If you want to understand the lack of sympathy for doctors that so characterizes the health care reform debate, read this superb piece by Elisabeth Rosenthal from today’s NY Times.

You think the government is out of control? So are we and the hospitals at which we work.

Keep in mind, once you understand that your salary at Anderson is a fixed cost and that every dollar that the administration can squeeze out of the payers for your work increases the variable revenue stream, you get the dynamic that is affecting you and the rest of American medicine. After all, how many clinical faculty make any where near what the administrators at the top of the Anderson food chain do, yet it is the faculty that generate the revenue. How crazy is that?

As this article shows, your colleagues in private practice get it. That’s why there are few going into primary care, especially given their med school debt, and many dermatologists.

If our goal is to deliver optimal health care to the American people because it is good for all of us, this economic system is geared to move in the opposite direction.

Please, talk among yourselves and recall that at some point, you are either part of the solution or part of the problem.

Leonard Zwelling