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It's this kind of full ****** attitude that is leading to situations in California where unionized nurses make more than some full-time physicians.
Medscape Salary Survey 2012: Radiology goes from $350k to $315k in 1 year
- Thread starter econdr
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It's this kind of full ****** attitude that is leading to situations in California where unionized nurses make more than some full-time physicians.
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That's your flaw my friend. Just marry another doctor and your problems are solved.
You also just doubled your med school debt and put both of you in a higher tax bracket.
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I don't know one suburban teacher, anywhere, that is making close to 100k with summers clean off and I know a lot of teachers. I do know two that inherited some money and started a business on the side that are doing ok. Really, just one inherited the money but they are married.
That higher tax bracket has little to no effect on purchase power as well.
If someone offers to pay less and people want to live there so bad that they are willing to take the job, then more power to the people for getting bang for their buck. Those docs don't have to practice in that area and it would shine more light on the problem if they couldn't recruit physicians to work there....but they do.
That higher tax bracket has little to no effect on purchase power as well.
If someone offers to pay less and people want to live there so bad that they are willing to take the job, then more power to the people for getting bang for their buck. Those docs don't have to practice in that area and it would shine more light on the problem if they couldn't recruit physicians to work there....but they do.
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deleted103644
What's wrong with that attitude? It's the right one if you want to actually be happy with your life.
I'm not asking to be paid less, but I chose a specialty I will enjoy regardless of pay scale.
And if you think teachers anywhere are making $100k, you're nuts. College professors at big schools can make six figures, but most teachers are lucky to break $50k.
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johnnydrama said:
It's clear that you two have been in school way too long and still have 1990s salary references.
Among the highlights of the Naperville, IL (population 141,000) teachers' salaries:
--- 2 sex ed teachers pulling down $122k and $115k
--- A $112k drivers ed teacher
--- 14 guidance counselors pulling down between $100k and $124k
--- 21 gym teachers with six figure salaries, the highest being $151k
--- 8 social workers and 4 psychologists reeling in 6 figures
--- And of course, an army of 57 administrators pulling down between 100k and $242k a year.
http://chicagolampoon.blogspot.com/2011/05/napervilles-fat-teachers-salaries-union.html
Naperville School District:
NAME SALARY
Aaron, Candice $89,844
Abbott, Jean $82,209
Abshire, Carolyn $81,587
Adamatis, Patricia $111,231
Adams, Kyle $60,756
Albiniak, Mike $74,627
Albiniak, Sarah $19,876
Allen, Megan $43,781
Allen, Richard $118,797
Allen, Tarah $77,311
Alles, Colleen $52,979
Allison, Patricia $46,642
Aloe-Millsaps, Mary $96,914
Alstadt, David $81,309
Amberger, Robin $104,179
Amburn, Amanda $68,048
Ameri, Charity $71,092
Ancira, Sara $74,560
Anderson, Debra $24,503
Anderson, Erin $123,814
Anderson, Kristen $65,060
Anderson, Noel $70,886
Anderson, Sarah $78,591
Anderson, Sheryl $30,325
Anderson, Susan $122,434
