Why is cardiology being cut so bad?

[wjs010]

The US is the most overfat country in the world. We have tons of obesity, CVD, heart disease, MI, all this bypass stuff , etc.. So why, in a country where cardiology should be a priority, is it being cut so bad? It's not like it's easy AT ALL to get into and complete a cardiology fellowship. I just don't understand it. It's sad that people who love cardio and are good at what they do get reimbursed less and less.

And by what mechanism and rationale is it being cut? Is it simply Medicare? Or does the ACA have equal impact? Thanks for clearing this up. I'm just a curious incoming student.

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[bronx43]

The US is the most overfat country in the world. We have tons of obesity, CVD, heart disease, MI, all this bypass stuff , etc.. So why, in a country where cardiology should be a priority, is it being cut so bad? It's not like it's easy AT ALL to get into and complete a cardiology fellowship. I just don't understand it. It's sad that people who love cardio and are good at what they do get reimbursed less and less.

And by what mechanism and rationale is it being cut? Is it simply Medicare? Or does the ACA have equal impact? Thanks for clearing this up. I'm just a curious incoming student.

Everything is being cut. Why? Because we have no money.

 

[nephappl]

Basic economics.
Health care is more or less 17% of our GDP and its growth is non sustainable so costs must be reduced or at least contained. The easiest way to start is cutting payments to MDs. Healthcare expenditure is a non stop that eats everything else and there is no limit . Here in my state schools are bad, infrastructure is awful, basic services are below average and the state can not increase budget to serve those things as Medicaid eats up >20% of the budget and raising taxes is not the answer as they can not be raised anymore.
Welcome to Medicine: our generation and the next ones will have to do more with less (including your income)

 

[wjs010]

Basic economics.
Health care is more or less 17% of our GDP and its growth is non sustainable so costs must be reduced or at least contained. The easiest way to start is cutting payments to MDs. Healthcare expenditure is a non stop that eats everything else and there is no limit . Here in my state schools are bad, infrastructure is awful, basic services are below average and the state can not increase budget to serve those things as Medicaid eats up >20% of the budget and raising taxes is not the answer as they can not be raised anymore.
Welcome to Medicine: our generation and the next ones will have to do more with less (including your income)

So instead of cutting cost with common sense, we reduce the salaries of the people who provide the care. Sounds legit.

 

[nephappl]

Yes Sir,
Our system is directed by politicians. Expect no common sense here.
Not in vain MDs income has become a hot issue in the news.
MDs are the weakest in the chain; there will be cuts in many other things but we go first.

 

[bronx43]

So instead of cutting cost with common sense, we reduce the salaries of the people who provide the care. Sounds legit.

Lol, define "common sense cutting." Everyone thinks they deserve what they make.

With our limited resources, I would argue that putting a large chunk into progressively more expensive care for minimal return on investment makes no sense. I can see the argument for massive movement towards preventative care, but spending $100k on a TAVR on a 75 year old or keeping someone in the CCU on 4 pressors/inotropes for cardiogenic shock is asinine. As a bottom line, we as a society must make a decision on how much we value life - not just quality of life, but life itself. Do we value it so much that we are willing to go down the road of perpetual debt creation? Do we allow the Fed to institute QE to inifinity? You simply cannot sustain your financial system when such a large portion of your resources are put into a resource drain. Financial slights of hand such as what the Fed is doing can only keep the game going for so long. Every empire has collapsed from within, under the weight of its own excess. The West is no different.

 

[Trifling Jester]

Because our lobbyists aren't as good as the non-MD's lobbyists.

 

[IMDoc607]

The US is the most overfat country in the world. We have tons of obesity, CVD, heart disease, MI, all this bypass stuff , etc.. So why, in a country where cardiology should be a priority, is it being cut so bad? It's not like it's easy AT ALL to get into and complete a cardiology fellowship. I just don't understand it. It's sad that people who love cardio and are good at what they do get reimbursed less and less.

And by what mechanism and rationale is it being cut? Is it simply Medicare? Or does the ACA have equal impact? Thanks for clearing this up. I'm just a curious incoming student.

