Dr. Gina Piscitillo, a palliative care physician, recently penned an article for CNN on how volume based bonuses could be considered immoral because they might encourage physicians to treat a patient more than is necessary (let’s assume “more” could be the number of visits, or the amount or type of treatment). She isn’t alone in this sentiment. The entire premise behind value-based care is to reward physicians financially for providing high quality care, and minimizing the cost of care to do so. Don’t get me wrong, I’m here for it. Quality matters. Outcomes matter.

Volume also matters.

The current reality of US healthcare is that the vast majority of both physician compensation incentives and payer/provider arrangements are volume-based. Instead of basing significant incentives or payments on quality we rely on the power of the Hippocratic oath and the belief that physicians are innately motivated to provide the best care possible, with the best outcomes. And it mostly works for now – the vast majority of physicians will do everything in their power to help the patient sitting in front of them. 

The problem is the patient that isn’t sitting in front of them yet. The average wait time to see a physician for a new patient visit is 24 days. In my hometown of Boston, the wait time is 45 days to see a cardiologist. No one can claim that a month-long wait is the best care we can provide as an industry. (Not a cardiologist over here, but the anxiety and stress of such a wait time can’t be ideal for a cardiac patient…or for almost any of us when we have a medical need ranging from uncomfortable to worrisome to life threatening.) Can’t this waiting period be as harmful to patients as poor quality of care? Should we completely deprioritize a patient’s ability to see a physician simply because the metric has the potential to be misused for personal gain?

Volume and access are important. Without making those metrics meaningful and transparent priorities, I suspect that many physicians simply don’t know how long the average patient waits to see them. The truth is, healthcare systems do still rely on volume-based models, and the growing number of patients in our aging population rely on the healthcare industry’s ability to care for them when the need arises, not weeks later.


https://www.cnn.com/2021/06/09/opinions/financial-incentives-doctors-ethical-concerns-piscitello/index.htmlhttps://www.beckershospitalreview.com/hospital-physician-relationships/patient-wait-times-in-america-9-things-to-know.html – avg 24 days