Why the Mayo Clinic is not a national model

Last month I wrote a response to Atul Gawande's great article in the New Yorker, where he profiled a local community in South Texas that was a high-utilizer and high-cost center of care. He contrasted that area with the Mayo Clinic, and I pointed out that Gawande himself is from the Peter Bent Brigham Hospital in Boston, another elite institution. I opined that these institutions, being elite, could not really be models for the bread and butter health care of the United States.

Now, here is a commentary from the Fort Worth Star-Ledger, July 2, that makes a similar point but with more insight to the financing of those institutions. The author is David Maldonado, M.D., a Fort Worth pulmonologist practicing in Fort Worth.

>>The Mayo Clinic receives millions and millions of dollars in donations from foreign and domestic donors, which the U.S. healthcare system would not have (other than, of course, by increasing our tax burden even more). The Mayo Clinic is the largest training program in the country, giving it an enormous pool of very low-wage physicians-in-training who provide medical care at a teacher’s salary.

The clinic is an organization whose physicians are hired as salaried employees rather than fee-for-service physicians. Mayo can attract top-notch physicians to work there for salary because of its historical reputation and its ability to offer research-based physicians the same salary as its clinical physicians.

At other high-profile medical institutions such as Harvard’s Brigham and Women’s Hospital, where Gawande is employed, a significant number of staff physicians must moonlight to make ends meet.<<

Budd Shenkin