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February 9, 1994

Physician Payment: Fee for Time

Author Affiliations

Wake Forest University Medical Center Winston-Salem, NC

JAMA. 1994;271(6):425. doi:10.1001/jama.1994.03510300025014

To the Editor.  —In their article on a fee-for-time system, Drs Wachtel and Stein1 argue for the controversial proposal that physician compensation should be based solely on time. The approach is inherently counterintuitive. Should a talkative dermatologist who sees 20 patients a day be paid the same as a terse one who sees 60? Is 2 hours spent replacing a hip equivalent to four half-hour sessions demonstrating back exercises? Is 1 hour spent doing laparoscopic tubal ligation worth the same as time spent discussing the use of birth control pills? Given such obvious shortcomings of the feefor-time proposal, one wonders how it merits serious consideration. Perhaps the authors were so concerned with pay differences between specialties that they overlooked the adverse effects of a fee-for-time system within specialties.Attempts to define relative value by formula, although new to medicine, are not new to the workplace. Rhoads, in one of

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