CMS Proposes Primary Care Raises Funded With Specialist Cuts

[DrAwsome]

Hold on there now, there seems to be a huge disconnect with what's being said. So let's summarize what's actually going on:

1.) There is a massive shortage of PCPs in this country

2.) Med students aren't going into PC because of the pay

3.) Therefore, increase pay, increase PCPs

This is not about paying PCPs more to do the same job. It's about paying them the compensation they're due, as well as increasing the amount of students pursuing PC.

So if 1 is true, then shouldn't we increase the # of residency positions for PCPs and reduce the specialist # of positions?
If 2 is true, and we cut specialist pay, who will go into specialty training that requires double + the amount of training as a PCP?
Reason in part why many specialists make what they do is because of previous shortages. In earlier 2000 or so, there was a huge need of radiologists, which allowed them to command large starting salaries. So let's say we now cut their salaries-who goes into rads and other similar lengthy residencies?

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[bigkahunaburger]

You see, before they start worrying about increasing residency positions, enough people actually have to be interested in going into it. Secondly, why do you constantly keep saying that PCPs are going to be paid like a specialist? Whoever said that? All anyone is saying is that the discrepancy in pay between PCPs and specialist's is too large, not that they should be paid equally.

 

[DrAwsome]

You see, before they start worrying about increasing residency positions, enough people actually have to be interested in going into it. Secondly, why do you constantly keep saying that PCPs are going to be paid like a specialist? Whoever said that? All anyone is saying is that the discrepancy in pay between PCPs and specialist's is too large, not that they should be paid equally.

Ok, well you said there is a huge shortage of PCPs right? So let's assume that's 100% correct. And we have "established" by popular opinion that med students go where the money is right? So you are saying let's increase PCP pay so that more students go into primary care. Right?

Well just about every position in primary care fills, whether it is by AMGs or IMGs. So regardless of current income, they are still being filled. So given that, if you still think there is a huge shortage, then inevitably we would need to increase spots, since all the ones taht the gov has funded are full.

I keep saying that PCPs are going to get paid like specialists because that is the hope/trend. Just think of this-specialisties like anesthesia, rads, rad onc, etc start at an avg of 300-350kish or so. In glutted area, maybe 50/75kish less or so. PCPs are right at the 200k mark and above, so increasing PCP pay makes going into specailist type pay.

To give you a further example as to not be accused of just giving opinions, I keep getting recruiters emailing me with job offers in primary care in the 250k-300k for some. I would say that is what I would expect a specialist to make, not a PCP. Specialists don't start at 500k or something crazy like that, they start in the 300's, PCPs start in the 200's. I don't think 100kish is such a huge discrepancy. Do you?

 

[bigkahunaburger]

Let's assume that is 100% right? Do you think I'm only 70% right about there being a PCP shortage?

http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf

(page 4, 4th paragraph) A 2008 study predicted that the U.S. will experience a shortage of
35,000–44,000 adult primary care physicians by 2025. The study also
predicted that population growth and aging will increase family physi-
cians' and general internists' workloads by 29% between 2005 and 2025.
Further, greater use of nurse practitioners and physicians assistants and
increased primary care by specialists are not expected to make enough of
an impact on this shortfall. (6)

 

[bigkahunaburger]

also, just underneath that on page 4

"Summary of the Evidence on the Value of Care Provided by Primary
Care Physicians
Evidence from the available medical and scientific literature suggests that:
When compared with other developed countries, the United States
ranked lowest in its primary care functions and lowest in health care
outcomes, yet highest in health care spending. (15-17)
Primary care has the potential to reduce costs while still maintaining
quality. (18-22)
States with higher ratios of primary care physicians to population have
better health outcomes, including decreased mortality from cancer,
heart disease, or stroke. (23, 24)
Individuals living in states with a higher ratio of primary care physi-
cians to population are more likely to report good health than those
living in states with a lower ratio. (25)
The supply of primary care physicians is also associated with an
increase in life span. (26, 27) An increase of just one primary care
physician is associated with 1.44 fewer premature deaths per 10,000
persons. (28) "

 

[DrAwsome]

Let's assume that is 100% right? Do you think I'm only 70% right about there being a PCP shortage?

http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf

(page 4, 4th paragraph) A 2008 study predicted that the U.S. will experience a shortage of
35,000–44,000 adult primary care physicians by 2025. The study also
predicted that population growth and aging will increase family physi-
cians' and general internists' workloads by 29% between 2005 and 2025.
Further, greater use of nurse practitioners and physicians assistants and
increased primary care by specialists are not expected to make enough of
an impact on this shortfall. (6)

I gave you the benefit of the doubt and assumed you were 100% right. But the thing is, there are shortages of everything.