Anderson, Wayne $137,492
Andonian, Ann $64,063
Andre, Donald $110,314
Andrees, Lynn $33,753
Angelos, Kathleen $107,541
Antonio, Dennise $86,965
Antonio, Lisa $108,002
Applegate, Lee $97,869
Arizaga, Sylvia $80,522
Arlis, Thomas $98,840
Armitage, Geralyn $116,625
Arndt, Jeffrey $48,225
Ashton, Cary $64,928
Aspan, Stephanie $57,347
Atiq, Jihan $69,458
Atseff, Jennifer $42,629
Atseff, Laura $70,373
Auld, Thomas $83,899
Awe, Nanette $86,460
Bach, Janel $31,780
Bachar, Candace $51,326
Bailey, Joyce $101,227
Bailey, Mark $94,146
Baird, Hiram $67,549
Baker, Debra $84,463
Baker, Diane $97,127
Bakke, Brian $111,582
Bakke, Mary $96,550
Baldwin, Barry $91,802
Ballard, Richard $89,016
Banach, Nancy $57,928
Barach, Denise $120,352
Barbino, Eleanor $59,227
Barenbrugge, Karen $59,177
Barr, Katherine $54,510
Barrett, Andrea $48,506
Barry, Kathleen $73,748
Barth, Amy $70,937
Bartosz, Rebecca $83,966
Barz, Margaret $115,511
Baumgartner, Gina $82,944
Baumgartner, Jennifer $101,105
Bean, Marcia $107,971
Bedore, Jeffry $77,464
Bee, Martin $122,679
Beehler, John $118,210
Beehler, Julie $120,255
Behrends, Charlene $113,744
Belasich, Taryen $44,945
Bell, Barbara $76,215
Bell, Charles $104,199
Bell, Christine $104,470
Benages, Kevin $58,130
Bender, Doris $62,234
Bennett, Linda $60,754
Benning, Allison $55,385
Benson, Joan $71,945
Bentel, Christina $45,520
Bentley, Jeromy $68,558
Benyo, Christopher $109,526
Berg, Dori $69,597
Bergantino, Angela $55,488
Berkley, Ross $61,208
Bessler, Linda $105,354
Betterman, Kathleen $116,521
Bey, Charles $60,470
Beyer, Susan $71,979
Bibby, Carole $74,365
Biddinger, Patricia $100,661
Biggs, Kathryn $72,791
Bilardello, John $103,310
Billings, Nancy $81,059
Birch, Stephanie $66,168
Bishop, Emily $75,068
Biskup, Jamie $72,756
Blackburn, Thomas $117,867
Blaisdell, Regina $105,764
Blaskovich, Kathryn $0
Blaskovitz, Jennifer $45,779
Blondell, Matthew $33,844
Bluhm, Karen $0
Blumthal, John $49,241
Bochenski, Michael $79,595
Bockman, Gwen $113,659
Bodinet, Dora $52,936
Bogen, Suellen $118,548
Bohdan, Thomas $116,188
Bonet, Don $100,937
Boor, Jane $105,534
Borgetti, Caryn $30,207
Borgman, Brianne $55,660
Bornancin, Nathan $54,823
Bostrom, Barbara $69,006
Bowman, Barbara $75,258
Boykins, Denise $107,531
Bradley III, Charles $55,331
Brady, Lori $90,196
Brady, Seth $67,509
Brandes, Jennifer $58,746
Brasel, April $66,448
Brate, Philip $120,900
Braun, James $122,735
Breese, Karen $116,431
Brenner, Lindsey $60,755
Breslin, Pamela $68,416
Brindle, Kristin $85,432
Briseno, Dr. Kathleen $120,624
Brooks, Renae $116,250
Brotherly-Lamb, Ann $108,270
Brown, Catherine $76,535
Brown, Daniel $53,188
Brown, Melissa $65,161
Brown, Timothy $89,406
Brucker, Elizabeth $81,518
Buckland, Allyson $104,060
Buckley, Michael $96,096
Buhrandt, Sue $112,683
Bukusi, Wanjugu $79,559
Buresh, Scott $26,226
Burghardt, William $75,997
Burke, Jeffrey $96,178
Burke, Lisa $110,580
Burke, Marjorie $118,548
Burke, Tamara $82,969
Burns, Kathleen $105,521
Burns, Lauren $57,382
Butler, Heather $27,494
Cabrera, Karen $95,153
Cain, Sarah $55,251
Callahan, Jane $114,681
Campbell, Karen $62,210
Campise, Gino $51,041
Campos, Christine $111,855
caneff, Cathy $104,179
Cannon-Ruffo, Colleen $83,519
Cantu, Joey $55,905
Canty, Karen $52,741
Carbonaro, John $77,756
Cardenas, Lisa $39,887
Carlson, April $107,971
Carlson, Janet $108,427
Carlson, Keith $59,886
Carlson, Lisanne $47,808
Carpenter, Madeline $59,397
Carroll, David $80,929
Carson, Jean $114,996
Carter, Joyce $86,021
Caruso, Amy $62,828
Casey, Edward $51,996
Castner, Kimberly $108,689
Catalano, Lisa $97,541
Catapano, Rosanna $49,871
Caudill, James $147,514
Cave, Joseph $129,803
