By NextBestFitSalaried clinicians in public or non-profit groups
Clinicians are paid salaries, so there's no direct financial reason to do more or less.
Draft decision:RejectedConfidence: low · not yet reviewed
Fee schedule chosen for clinicians.
Review ledgerHow this path connects
This path
Salaried clinicians in public or non-profit groups
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Pay clinicians salaries in public or nonprofit groups
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Paying a fixed amount per patient rewards doing less
Paying salaries removes a direct financial reason to provide more or less care and makes costs predictable.
What it creates or worsens
- Weakens incentives for desired behavior
Salary payment may reduce clinician productivity.
- Limits choice or applies one rule to every setting
Salary payment gives clinicians less autonomy.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Paying a fixed amount per patient rewards doing less: Fixed payments encourage avoiding sick patients or providing less care.
- Doctors, nurses, and other clinicians
- Paying a fixed amount per patient rewards doing less: Paying salaries removes a direct financial reason to provide more or less care and makes costs predictable.
Who loses
- Hospitals, clinics, and care organizations
- Paying a fixed amount per patient rewards doing less: They keep the difference when care costs less than fixed payments.
- Health insurers, brokers, and their shareholders
- Paying a fixed amount per patient rewards doing less: They keep the difference when care costs less than fixed payments.
- Doctors, nurses, and other clinicians
- Weakens incentives for desired behavior: Salary payment may reduce clinician productivity.
Other ways to soften the losses
- Productivity bonuses
Where it has been tried
- U.S. VA, Kaiser Permanente; Nordic hospitals: Salaried physicians.
- Sweden: A 2024 Swedish primary-care study describes salaried professionals and centres averaging four GPs and 20 staff, with a mean patient list of 8,280 in its 2016 data.Sources: PLOS ONE (2024)