Same with rad oncs:

http://journals.lww.com/oncology-ti...f_Radiation_Oncologists_May_Be_Looming.1.aspx

Same with derms:

http://www.modernmedicine.com/moder...Article/detail/754204?contextCategoryId=40158

and i can go on. The shortages are present in just about everything, not just primary care.

 

[bigkahunaburger]

It's more cost effective to stop a disease before it gains momentum than to cure it after it's already rolled down hill, so it's more imperative to increase PCPs immediately vs increasing specialists

 

[deleted87716]

Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve?

http://www.commonwealthfund.org/~/m...vsky_paying_more_for_primary_care_FINALv2.pdf

ABSTRACT: The health reform law boosted Medicare fees for primary care ambulatory visits by 10 percent for five years starting in 2011. Using a simulation model with real-world parameters, we evaluate the effects of a permanent 10 percent increase in these fees. Our analysis shows the fee increase would increase primary care visits by 8.8 percent, and raise the overall cost of primary care visits by 17 percent. However, these increases would yield more than a sixfold annual return in lower Medicare costs for other services—mostly inpatient and postacute care—once the full effects on treatment patterns are realized. The net result would be a drop in Medicare costs of nearly 2 percent. These findings suggest that, under reasonable assumptions, promoting primary care can help bend the Medicare cost curve.

 

[bigkahunaburger]

Yup, all this seems pretty straightforward, glad this country finally realized the importance of primary care, hopefully we keep moving in the right direction, great article bluedog

 

[primadonna22274]

Oh my...such vitriol.

First, the job of a PA/NP is NOT to "save money", as I think you suggested a few posts back (my apologies if that was another misguided poster), but to act as a PHYSICIAN EXTENDER. A good PA/NP works in concert with the supervising physician to broaden the reach of that SP and effectively treat many more patients, and in the best case keep them healthier.

PAs are less expensive because we are cheaper to train. Very little Medicare funds were used to support my education, and I was out working and taking care of folks with my supervising physician at 26. Since then I have cared for many thousands of patients and have extended my education and have taught about 200 other PA students and 20-odd student nurses. Not satisfied with that, I am back for more, on track to finish medical school at 40, residency at 43 and easily working another 2-3 decades.

Your status still says medical student...but please, enlighten us.

Well then you are part of the problem, who's bankrupting the system. How do you think specialists feel then?

I think this statement you just made is exactly the issue-it's not about SAVING money, it's about non-specialists wanting to make more money, in the guise that it will help patient care.

I would be willing to take a reasonable pay cut as a specialist if it meant more people being taken care of, and lower overall costs. But when I hear a PA tell me how they want to bill the same as a physician, and how "not gonna happen" then we find the problem. The role of PA's and other midlevels is to cut costs. If you are just as expensive as a physician, then there is no point, is there? If midlevels were hired to do midlevel type work with midlevel type pay, we would save millions and millions. But no, let's not do something rational.

Oh and reason why it's not going to work to pay PCP more money to do "preventive" care. I think it will be a complete and epic failure, which will indebt us to oblivion. But when did money ever get in the way of the gov doing ridiculous things? Oh well.

 

[deleted87716]

http://www.fightchronicdisease.org/node/293

"An ounce of prevention is worth a pound of cure."

 

[Bernie3144]

Interesting thread. Thankful to be in the military right now (annual difference in primary care to specialist salary is at most, $20,000: avg of 10% of what it is out there in the wild).

Anyways, you may want to read, in detail, the 20th Report by the Council on Graduate Medical Education: "Advancing Primary Care"

Document page 19 gives a detailed explanation about payment reform and changes needed to boost primary care interest/workforce, etc.

Here is a brief summary of COGME's 2nd recommendation:

"Primary care incomes that are at least 70 percent of specialty incomes are needed to stimulate a change in medical student interest toward primary care careers. Medical student choice of primary care careers nears optimal levels when primary care incomes are 80- 85 percent of non-primary care incomes. Increases in reimbursement policy should reflect payments needed to achieve these levels of primary care physician income and to provide appropriate practice transformation and care coordination."