Cavlovic, Amy $70,449
Cerchio, Pamela $97,303
Ceresa, Andaree $63,380
Cesareo, Meghan $0
Cesena, Joseph $118,548
Champion, Thomas $84,942
Chaney, Jeremiah $89,734
Chavez-Davalos, Laura $67,235
Chenelle, Julia $43,661
Cheng, Yvonne $57,868
Chesters, Katherine $62,857
Chiappetta, James $58,381
Chidley, Carin $79,146
Chipman, Katrina $74,365
Chiszar, David $124,843
Chiu, Piling $82,236
Choate, Pamela $121,648
Christensen, Cynthia $107,990
Christenson, Lynette $51,989
Christoff, Samantha $66,938
Churchill, Keri $91,920
Cibils, Lynn $60,742
Cirko, Leslie $95,542
Clancy, Marissa $64,828
Clark, Cheryl $105,316
Clark, Leslie $53,522
Clark, Lorraine $80,159
Clarke, Barbara $64,807
Clarke, Jennifer $60,346
Clayton, Linda $93,694
Cleveland, David $125,712
Cluver, Michael $96,066
Cohen, Deborah $92,178
Cohoon, Catherine $102,926
Cole, John $61,143
Collier, Flint $63,703
Colon, Laura $72,847
Comerford, Julie $52,960
Compton, Jeffrey $120,726
Conant, Elizabeth $57,069
Cone, Eva $49,015
Conley, Jennifer $44,854
Connell, Lisa $86,221
Connolly, Mary $117,619
Connor, Martha $112,728
etc
etc
You get the point.
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deleted103644
http://schools.nyc.gov/nr/rdonlyres/eddb658c-be7f-4314-85c0-03f5a00b8a0b/0/salary.pdf
$100k is the maximum possible salary for NYC teachers, only with a masters + 30 credits extra education and only after working for 22 years.
I'm sure the NYC numbers are more in line with the average than your cherry-picked numbers.
$100k is the maximum possible salary for NYC teachers, only with a masters + 30 credits extra education and only after working for 22 years.
I'm sure the NYC numbers are more in line with the average than your cherry-picked numbers.
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I said specifically wealthy suburbs, and you challenged me by saying teacher anywhere do not make around $100k, and I provided the data to refute you. And now you pull out NYC public schools with some of the most impoverished and failing schools to argue against me.
And you do know that many family docs in NYC make barely $100k with NO PENSION after 22 years, right?
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While I'm not sure that you are correct on what you are saying, I do think you certainly have a point regarding compensation, opportunity cost, etc. etc. in comparison with other professions.
I agree that actuaries make decent money after a point, but it takes years for them to make 6 figs, and it will pretty much hover at around 100ish k for the rest of their lives. They won't be making 200, 300, 400k + ever. Most teachers don't make 100k, but some make 60-70k. Law-is in the dumps right now. While some partners in particular enjoyed tons of $$ in the past, law has dried up significantly in the recent 5 + years, and law grads are lucky to get jobs these days.
MBA-dime a dozen. While some who go to top 10 schools may fare better, most don't make much more than 100-130k. And not everyone can be CEO of Chase/Morgan Stanley, etc.
At the same time, I agree that it's time as physicians for us to mobilize and demand what we are worth. It's time for our salaries to stop being cut, and for other people's salaries who make up a significant cost-including nurses. When nurses in CA are making almost as much as a pediatrician, I think there is a big big problem with that.
We should be able to unionize, and to be able to demand and expect salaries that make sense, and not expect our salaries to be cut all the time. Nurses walk out and strike, why can't we?
Also, why are nurses salaries so sky high and no one puts a stop to this?
