage of a system that truly incentivizes strong performance from doctors.

Because if the prospect of earning more money doesn’t motivate our doctors to do great work, I seriously question what would motivate them.

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