That is all.

 

[bronx43]

Bronx, aren't you going for Rehab Med?

Nah. I had a short few months where I thought I did (when I did my pm&r elective that came right after gen surg), but I changed my mind pretty quickly when I was on my IM sub-i.

 

[bigmctuffy]

Radiologists train for 8 years (med school + 4 years of rads residency). FPs train for 7 (med school + 3 years of residency). That's a 12% difference in training years, and does not justify the enormous difference between the average primary care income and the average radiology income ($199,850.00 for FM, $444,850.00 for non-interventional rads - source: http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey), nor do average hours worked (FM=52.5, rads=58, a 10% difference - source: http://www.medfriends.org/specialty_hours_worked.htm).

Disclaimer, I'm a rads resident and my wife is a family med resident, so I have some unique perspective on this issue.

Sorry to jump in late, just had to correct a few misconceptions here. Rads residency is 5 years, 1 as med or surg intern (mandatory), 4 as resident. Greater than 95% of rad residents do 1 or 2 year fellowships (Interventional Neurorad 3 years), making rads training typically 6, but potentially 7 or 8 years of postgraduate training at resident salary. FM, IM PED, are all 3 year residencies. IMO, this does justify some difference in pay as there is a large opportunity cost of staying at trainee pay for those years, with little or no retirement benefits or significant ability to pay down student loans.

Also, consider the numerous sweetheart student loan deals and forgiveness programs for primary care.

I can tell you that the salaries you are posting for rads are overblown and what I am typically seeing nowadays is more like 200-300k range, mainly depending on location. The numbers are probably inflated by older private practice rads who own practices which own CT and/or MRI machines, which is where the big money used to be.

I agree with the other posters that comparing numbers from one field to another is extemely problematic and poor practice as it will lead to eventual ratcheting down of all physician pay. They may be giving PC a small boost now, but eventually they will decide that you are overpaid too. Docs need to pull together as a unified front and say enough is enough. We are an overall small piece of the health care cost pie which has been cut or flatlined for years. Yet, health care costs continue to spiral out of control. Where is our voice in this? Why the massive profits to drug cos and insurance cos, why so many overpaid admins and noctors?

 

[DrAwsome]

Disclaimer, I'm a rads resident and my wife is a family med resident, so I have some unique perspective on this issue.

Sorry to jump in late, just had to correct a few misconceptions here. Rads residency is 5 years, 1 as med or surg intern (mandatory), 4 as resident. Greater than 95% of rad residents do 1 or 2 year fellowships (Interventional Neurorad 3 years), making rads training typically 6, but potentially 7 or 8 years of postgraduate training at resident salary. FM, IM PED, are all 3 year residencies. IMO, this does justify some difference in pay as there is a large opportunity cost of staying at trainee pay for those years, with little or no retirement benefits or significant ability to pay down student loans.

Also, consider the numerous sweetheart student loan deals and forgiveness programs for primary care.

I can tell you that the salaries you are posting for rads are overblown and what I am typically seeing nowadays is more like 200-300k range, mainly depending on location. The numbers are probably inflated by older private practice rads who own practices which own CT and/or MRI machines, which is where the big money used to be.

I agree with the other posters that comparing numbers from one field to another is extemely problematic and poor practice as it will lead to eventual ratcheting down of all physician pay. They may be giving PC a small boost now, but eventually they will decide that you are overpaid too. Docs need to pull together as a unified front and say enough is enough. We are an overall small piece of the health care cost pie which has been cut or flatlined for years. Yet, health care costs continue to spiral out of control. Where is our voice in this? Why the massive profits to drug cos and insurance cos, why so many overpaid admins and noctors?

Thank you! This was my point. And as a number of people have pointed out, hospitalists, which can include both FM/IM are getting offers in the 200k+/even 250k for a 3 year residency. See the pendulum start to switch.

 

[bigkahunaburger]

"We are an overall small piece of the health care cost pie which has been cut or flatlined for years. Yet, health care costs continue to spiral out of control. Where is our voice in this? Why the massive profits to drug cos and insurance cos, why so many overpaid admins and noctors?"