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Hah! It takes a decade for us too. And that's my point. We tend to bipartition our training period from our attending period. In other professions, it's just an entry-level job where you gradually advance up with the right certifications. My brother is an actuary, so I'm very familiar with their process. It's very much like specialty boards certification. Physician salaries are all misleading because the average doesn't include residency training. Other fields have lower averages because they include all the entry level jobs. And for all the talk about the stability of our job and that you'll find a job everywhere, our training period is horribly uncontrollable. We move everywhere across the country for opportunities. It's very difficult during this period to start a family and buy a house. The headaches go up exponentially when you have a spouse who is also in medicine and you try to coordinate your residencies and fellowships with practice. It's really not too much different from early entry level positions where you're jumping around a lot.
There are more nurses in America, many of them unionized, so more political heft. They also have overtime rules and patient bed regulations, which require more of them to cover a day, increasing their demand. Doctors are cannibalized by specialty organizations. Once a physician goes into orthopedic surgery, his major focus will be with the ABOS. Divide and conquer.medstudentquest said:
And doctors unless directly employed cannot collectively bargain because of anti-trust laws. To be honest, I'm morally opposed to modern unions and would have never considered medicine if it were unionized. I think ultimately they are self-destructive because mediocrity eventually engulfs every aspect of the institution. My wife did a stint of Teach For America, and faced a lot of headwinds from the unions. I know that union teachers have about 1/2000 chance of being fired. Do you really think 1999/2000 teachers are doing a good job? Even doctors after our multiple steps of screening have a 1/50 chance of losing their license over a career (often due to substance abuse, age/illness or incompetence).
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I understand the nurse # issue, but why are they so overly compensated, and why are their salaries not cut as well is my question?
Why is it that we cannot be more significant decision makers overall as doctors? The whole overtime issue also kinda boils my blood. I think if we don't become involved, we are screwed.
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Because our incomes are dependent more on Medicare fee schedules and RVUs, while theirs are based on hourly wages. It's very rare for any profession to see decreasing wages. Most business would rather lay off people than to cut wages. This is why we say wages are sticky. Cutting Medicare reimbursement however is one degree removed and becomes more abstract and politically feasible. If you look at the incomes hit most by the recession, you'll see many of them are the ones that do piecemeal or contract work, not the salaried employees. Government workers get up in arms over salary freezes, much less significant cuts.
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[YOUTUBE]http://www.youtube.com/watch?v=8UkutfgBMqM[/YOUTUBE]
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Interesting talk. It's pretty surprising that a lot of the things he mentioned haven't already been implemented by PP groups. Seems like a lack of business acumen is a big reason for PP difficulties (in addition to obvious cuts, etc.).
I think it'll be crucial that future radiologists undertake leadership and management training to further the specialty.
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Very true. Also, in my opinion, the folks who get the MD/MBA concurrently often do it just for the name or to leave medicine altogether. To me, it makes little sense to get an MBA during medical school. That skill set will be so soft by the time you're an attending, I can't imagine it'll be super useful. Also, a big part of business school is establishing a lifelong network. That's hard to do when you're basically a professional student in med school with no real world experience (especially w/ the case method at HBS...).
The lack of incentives to get an MBA during residency or as an attending is a big issue. That said, it does make sense to do an EMBA as an attending, if you're still able to practice as an attending. That's my plan and I feel like it's the best way to build the framework for success when the economic climate is becoming increasingly challenging.
He's really right that there will be winners and losers in our generation. Strong business skills will be invaluable in the years to come. The corporate model has so many advantages over private practice that it's the natural path for the field unless radiologists actively oppose it. The loss of autonomy and profit potential by becoming employees vs. ownership is astronomical. I hope that folks do work to oppose corporatization in rads.
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Fellas you really are underestimating the true nature of a specialty and whether you can look in the mirror and say that it is worth it.
Personally I transferred into rads from a surgery subspecialty and it is nothing like I thought it would be like as an observer during med school and internship.
Believe it or not there are people in radiology right now that truly hate it but are stuck because turning around requires redoing residency in another field. Not possible because they have a family and golden handcuffs.
