Oncologists' Income

The Journal of Clinical Oncology just released the results of a study that shows that some oncologists could potentially increase their income by over-treating their patients.

The article stated the results of a survey of oncologists, and found that while most oncologists are paid a salary, about 27% of them are paid through fee-for-service; that is, they get paid depending on what they do for a patient. So while some oncologists could send a patient to a hospital for treatment, others will have patients receive treatment in their office; for the latter doctor, he or she, and not the hospital, would get paid for administering the treatment.

As an article from Reuters points out, this has the potential for a lot of abuse. It would be easy to give a patient a treatment that isn't quite needed, or one that's a little more expensive, if there was some kind of cash incentive to do so.

For example: I spend two years watching and waiting, with regular doctor visits, but no treatment. Many oncologists recommend that their patients go through treatment immediately. Current research suggests that there is no harm in watching and waiting, and that there are some benefits to it. But a doctor might look at all of the choices available, and consider: W & W? No income from that. Straight Rituxan? A cheaper option for the patient, but less income for me. CHOP? Maybe we can stretch it out to 6 rounds instead of four -- hope he's got a strong heart. We'll make it R-CHOP, and throw in 6 rounds of Rituxan, too. And let's not forget Rituxan maintenance.....

Now, all of that is a little alarming, but the Reuters article is maybe a little bit alarmist. The study didn't find that there was abuse going on. It did what a good scientific study should do: it raised some questions. So while it's probably not a bad idea to find out of a doctor is benefiting financially from the treatments being prescribed, it's probably not the best idea to assume that your doctor is putting her own pocketbook ahead of your health. If you're thinking that way, you probably need a new oncologist anyway.

Still, it would be nice to see if this was being done by lots of doctors. No one wants over-treatment; it hurts everyone when the cost of health has to go up unnecessarily. But no one wants under-treatment either. There has to be some way of determining the best options, so a patient's health is ultimately the priority. Unfortunately, that's not always easy to do. What "the best" way to treat Follicular NHL? We're still trying to figure that one out.

So I guess the solution is to find a doctor you trust. Always your best bet anyway....