Totally agree

 

[DrAwsome]

"We are an overall small piece of the health care cost pie which has been cut or flatlined for years. Yet, health care costs continue to spiral out of control. Where is our voice in this? Why the massive profits to drug cos and insurance cos, why so many overpaid admins and noctors?"

Totally agree

90% of administrators should be removed from their posts, they are unnecessary and just increase costs. Noctors should be paid a decent but not overblown salary.

We are stupid and politically un-involved, that's your answer.

 

[MedicineDoc]

Disclaimer, I'm a rads resident and my wife is a family med resident, so I have some unique perspective on this issue.

Sorry to jump in late, just had to correct a few misconceptions here. Rads residency is 5 years, 1 as med or surg intern (mandatory), 4 as resident. Greater than 95% of rad residents do 1 or 2 year fellowships (Interventional Neurorad 3 years), making rads training typically 6, but potentially 7 or 8 years of postgraduate training at resident salary. FM, IM PED, are all 3 year residencies. IMO, this does justify some difference in pay as there is a large opportunity cost of staying at trainee pay for those years, with little or no retirement benefits or significant ability to pay down student loans.

Also, consider the numerous sweetheart student loan deals and forgiveness programs for primary care.

I can tell you that the salaries you are posting for rads are overblown and what I am typically seeing nowadays is more like 200-300k range, mainly depending on location. The numbers are probably inflated by older private practice rads who own practices which own CT and/or MRI machines, which is where the big money used to be.

I agree with the other posters that comparing numbers from one field to another is extemely problematic and poor practice as it will lead to eventual ratcheting down of all physician pay. They may be giving PC a small boost now, but eventually they will decide that you are overpaid too. Docs need to pull together as a unified front and say enough is enough. We are an overall small piece of the health care cost pie which has been cut or flatlined for years. Yet, health care costs continue to spiral out of control. Where is our voice in this? Why the massive profits to drug cos and insurance cos, why so many overpaid admins and noctors?

Feel free to post a salary survey with both primary care and radiology. Taking separate surveys For each specialty is obviously bogus. Here's one:

http://www.medscape.com/features/slideshow/compensation/2012/public

Here's another:
http://www.studentdoc.com/family-practice-salary.html

Also if you are going to count fellowships you should post the salary survey for the specialty within the specialty not general radiology

Example you cite above neurointerventional radiology: this source says 507,000 or about 15.2 million over 30 yrs:
http://specialty.drjobs.us/Interventional_Radiologist.php

"Numerous sweetheart student loan deals"? It's all negotiated as part of the contract primary care or not whether in the form of salary or student loan repayment.

Also moonlighting beginning 3rd yr of residency can pay 1000 dollars per night for example in radiology.

 

[DrAwsome]

Feel free to post a salary survey with both primary care and radiology. Taking separate surveys For each specialty is obviously bogus. Here's one:

http://www.medscape.com/features/slideshow/compensation/2012/public

Here's another:
http://www.studentdoc.com/family-practice-salary.html

Also if you are going to count fellowships you should post the salary survey for the specialty within the specialty not general radiology

These days rads has to do a fellowship, so yes fellowship needs to be included. Also given recent changes in healthcare, salaries are changing significantly. Salaries for primary care have risen, and those for specialties have gone down. and as the other poster said, even if we assume rads for example is doing only one fellowship so 3 extra years of training vs. 3 of IM/FM, that's at the minimum a loss of 600k (given about 200k for primary care) right then and there. I don't understand why specialists would be paid the same as non specialists again?

I still don't understand that logic.

 

[MedicineDoc]

If you are going to use a survey with low 300's for rads you are going to have to use mid 150s for fm and IM. Also I am very much doubting that many rads residents don't moonlight and most probably are making at least 100 K if they do any moonlighting at all and probably more. I made 80 something with moonlighting myself in FM in urgent care the difference is I had to work alot more hours than a radiolgists resident would to make that kind of money in residency.

 

[DrAwsome]

If you are going to use a survey with low 300's for rads you are going to have to use mid 150s for fm and IM. Also I am very much doubting that many rads residents don't moonlight and most probably are making at least 100 K if they do any moonlighting at all and probably more. I made 80 something with moonlighting myself in FM in urgent care the difference is I had to work alot more hours than a radiolgists resident would to make that kind of money in residency.

What does moonlighting have to do with anything? As you point out, you can moonlight, as well as rads and any other resident who wants to, so that's a moot point no?