Keep in mind. Even if you pick peds or family making 150k, you will be able to payoff your loans. All of us would pick a specialty for $150K than a specialty for $300k that we hate.
I personally am neutral. I tolerate rads. It takes a special personality to handle the daily workflow of rads.
Regardless, talk to many private practice radiologists that you can before you pick rads. If you go into radiology for money you will hate your life.
Personally I transferred into rads from a surgery subspecialty and it is nothing like I thought it would be like as an observer during med school and internship.
Believe it or not there are people in radiology right now that truly hate it but are stuck because turning around requires redoing residency in another field. Not possible because they have a family and golden handcuffs.
Keep in mind. Even if you pick peds or family making 150k, you will be able to payoff your loans. All of us would pick a specialty for $150K than a specialty for $300k that we hate.
I personally am neutral. I tolerate rads. It takes a special personality to handle the daily workflow of rads.
Regardless, talk to many private practice radiologists that you can before you pick rads. If you go into radiology for money you will hate your life.
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deleted103644
Hahaha... Get an MBA? You can't be serious.
The only MBAs that are valuable are the real ones at top programs, and those are all about networking. There isn't much networking to be done in an executive MBA program.
You don't really learn anything you can't teach yourself in an MBA, so unless you're resume padding, it's really not worth it.
The only MBAs that are valuable are the real ones at top programs, and those are all about networking. There isn't much networking to be done in an executive MBA program.
You don't really learn anything you can't teach yourself in an MBA, so unless you're resume padding, it's really not worth it.
Can not agree more.
Do it only if you like it.
After living for 10-15 years on a very basic income, from no income in med school to a minimum salary in residency, it may be very exciting to make a high salary like 300K or so. You will enjoy it for the first 3-4 years as you can do things you were not be able to do before. You can buy that BMW you always wanted, you can have a luxurious vacation with family, you can buy your kids some expensive toys, buy your wife a fancy birthday gift, ....
But after 3-4 years, all of these will be routine. The BMW will become another piece of $hit, ... The only thing that will remain is the day to day work and the long hours you spend at work. vacation is only 2 weeks, but you have to work 45-50 weeks. Choose something that at least you do not hate.
Radiology is specific in a way that if you like it, you will really love it and if you hate it you will really be miserable. Like many other fields it needs its own personality. Similar to trauma surgery or ortho that need their own personality.
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Why are you so dismissive of other career options? Top MBA programs have class sizes of 300-800. So the top 15 MBA is equivalent to about top 40 medical schools. It's not that difficult to get into a top 15 MBA if you have a high GPA and a decent GMAT. The GMAT is a joke compared to the MCAT. And if you can write an AMCAS personal statement, you can BS your way through an MBA application about making the world more efficient.
An MBA is freaking two years. And you get paid during the summer year. Most fellowships in medicine are two freaking years. Let that sink in a little.
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I wouldn't act like I know everything when in fact all you know is what's regurgitated on SDN.
http://www.wharton.upenn.edu/mbaexecutive/los-angeles/index.html
There are plenty of high powered people that choose to do an EMBA at places like Wharton. It makes plenty of sense whether you realize it or not. They do teach you valuable skills and they expand your network to people in pretty high places when you're actually in a position to utilize them.
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Keep pooping your pants. Half a mil to read images is not sustainable. The specialist bubble must burst to make way for more equitable salaries in primary care.
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lulz. Just like 10mil to make excel spreadsheets is too. Haters will hate. Although, I agree rads has an image problem. It's difficult, time consuming work but people think it's easy and for lazy people. People couldn't be farther from the truth. Well, many rads are lazy but they have to work hard while they are at work.
There's a good argument PC docs could be replaced by an effective triage system conducted by NPs and PAs. Rads will continue to have good reimbursement as long as they maintain their position as an ownership specialty. If they cede that to employment, then their reimbursement will fall commensurately.
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There is a better argument that PCP's can provide high quality, cost effective care to the vast majority of Americans, minus the sickliest ones who are going to pass soon anyways and there is nothing you or I can do about it.
