Doctors On Salary, One Key To Mayo's Success

During the health care debate, President Obama and others have evoked the venerated name of Mayo. The Mayo Clinic in Rochester, Minn., has been singled out as a top flight provider of health care and a program which also manages to keep costs down. President of the Mayo Clinic Dr. Denis Cortese talks with Linda Wertheimer about the key to the clinic's success.

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During this health care debate, the president and others have evoked the venerated name of Mayo. The Mayo Clinic in Rochester, Minnesota has been singled out as a top flight provider of health care and a program which manages to keep costs down. We're joined by Dr. Denis Cortese, who's the president of the Mayo Clinic. Welcome to our program.

Dr. DENIS CORTESE (President, Mayo Clinic): Well, thank you for having me and look forward to the discussion.

WERTHEIMER: Dr. Cortese, the most interesting thing that you do, I think, at Mayo is to put your doctors on salary. Is this one of the reasons, do you think, why you have a good record on costs?

Dr. CORTESE: I think it's one of several factors that we have in place that are designed, specifically designed, to reduce the potential conflict of commitment for our physicians so that they...

WERTHEIMER: Could you just sort of explain why it would be a conflict or not a conflict?

Dr. CORTESE: Well, if your salary or the amount of money that you are paid varies depending on how much you do to people, there can be a conflict of interest for a physician because if they end up doing less, keep people healthier, they may actually make no money. And what we've tried to do at Mayo Clinic is to reduce the conflict of commitment as the salary approach - build around what's still best for patients.

WERTHEIMER: I wonder if you have a tough time recruiting doctors. I mean if you just leave aside greed, lots of young docs graduate from medical school with big debt and they need to catch up with their contemporaries.

Dr. CORTESE: We do pay close attention that are salaries are based at a competitive level that we can recruit and retain people. The turnover rate is below two percent. It's quite a low turnover rate. And you'd say, well, okay, then we must be either pay them an awful lot of money or there's something else that keeps people here.

WERTHEIMER: Some of your critics suggest that your success depends a very great deal on your patient base, that from Rochester you serve Minnesota, Iowa, Wisconsin, states that are relatively homogeneous, poverty is relatively low. Maybe your success would not be translatable.

Dr. CORTESE: Well, let's look at - that is an observation, although I can tell you, many of the people who live in Wisconsin and Iowa and Minnesota and significant leaders in those states feel that there's poverty here, there is a high level of retired people here for which there is lots of multiple complex diseases, which by the way is where Mayo Clinic's strongest point is. For people who are going to be living longer, how do we coordinate the care for those people so that when they've got five to seven conditions, one physician is able to conduct the care for that patient?

Now, when we built our practices in Florida and Arizona, turns out after about 20, 25 years of experience in both those places, it is transportable, with difficulty, because you have to be able to recruit and retain the right people, like we just talked about, for the purpose of improving care for patients.

WERTHEIMER: Dr. Cortese, as you look at the various plans for revamping health care systems that the Congress is struggling with, I understand that one of your concerns was having some sort of public option.

Dr. CORTESE: Well, we are not fighting the issue so much from the insurance side. We just think everybody should have insurance. When people start talking about the public plan, it wasn't clear what kind of public plan we were talking about. And if a public plan looks like Medicare, I think the country would go broke almost overnight because Medicare is already proposed to go broke by 2015 to 2017.

If what they meant by a government-run public plan was the federal employees' health benefit plan - well, that one's quite good. That is one that could be used to insure people. So we want people to be focused and end up with our citizens insured and that we're starting to pay for value in the near term.

WERTHEIMER: Dr. Denis Cortese is president of the Mayo Clinic. We reached him in Rochester, Minnesota. Dr. Cortese, thanks very much.

Dr. CORTESE: Linda, you are welcome.

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