I am personally not going on old data, but data that I have seen myself in today's market. To me, those #'s are not accurate. It does not tell us how many hours people are working, who is full time/part time, mid career vs. starting or late career, etc.

I'm not a radiologist, but those people work hard. I'm not saying that FM's don't work hard, but I think it is very mentally taxing to do certain specialties.

I am not sure what you mean with "the difference is that I had to work alot more hours..."

What does that even mean? Doing urgent care work is pretty low stress and pays pretty darn decently (around 80-100$ per hour where I'm at), and work can be found very readily so not sure what type of compensation you are expecting?!

 

[MedicineDoc]

Were expecting and no urgent care did not pay 100 an hour that is more like ER. Urgent care paid 60. As I said above give me a survey with both FM and radiology not two separate surveys. The surveys I posted above do not purport to be using "old numbers". Higher numbers surveys are likely out there but the descrepancy is the point and I would expect both specialties to be higher. Misrepresenting Commonly known data is not a useful or effective argument technique.

 

[DrAwsome]

Were expecting and no urgent care did not pay 100 an hour that is more like ER. Urgent care paid 60. As I said above give me a survey with both FM and radiology not two separate surveys. The surveys I posted above do not purport to be using "old numbers". Higher numbers surveys are likely out there but the descrepancy is the point and I would expect both specialties to be higher.

I am not understanding what you are saying. I don't know what "Were expecting" means. And I'm sorry that your state/city pays poorly for urgent care, it pays very well here, and if you are bilingual, it pays even more. Heck I'm kicking myself in the buttocks for not having already having an license, because the pay rate is around $100, and goes to like $125 or so if bilingual. Why would you expect both specialties to be higher? One is a primary care position, that requires less training and is not a specialty per se, and the other is a specialty with extensive training, so if you don'tthink that deserve extra compensation, I don't know what is.

As I asked before-what makes you think that specialists and non specialists should be paid the same?

 

[MedicineDoc]

I am not a resident. That's what were means. I am speaking with regard to the number of millions of dollars a specialist can be expected to be paid over the course of a career as compared to a primary care physician and the relative ability to pay down student debt. That is the issue. It is in the news very frequently and I don't expect you missed it or truly believe even half of what you state aside from your obviously bogus statements about primary care (urgent care aside) not being very taxing or cognitive work with compared to specialty work. I attribute these statements to trolling in giving you the benefit of the doubt with regard to your perceptive abilities as you purport to have graduated medical school.

 

[DrAwsome]

I am not a resident. That's what were means. I am speaking with regard to the number of millions of dollars a specialist can be expected to be paid over the course of a career as compared to a primary care physician and the relative ability to pay down student debt. That is the issue. It is in the news very frequently and I don't expect you missed it or truly believe even half of what you state aside from your obviously bogus statements about primary care (urgent care aside) not being very taxing or cognitive work with compared to specialty work. I attribute these statements to trolling in giving you the benefit of the doubt with regard to your perceptive abilities as you purport to have graduated medical school.

If not a resident, what are you? An attending? I don't think all specialties are created equal, and I will leave it at that. Are you an IMG? PCPs also make millions throughout their career, btw.

A lot of the debt people have is of their own doing; I have both an MD and an MPH and 0 debt. People simply need to live within their means and borrow adequately.

 

[MedicineDoc]

As I said before I am a hospitalist which is beside the point. Live within their means and borrow adequately? Obviously specialty care is not cost effective care and it takes a good primary doctor who knows 80 percent of most specialties to keep it at a minimum much less prevent medical errors resulting in the need for further specialty care. Quality of specialty care is on a steep decline as well as specialists opt to pan out cognitive cases to nurse practitioners while they concentrate on procedures that make money often resulting in questionable calls on procedures and unnecessary risks and expense.

 

[DrAwsome]

As I said before I am a hospitalist which is beside the point. Live within their means and borrow adequately? Obviously specialty care is not cost effective care and it takes a good primary doctor who knows 80 percent of most specialties to keep it at a minimum much less prevent medical errors resulting in the need for further specialty care. Quality of specialty care is on a steep decline as well as specialists opt to pan out cognitive cases to nurse practitioners while they concentrate on procedures that make money often resulting in questionable calls on procedures and unnecessary risks and expense.