In my short time in medicine specialists have, more often than not, added very little to the treatment plan, save for a few complex cases.... usually its the ol' "agree with a & p, will follow." Cha-ching goes the cardiologist.
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Well, it's a good thing your observations don't really matter. Imaging use is soaring even in managed care organizations. http://healthland.time.com/2012/06/13/too-many-scans-use-of-ct-scans-triples-study-finds/
What idiot really believes imaging is going anywhere and that we're returning to the era of PCP physicians? We aren't. Specialists may not make bank like before, but there will not be a return to a general practice model in this country.
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Imaging is here to stay, not saying other wise. What I am saying is half a mil to read CT's is not and will never be sustainable in this country.
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You obviously have no understanding of business or medical reimbursement. You're just making a broad statement without any analysis. People don't listen to or care what your general feelings are. Try modeling things out or telling me some supply/demand figures. I already said demand is persistently high. Rads is only a small but significant part of the healthcare cost pie and it will remain despite assaults to reduce its growth rate. I can also assure you that more innovations will come out of rads that will drive new revenue streams. Family med and innovation? ... Lol
C
cowme
Why would we pay generalists more when nurses have already shown that they are more cost effective than family practice doctors?
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Specialists have ridden the gravy train while disproportionately benefiting from fee for service reimbursement. Do you really think radiologist/derm/take-your-pick-of-overpaid-specialists are really worth double or triple a PCP? I don't. I would argue their services are often less critical than the PCP's when it comes to long-term outcomes of their patients. Most folks in this country do not need to see specialists, I would argue. A good PCP will do.
Put another way, the total pie cannot get any larger. What I am saying is your piece of the pie should and probably will look more like a PCP's piece of the pie.
Put another way, the total pie cannot get any larger. What I am saying is your piece of the pie should and probably will look more like a PCP's piece of the pie.
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Unfortunately, I think you are incorrect. It has been shown that midlevels can do a very similar job to PCPs for half the cost or less. In the future, I think that PCPs will become less and less, and midlevels will increase in #'s. I think it's not unlikely that a few PCPs will oversee a number of midlevels. Even these days, many PCPs have midlevels who do low acuity care in their offices. I think it will become more and more common. Also you have to realize that many PCPs consult a variety of specialists, and their management is based on specialists' decisions. They are sort of the integrator of care many times, but not really the decision maker. Who are you going to replace specialists with? Also you have to realize that specialists' training is generally twice as long as PCP. And yes I would argue that overall they are more "valuable" in terms of care provided. What does the PCP do without the GI, cardiologist, rad, gas, surgeon? Not much.
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I can't even reply to this. It's so non-sensical. Yeah, that bleeding popliteal aneurysm that was repaired with a percutaneous intervention. Unnecessary. That dude was a goner anyway... he wasn't taking his diabetes meds.
Sorry bud, but you're arguing emotions and we only deal in data/reality. I understand, as a DO, specialists receiving higher reimbursement may seem unfair, but I contend that is pretty ridiculous.
Specialists are -- on average -- more intelligent and have performed significantly better for a much longer training period. Those higher salaries are earned by the additional skill sets that are obtained by the additional years of training. I refuse to acknowledge anyone saying a PCP is of equal worth to a surgeon, med-specialty, or radiologist. It's obvious these specialists could pretty easily pick up primary care medicine with little to no additional training. The converse is unequivocally false. That's why mid-levels are all over your turf. They're cheaper and more efficient. In other words, they're the future for your field.
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Just wanted to raise a salient point that comes up in counter-arguments. How do you account for the money saved by the PCP by say treating the person's diabetes, CHF, and pneumonia? Are PCPs entitled to a cut of those savings? I find it easy to say that surgeon deserves a certain amount because he is performing a finite action with more or less a beginning an end. The same cannot be said for PCPs but one could argue their actions should be better compensated since there is a savings aspect of it that takes burden off the system. How would one explain the high reimbursements of PCPs in Canada compared to the US. They place the opposite value than we do in the US. One could argue this is the reason why the US is the only place in the world that has allowed for the encroachment of midlevels.
