Becker's Spine Review

37 37 HEALTHCARE NEWS Does prestige belong in medicine? By Mackenzie Bean and Erica Carbajal A n air of prestige has accompanied a career in medicine for centuries. Today, those in medicine are still largely respected, but different factors — including the democratization of information, an increasingly polarized society and new care models — are changing the public's view of physicians and the patient-provider relationship. "Historically — for centuries, really — a career in medicine has been one that was meaningful and highly valued by communities," said Gary Kaplan, MD, who has 43 years of healthcare experience and served as CEO of Seattle-based Virginia Mason Franciscan Health from 2000 to 2020. Fast forward to 2022, and research indicates some physicians' own interest in and positive perception of the field may be declining, with some even second-guessing a career in medicine entirely. Only 68 percent of physicians under age 40 said they would choose medicine again if they could redo their careers, down from 76 percent the previous year, a Sept. 23 Medscape report found. To understand how and why the perception of medicine has changed — and what benefits or drawbacks this brings to the profession — Becker's spoke with two physician leaders with a combined 82 years in the industry. An evolving view of medicine and the patient-provider relationship An esteemed view of physicians dates to at least 91 B.C., when a Bithynian physician named Asclepiades established Greek medicine in Rome. "He brought a prestige to Greek medicine" and laid the groundwork for Greece's Methodic school of medicine, which significantly influenced how medicine is practiced today, researchers wrote in a 2017 study published in Medicines. roughout history, different theoretical models of the doctor-patient relationship also existed. From the time of ancient Greek physician Hippocrates through the 1970s, most of these models were highly paternalistic and based on the idea that physicians are the sole experts and decision- makers regarding medical care. A growing recognition for patient autonomy and values began to shi the physician- patient dynamic in the 1970s. "ere was a huge transformation in American medicine — in particular in the 1960s and 1970s — that paralleled what was going on in the country with the civil rights movement, feminist movement, and the antiwar movement and challenging authority," said Joseph Carrese, MD, a bioethicist, physician and professor in the department of medicine at Baltimore-based Johns Hopkins. "We went from a system where doctors … know best — a very paternalistic, hierarchical model — to one where patients took center stage with patient autonomy and self-determination," he said. "e model of the doctor-patient relationship changed to one where now, I think appropriately, [it's] sort of a partnership." Today, shared-decision making dominates the lexicon in healthcare, which the Agency for Healthcare Research and Quality defines as "a model of patient-centered care that Mayo Clinic defends executive raises By Molly Gamble M ayo Clinic returned to raises for its executive team in 2021 with top-paid employees seeing the largest increases of 20 percent or more, the Rochester Post Bulletin reported Dec. 8. Financial hits brought on by the COVID-19 pandemic in 2020 left many Rochester, Minn.-based Mayo Clinic executives taking small pay cuts. Compensation for CEO Gianrico Farrugia, MD, dropped 1 percent, for instance. The next year, Mayo returned to raise executive pay, with a total of 26 employees reporting compensation of more than $1 million in 2021. That tally is up from 23 in 2020 and 21 in 2019. In 2021, Dr. Farrugia's compensation increased by 27 percent to $3.48 million. Then-Chief Administrative Officer Jeff Bolton's compensation increased by 24 percent to $2.11 million. Kent Thielen, MD, CEO of Mayo Clinic in Florida, saw his compensation increase by 20 percent to $1.79 million and Richard Gray, MD, CEO of Mayo Clinic in Arizona, saw his compensation increase 26 percent to $1.78 million in 2021. "Mayo Clinic is the top-ranked healthcare provider in the country in large part because of our staff," system spokesperson Ginger Plumbo said in a statement to the Rochester Post Bulletin. "A structured compensation program has been used for salaries at Mayo Clinic for more than 45 years to remove financial incentives to do more than is necessary or less than required for the patient. There are no incentives or bonus pay. Executive compensation is no exception to this model and is necessary to deliver on our plan to cure, connect and transform healthcare." Mayo Clinic has been an outlier throughout 2021 and 2022 for its financial performance. As many health systems report large losses and fallen margins, the system posted $1.2 billion in net operating income for 2021. More recently, the system reported net operating income of $157 million on $4.12 billion for the third quarter of 2022 with an operating margin of 3.8 percent. This fall, Mayo announced it would raise pay by 6 percent in early 2023 for about 64,500 allied health staff — a change it described as the biggest across-the-board pay jump in more than two decades. That comes in addition to raises of 3 percent across all allied health job categories. Mayo has a 73,000-person workforce. n

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