Example of how those figures are outdated:

http://www.indeed.com/viewjob?jk=20...ent+Moonlighting&tk=172j9j6dj18222mg&from=web

http://www.merritthawkins.com/job-s...Indeed&utm_medium=organic&utm_campaign=Indeed

http://www.nejmcareercenter.org/job...Indeed&utm_medium=organic&utm_campaign=Indeed

http://careers.acponline.org/jobdet...Indeed&utm_medium=organic&utm_campaign=Indeed

http://careers.acponline.org/jobdet...Indeed&utm_medium=organic&utm_campaign=Indeed

http://www.practicelink.com/jobs/32...Indeed&utm_medium=organic&utm_campaign=Indeed <----- my favorite! gotta love Naperville!


Again-how is primary care underpaid?

 

[MedicineDoc]

Come up with a salary survey "awesome doc" comparing specialties to primary care not oftentimes misleading individual offers to lure people to areas of extreme need. Let's hope you're a much more awesome doctor than your posts would leave one to believe. There is a reason why it's 70 to 30 specialist to primarry care when it should be 50 to 50 at the most. The rvu setting specialist dominated board needs to fall and it is well known and can't be swept under the rug anymore. I hold that board is largely responsible for the sad state of our current healthcare crisis and declining quality of patient care.

 

[bronx43]

Wait... so 3 extra years of residency training equals a $150-200k difference over a career span? Somebody explain to me how that math works out.

 

[Silent Cool]

Nah. I had a short few months where I thought I did (when I did my pm&r elective that came right after gen surg), but I changed my mind pretty quickly when I was on my IM sub-i.

Gotcha. What are you thinking of going into instead?

 

[MOHS_01]

 

[deleted87716]

(Not you.)

 

[MOHS_01]

(Not you.)

Oh, I'd say it has been pretty much equal parts

and ,

 

[MOHS_01]

Come up with a salary survey "awesome doc" comparing specialties to primary care not oftentimes misleading individual offers to lure people to areas of extreme need. Let's hope you're a much more awesome doctor than your posts would leave one to believe. There is a reason why it's 70 to 30 specialist to primarry care when it should be 50 to 50 at the most. The rvu setting specialist dominated board needs to fall and it is well known and can't be swept under the rug anymore. I hold that board is largely responsible for the sad state of our current healthcare crisis and declining quality of patient care.

Okay, not going to argue the CPT BS system -- it's a knife that cuts both ways, by the way -- but do you honestly believe that people would be healthier if there were fewer non-PCP's?

 

[bigkahunaburger]

No MOHS, we all think that if we had more non-PCP docs we'd all be healthier. We also think that it's cost effective to see a cardiologist for heart burn. Maybe a neurosurgeon for migraines? Now then we'd be super healthy!!!

 

[MOHS_01]

No MOHS, we all think that if we had more non-PCP docs we'd all be healthier. We also think that it's cost effective to see a cardiologist for heart burn. Maybe a neurosurgeon for migraines? Now then we'd be super healthy!!!

So what is it -- you do not believe that the purchaser should have the choice in who they want to see for what ails them? Or do you believe that the cardiologist would be incapable of diagnosing reflux without a stress test... followed by a cath... followed by... and then.... ? Okay, maybe a bad example given the cardiologists I know....

Seriously though, two questions -- how much do you think an office visit with a cardiologist or neurosurgeon costs Medicare relative to the same visit with their PCP? And do you really want to make the argument that folks are unhealthy because of the failure to implement a gatekeeper construct?

 

[bigkahunaburger]

"And do you really want to make the argument that folks are unhealthy because of the failure to implement a gatekeeper construct?"

Yeah, pretty much, right?

"Summary of the Evidence on the Value of Care Provided by Primary
Care Physicians
Evidence from the available medical and scientific literature suggests that:
When compared with other developed countries, the United States
ranked lowest in its primary care functions and lowest in health care
outcomes, yet highest in health care spending. (15-17)
Primary care has the potential to reduce costs while still maintaining
quality. (18-22)
States with higher ratios of primary care physicians to population have
better health outcomes, including decreased mortality from cancer,
heart disease, or stroke. (23, 24)
Individuals living in states with a higher ratio of primary care physi-
cians to population are more likely to report good health than those
living in states with a lower ratio. (25)
The supply of primary care physicians is also associated with an
increase in life span. (26, 27) An increase of just one primary care
physician is associated with 1.44 fewer premature deaths per 10,000
persons. (28) "

http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf

 

[MOHS_01]

"And do you really want to make the argument that folks are unhealthy because of the failure to implement a gatekeeper construct?"