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There is clearly a role for specialists. However, I do believe they are over-utilized (more so by mid-levels) and over compensated, as most patients do not need specialist services.
You can 'save' them when they're really sick and borderline dead, and then bill for boatloads of money. In the meantime I'll care for the 95% who still resemble life. Guess we'll call it even. Cheers.
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Replace in your sentences PCP with PA and specialist with PCP.
Do you really think PCP is really worth double or triple a PA ? I don't.
And you are correct. The pie is getting smaller. But who says PCP's salaries should stay the same.
That is nature of human. I was once talking with some nurses. All of them agreed that doctors are really really overpaid.
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Some doctors are overpaid. I would argue they are the specialists who, in my experience, often offer little to the treatment plan put forth by the primary team and then bill exorbitant fees for their "expertise."
Second, mid-levels working in primary care that are reimbursed at 50% of a physician in primary care is close to equitable, I would say. PA's refer like crazy and depend upon the guidance of their physician colleagues. The education gap between a physician and PA is greater than the gap between a partialist and physician PCP.
Didn't realize the hornets are out tonight.
C
cowme
I'm honestly not really sure what a PCP does that requires a doctor to practice it at all.
They check your cholesterol, sugars and blood pressure and adjust medications. There are such strict guidelines in place that a monkey could do these things. They make sure you have had proper screening (colonoscopies, mammograms, paps, etc) Big deal. A national email reminder service could do the same. They try to get you to stop smoking and drinking. Didn't realize that you need an MD to do that nowadays.
They prescribe antibiotics for viral syndromes. They reassure you about your diarrhea. And 90% of the visit is schmoozing. When anything actually important comes up, or anything actually gets done, they refer to the specialist.
Feeling down? go see the psychiatrist
Eye pain? go see the optho
Knee pain? Lets get you some imaging and then follow up with ortho
can't pee well? go see the urologist
They check your cholesterol, sugars and blood pressure and adjust medications. There are such strict guidelines in place that a monkey could do these things. They make sure you have had proper screening (colonoscopies, mammograms, paps, etc) Big deal. A national email reminder service could do the same. They try to get you to stop smoking and drinking. Didn't realize that you need an MD to do that nowadays.
They prescribe antibiotics for viral syndromes. They reassure you about your diarrhea. And 90% of the visit is schmoozing. When anything actually important comes up, or anything actually gets done, they refer to the specialist.
Feeling down? go see the psychiatrist
Eye pain? go see the optho
Knee pain? Lets get you some imaging and then follow up with ortho
can't pee well? go see the urologist
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Up here in Canada there are two types of family docs:
1. Urban family docs: these are the integrators of care, as Shark puts it. Basically they act as a nurse or social worker. I think its lame, and its not a real medical specialty.
2. Rural family docs: these guys do everything because they're the only game in town. Some of them in the really remote areas are doing appys and choles on their own. In my opinion they should be their own specialty: rural medicine.
Family medicine should just be discontinued as a specialty because extra residency training is not required to do the job they primarily do. One year of a rotating internship would be sufficient, like it was in the 70s and 80s.
1. Urban family docs: these are the integrators of care, as Shark puts it. Basically they act as a nurse or social worker. I think its lame, and its not a real medical specialty.
2. Rural family docs: these guys do everything because they're the only game in town. Some of them in the really remote areas are doing appys and choles on their own. In my opinion they should be their own specialty: rural medicine.
Family medicine should just be discontinued as a specialty because extra residency training is not required to do the job they primarily do. One year of a rotating internship would be sufficient, like it was in the 70s and 80s.
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That is crappy lazy medicine. Most patients do not require specialist knowledge to treat with conventional medicine... DM, HTN, COPD, thyroid, joint pain, are not that tough to treat with conventionally. Malignancies can go to onc. Most diabetics do not require endocrine and nephrology to write for metformin and lisinopril. A monkey -as you say- could do that.
