Laura Berenstain, MD
RE: Lisa Wise-Faberowski, MD, MS
I am heartbroken at the loss of my friend. We didn't talk often, but when we did it was always about deep and important things - common humanity. I will miss her greatly, and I send condolences to her family.
Elliot Krane, MD
In the world of pharmaceuticals placebo and nocebo are fascinating phenomena. Did you know that when valproate was in Phase III testing by J&J there was no difference in seizure suppression between valproate and placebo? That is, not until about 3 months, at which time there was divergence. How can placebo suppress epilepsy? IDK, but it does.
Similarly, if you look at the side effect profile in the PDR for any drug, ANY drug, you'll see that placebos always result in side effects in 1-5% of the population: you name it -- nausea, vomiting, headache, rash, weakness, constipation...this is the nocebo response in real life.
So I fully agree that telling people that something is going to hurt a little will make it hurt for many people.
Regarding discussions of risk pre-anesthesia, is there a parent alive who doesn't know that anesthesia can kill their child? So why bring it up? In 30 years of expert witnessing for both plaintiffs and defense, I've never seen or heard of a case being decided for the plaintiff because the informed consent was not complete or comprehensive. It's always something plaintiff attorneys throw into the litany of charges, but never something that decides an outcome.
Randall Flick, MD, MPH
Nice article on pay equity, thanks for taking on the article and especially thanks for not shying away from challenging issues. I agree that the data is limited by the very, very low response rate . In fact one can for the most part discount the information as uninterpretable. That said we can agree that there certainly is no doubt that women are paid less than men not only in anesthesia or medicine but across the board.
A larger point that the article raises relates to physician compensation models in general. We all know that pay inequity exists across gender as well as race and other factors. We also know that salary models that reward productivity provide perverse incentives that reduce the quality of care and increase costs. These things we know to be true yet when I travel to other institutions I universally find that pay is based on complex formula that rewards productivity whether it is academic productivity (pay advancement tied to academic rank), clinical productivity (RVU’s) or educational productivity (resident evaluations). Compensation is typically intentionally opaque and typically left largely within the purvue of the department chair.
The attached article is authored by our former and current CEO’s as well as our Director of Diversity and Inclusion. (Sharonne N Hayes, John H Noseworthy, Gianrico Farrugia. A Structured Compensation Plan Results in Equitable Physician Compensation: A Single-Center Analysis. Mayo Clin Proc. 2020 Jan;95(1):35-43. PMID: 31902427) (NOTE: we will review this paper in an upcoming PAAD) What is shows is that gender pay equity is achieved in a salary based compensation model in which there are no incentives for academic, educational or clinical productivity and salary is determined using a formula that is pegged to compensation in similar organizations and, importantly, applied across pay categories with essentially no option for department chairs or other leaders to adjust. For example, once an individual has passed through the initial 6 years of tenure (stepped salary increased through 6 levels), every anesthesiologist in the department gets paid the same amount regardless of age, academic rank research commitment… Those in leadership positions (division, department chairs…) receive very small increments in salary (3-10%).
If we want to eliminate pay inequity, improve quality and reduce costs; we must move toward adopting compensation models that are transparent, broadly based, determined by formula and do not allow for incentives. Our patients and our profession will be better off.
Daphne Klausner (Ron Litman’s widow)
Thank you so much for today's PAAD. The subject matter was one that Ron and I spoke of frequently as he supported me through my own career. I was so lucky to have a husband who KNEW that there was an issue-but would have been equally thrilled to see this issue raised in the PAAD. He would have encouraged all of us to fight for what is fair and equitable. Ask for the data. Use the PAAD as the jumping off point to ask the question to your leadership. Ron is cheering us all on.
Linda B Hertzberg, MD, FASA
Thank you very much for discussing and highlighting our committee's survey and study. You are correct about the limitations of the work; these were noted in our discussion as well. Having said that, I believe we adjusted for as many confounding factors as we could in our analysis and still saw a difference in compensation after adjustments. We were unable to obtain results by subspecialties in anesthesia due to inadequate numbers, even though we did ask about subspecialties in the survey. I would be very interested in having the study repeated among SPA members and seeing the whether the SPA results are similar.