A couple weeks ago I wrote about whether physicians should counsel their patients about diet and lifestyle choices. It’s a little naïve to assume a 5-minute discussion with your doctor will change a lifetime of bad habits. It’s probably a conversation worth having though. However, does your doctor have time to discuss healthy behaviors? Are patients willing to pay extra for counseling on diet and exercise? And how would that even work?
I have heard numerous discussions about why doctors don’t do more to encourage prevention rather than mitigate disease and chronic conditions once they’ve started. I’ve heard the cynical view that disease pays better than prevention. It’s true and I have proof of that. According to the Medscape Public Health and Preventive Medicine Physician Compensation Report 2023, public health physicians’ pay is the lowest of the specialties surveyed.
Public health and preventative medicine physicians’ average compensation is $249,000 a year, or about 40% of what plastic surgeons get paid. Pediatrics and family medicine are barely better ($251,000 and $255,000, respectively). In last year’s survey, public health & preventive medicine was $243,000, so with inflation it appears to be a cut in pay.
Your physician probably can’t spend much time trying to change your behavior for the better due to the economics of health care. The economic reality is health insurance can’t capture the benefits of investments in prevention and too many patients aren’t willing to pay for it either.
One of the biggest misunderstandings in health care is the notion that prevention pays for itself and is an investment. To be clear, prevention is a good idea. However, there should be a distinction made between prevention, things like sensible diet and exercise, watching your weight, eating healthy foods versus preventive medical screenings. Whereas prevention is often free or low cost, preventive medical care has a positive cost per life year saved. Getting an annual physical, getting a PSA test, a mammogram or other screenings are often beneficial, but they’re not cost saving. They purchase years of life at a cost. Every time you get a mammograph and it’s negative, that is a cost that did not extend life. The one-in-a-200 mammograms that find cancer may well save years of life but that life comes at the cost of a thousand mammographs required to find that one cancer. That doesn’t mean mammograms are a bad deal, just not money saving.
What about employers? Can’t they change unhealthy behaviors? I have often heard that corporate health & wellness programs are all the rage and how corporations save tons of money after implementing them. Of course, I often hear that from people who sell these plans or just don’t know any better. Health & wellness may be beneficial to some workers, but these programs do not save money. There have been numerous studies and most of the time any cost-savings are slim or negative. What especially does not work are wellness programs that consist of a website questionnaire and no participation from senior executives. I’ve talked to people who have told me the degree to which corporate wellness programs work is basically running off all the unhealthy employees. If your employer has a culture of wellness, the ones most likely to leave are probably those who don’t want to participate in the contests where you record how many steps you take each day and try to out do other teams (by taping your pedometer to a ceiling fan or a robotic vacuum cleaner).
The good news is you don’t have to spend a ton of money to lead a healthier life. You may have to lay off the potato chips, Twinkies and high fructose corn syrup-laden soda. Also, you will need to get moving. I bought a rowing machine so I can work out while I watch YouTube videos explaining how to make fattening French cuisine.