Family Physicians are fully capable of caring for 90% of the above, with the weird cases being referred out. What I am calling for is a shift from the crappy referral based system you have mentioned, to one where the PCP utilizes their generalist training to treat all of the horses and maybe the occasional zebra if they're feeling bold, not punt all with elevated blood pressure to cards, nephrology, and endocrine for them to say the patient has hypertension, start with metformin and an ace-i and then bill the bejesus out of our health care system.
In the end I would argue that outside of the very acute conventional medicine actually does very little healing. True healing occurs not with the sickliest 10% on dialysis and 15 medicines that hospitals and specialty clinics profiteer off of. Real healing occurs at the other end of the spectrum, where disease is avoidable and at times reversible. That should be the future. We've bankrupted the nation with reactionary specialist-driven medicine, and healed very few patients in the process.
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Crappy lazy family medicine pays better than your way. The FM is going to either be paid low, or paid very low, and what it depends on is time per patient.
You are BSing left and right.
STFU and go and write these BS is the family medicine forum and not here. You will get a lot of support there.
We have some more important things to discuss here.
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Like complaining how $500k is not enough.
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That was pretty unnecessary and I think reflects a lot about yourself. MtHood made some good points. Anyone who has spent a few years in our health care system knows we need more good family doctors in this country as our system is incredibly fragmented.
Good luck in your career in medicine with the attitude you have towards your colleagues who chose a "lesser" specialty.
1-In true life I always support family doctors and talk about how hard they job is. But if someone calls my specialty unnecessary, overpaid, redundant, .... I do not have any respect for him/her.
2- There is a big delusion among family doctors that they are over-worked and under-paid. This will not change as almost half of doctors are PCPs in this country and WE ARE DOOMED to accept it. They have a strong voice.
3-I do not see any good points in what MtHood says. His argument is why we get paid more than PCPs. You can continue it forever. We cover a family doctor big clinic. I get paid 4 bucks to read a chest X-ray and a family doctor gets 50 bucks just to say hello to the patient, order the chest X-ray and then fill some paper work. To me he is really over-paid. You do not understand what does it mean to be RESPONSIBLE for an entire image.
4- After interacting with family doctors as a part of my work, I have found a lot of them really cool great personalities. But there are a large number of them with inferiority complex and delusions of being under-paid,. ...
5- Your have a very false perception of radiology. I have done outpatient medicine as intern, I have done 30 hour ICU shifts in a busy hospital, . .. Clearly non of them is as difficult as radiology call. We have sometimes senior residents from other fields like PM&R, Family medicine, Neurology, Orthopedics, ... who rotate with us. All of them get surprised by the pace of our work. And FYI, the pace of work in university setting is almost half of what is in true life.
6- Family doctors in my neiborhood do not open their office before 9 and usually leave about 5-6 pm. Whenever I call them, they are "AT LUNCH" from 12-2 or they are on vacation. Dude, family doctors are overpaid.
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The guy who make $150k working 50 hrs a week is overpaid compared to the guy who makes $350k working 50 hrs a week and entirely dependent on referrals?
I don't think radiologists are overpaid, I think all doctors are underpaid, but you're pretty full of yourself.
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Ah Harvard economist now. So then you're totally game that these economists are recommending 50% cuts on some imaging studies.
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I agree with your assessment of the problem, but not the lack of solutions. The government isn't going to do us any favors in terms of reimbursement, so its up to physicians to stand up and fight any cuts. We have many weapons in our arsenal. Two of the big ones:
(1) stop taking medicare. A nationwide coordinated action of physicians to stop taking medicare would get A LOT of attention and halt reimbursement cuts in their tracks. In the current US political climate, there is no way a law forcing doctors to accept medicare (the logical response) would pass.
(2) Political support: in addition to the usual lobbying and political contributions (AKA bribery), physician organization support is ESSENTIAL to any political party seeking to reform healthcare given the status that doctor's hold in society. This was foolishly squandered by the AMA in the last debate (supporting obamacare without extracting concessions that support physicians).