Yeah, pretty much, right?

"Summary of the Evidence on the Value of Care Provided by Primary
Care Physicians
Evidence from the available medical and scientific literature suggests that:
When compared with other developed countries, the United States
ranked lowest in its primary care functions and lowest in health care
outcomes, yet highest in health care spending. (15-17)
Primary care has the potential to reduce costs while still maintaining
quality. (18-22)
States with higher ratios of primary care physicians to population have
better health outcomes, including decreased mortality from cancer,
heart disease, or stroke. (23, 24)
Individuals living in states with a higher ratio of primary care physi-
cians to population are more likely to report good health than those
living in states with a lower ratio. (25)
The supply of primary care physicians is also associated with an
increase in life span. (26, 27) An increase of just one primary care
physician is associated with 1.44 fewer premature deaths per 10,000
persons. (28) "

http://www.acponline.org/advocacy/where_we_stand/policy/primary_shortage.pdf

Fair enough. Maybe I'll have the energy and time to look at the original study over a beer or two this weekend.

Out of curiosity -- do you know how they assigned causation? By what mechanisms do these savings occur? I've seen a few studies on the cost effectiveness of prevention and am not sure they help your cause all that much... and please keep in mind that I'm not attacking primary care in any way -- I just want folks to rethink this panacea utopian BS and realize that Americans are unhealthy for reasons that reach far beyond the relative proportion of FP's to radiologists...

I should also point out that if physician ratios and top down dictatorial healthcare were primary determinants of health the Soviets would have been much better off than they actually were.

 

[MOHS_01]

p.s. I should try to find a link to a cardiology propaganda piece in a cardiology specialty publication to make some equally biased point to the contrary.

 

[bigkahunaburger]

Wait, you mean this Russia? lol, I don't know if that compares...

"Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care."

http://news.heartland.org/newspaper...gram-exposes-perils-single-paye?quicktabs_4=2

 

[deleted87716]

p.s. I should try to find a link to a cardiology propaganda piece in a cardiology specialty publication to make some equally biased point to the contrary.

If you can, please do.

 

[DrAwsome]

Wait, you mean this Russia? lol, I don't know if that compares...

"Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care."

http://news.heartland.org/newspaper...gram-exposes-perils-single-paye?quicktabs_4=2

I still don't understand why they, us, etc accept the wages we do while nurses simply strike when they don't like their over bloated salaries.

 

[MOHS_01]

Wait, you mean this Russia? lol, I don't know if that compares...

"Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care."

http://news.heartland.org/newspaper...gram-exposes-perils-single-paye?quicktabs_4=2

Oh, my apologies. I somehow thought the premise proposed was that PCPopulation ratios were not just positively correlated with public health status, indeed, it is causative. I'm not sure where I got that.

If you can, please do.

Man, I really don't have that kind of energy any more. I'm sure that you do know they exist for other specialties, though. I know derm did a few prior to our big revaluation about 8 years ago now.

 

[deleted87716]

I really don't have that kind of energy any more. I'm sure that you do know they exist for other specialties, though.

No, I'm not, actually.

OTOH, it's pretty easy to find studies which demonstrate the overall benefits of good primary care, both in terms of improved outcomes as well as cost-effectiveness.

 

[deleted87716]

Doh...!

Complete PPT here: http://www.ncafp.com/files/UNC Roberts We Can Do Better 2 May 2011.ppt

 

[elfmonkey]

Doh...!

Complete PPT here: http://www.ncafp.com/files/UNC Roberts We Can Do Better 2 May 2011.ppt

Brilliant !

 

[DrAwsome]

Doh...!

Complete PPT here: http://www.ncafp.com/files/UNC Roberts We Can Do Better 2 May 2011.ppt

You post a lot of studies. I'm really curious to know what you think is the best way to solve this primary care crisis? I'm also interested in finding out what you think about my idea re shifting residency positions since medicare does not seem to be forking over any more $$ for new residency positions.

 

[DoctwoB]

Wow this thread degenerated fast. I personally believe that PCPs should earn more, though preferably not at the expense of specialists. I do have some problems with the "cut the specialists to pay the pcp" mentality when taken further, however, for the following reasons. :

(1) Longer training. This has been beaten to death already so I won't go too much into it, but suffice to say that longer training should yield larger compensation to compensate both for lost attending time, training rigor, and time value of money. Obviously this is currently taken to the extreme and a 1 yr longer residency in EM then FP doesn't justify 2x the salary.

(2) Expectations. For better or worse, people have entered their chosen field given certain salary expectations. Is it "fair" to cut the salary of the top student who went all out to get into that ENT program expecting a given level of compensation only to pull the rug out from under them, while one can coast through med school into a good fp/im program. One could argue that pcps knew the salary disparity when they made their choice (though of course one could also argue we shouldn't force people to choose between money and primary care).

(3) Shortages. Is there really a shortage of PCPs? Perhaps. But the much bigger issue mal-distribution of pcps (like with other specialties). Throwing money at pcps may make primary care more desirable for med students, but it won't increase the number of pcps (residency spots unchanged) and it won't make pcps go to underserved areas (or accept medicaid). In fact more may choose to live in expensive cities with their newfound pay raise.

(4) Liability. Many specialties expose themselves to much greater liability then pcps, which should be compensated.

(5) Hours. PCPs on avg. work fewer hours then some (obviously not all) specialties. I would be interested to see how big the pay disparity is between pcps and a general surgeon when hrs worked and call responsibilities are taken into account.

I'm certainly not saying there is no inappropriate pay disparity, just that all of the preceeding factors need to be taken into account.

 

[DrAwsome]

Wow this thread degenerated fast. I personally believe that PCPs should earn more, though preferably not at the expense of specialists. I do have some problems with the "cut the specialists to pay the pcp" mentality when taken further, however, for the following reasons. :

(1) Longer training. This has been beaten to death already so I won't go too much into it, but suffice to say that longer training should yield larger compensation to compensate both for lost attending time, training rigor, and time value of money. Obviously this is currently taken to the extreme and a 1 yr longer residency in EM then FP doesn't justify 2x the salary.

(2) Expectations. For better or worse, people have entered their chosen field given certain salary expectations. Is it "fair" to cut the salary of the top student who went all out to get into that ENT program expecting a given level of compensation only to pull the rug out from under them, while one can coast through med school into a good fp/im program. One could argue that pcps knew the salary disparity when they made their choice (though of course one could also argue we shouldn't force people to choose between money and primary care).

(3) Shortages. Is there really a shortage of PCPs? Perhaps. But the much bigger issue mal-distribution of pcps (like with other specialties). Throwing money at pcps may make primary care more desirable for med students, but it won't increase the number of pcps (residency spots unchanged) and it won't make pcps go to underserved areas (or accept medicaid). In fact more may choose to live in expensive cities with their newfound pay raise.

(4) Liability. Many specialties expose themselves to much greater liability then pcps, which should be compensated.

(5) Hours. PCPs on avg. work fewer hours then some (obviously not all) specialties. I would be interested to see how big the pay disparity is between pcps and a general surgeon when hrs worked and call responsibilities are taken into account.

I'm certainly not saying there is no inappropriate pay disparity, just that all of the preceeding factors need to be taken into account.

1) Well EM may be the same length at some programs, ie-3 years, although most programs are 4. Second, EM does not make 2x what FP makes. FP makes around 180kish and you can find many 8-5 MF jobs. EM make somewhat more, in the 230-250kish, but they do work overnight shifts, odd shifts, etc and I personally think it's more stressful so there needs to be compensation for that.
2) Completely agree with you. It's as if you say hey this is what the salary of this profession pays but oh wait next year you'll be making 1/2 that!
3) this is precisely what I have said. We can throw more $ at PCPs but given that all funded positions are filled, it won't do anything. I personally suggested redistributing some positions in specialties hwere there is a huge market saturation like path and rads.
4) Agreed
5) Agreed!!

In order to fix this, we need to take all of this into account as well as midlevels issues. I think what BlueDog posted about the midlevels was actually a great article to show that they are not really contributing all that much to solve this crisis.

And again-more money without more positions is pointless. I would imagine PCPS are pretty maxed out as far as the # of patients they can see.

 

[deleted87716]

You post a lot of studies.

And, obviously, you don't read them.