I think the cuts to cardiology are blown way out of proportion. Sdn is all about doom and gloom. Did anyone realize that in fact there were close to no cuts to cardiology this past year and an increase in some payments? I'm not sure where you're getting this information from but my bet is it's likely from sdn or older cardiologists that were used to making a killing . Bronx is right tho.... We arnt the only ones getting cut. All of the specialties are getting a reimbursement decrease. GI just got hit also. Cardiology consistently comes out on top as one of the highest paying fields yet we still complain. I am not going to lie and I say I'm so happy about cuts but it is what it is. Work in the right region, spend wisely, and think of alternative incomes and I guarrantee you that you can become very wealthy as a cardiologist.

 

[hotshotdoc]

Bronx43 you are spot on. We all face the dilemma of convincing 90 yr old patients with severe AS to undergo TAVR. They live in nursing homes, have lived a good life, dont have a lot of family around them now and want to die peacefully. We convince them and put them through these procedures. I dont know how useful it is in the long run for them, their families and this country. Its a dilemma we face everyday.

 

[Medstart108]

Actually US doctors make a lot more than most countries. A Cardiologist making 500k a year is literally unheard of in most countries. While cuts are never fun, I wouldn't be shocked if cuts were made.

 

[amine2086]

Actually US doctors make a lot more than most countries. A Cardiologist making 500k a year is literally unheard of in most countries. While cuts are never fun, I wouldn't be shocked if cuts were made.

True but cost of medical education is highly subsidized in most countries. So those physicians don't have big loans pay back. If they are going to cut reimbursement, they should cut tuition too.

 

[Silent Cool]

True but cost of medical education is highly subsidized in most countries. So those physicians don't have big loans pay back. If they are going to cut reimbursement, they should cut tuition too.

This.

Physicians in other countries generally:
-Start training sooner
-Are paid more during training (which is also more benign)
-Have no student loans

 

[DoctwoB]

This.

Physicians in other countries generally:
-Start training sooner
-Are paid more during training (which is also more benign)
-Have no student loans

Add to this:
Little to no malpractice liability
No headaches dealing with insurance companies.

 

[wjs010]

Add to this:
Little to no malpractice liability
No headaches dealing with insurance companies.

Is this including countries with universal healthcare? Something tells me it wouldn't be that great if we had UHC here

 

[Instatewaiter]

Is this including countries with universal healthcare? Something tells me it wouldn't be that great if we had UHC here

Yeah if you want to make 90K working 70 hours a week.

It is not in the US mentality to work as little as the europeans. What it would end up being is a low compensated field with the same workload. And that's why people flee primary care

 

[wjs010]

Yeah if you want to make 90K working 70 hours a week.

It is not in the US mentality to work as little as the europeans. What it would end up being is a low compensated field with the same workload. And that's why people flee primary care

Oh ok. I would rather have debt and pay it off and then make more than Europeans make. But what is it I hear about Canadians making almost as much as US docs make?

 

[gutonc]

Oh ok. I would rather have debt and pay it off and then make more than Europeans make. But what is it I hear about Canadians making almost as much as US docs make?

I hear Candaluckistani docs make almost as much as those of us in Quebec's Taint.

What's your point/question?

 

[wjs010]

I hear Candaluckistani docs make almost as much as those of us in Quebec's Taint.

What's your point/question?

the apparent discrepancy in salary between docs from US and docs from countries with UHC. You mentioned docs from the latter countries make much less ( 70K). Canada has UHC, but I have read that their docs make a pretty large sum, comparable to US docs. I have also heard that canadian docs cross the border to practice in the US...there's probably a ton of reasons for both.

 

[IMDoc607]

who cares.....cardio is awesome. Had a STEMI today. Opened a completely occluded RCA secondary to thrombus formation. Circ lesion also sub totally occluded and will need PCI in 2 weeks. LAD also looks like it had a lesion but not the culprit one. Stage those bad boys.....People bitch about cuts but there are ways to make money. Two lesions? Okay, stent one and bring them back for a second one in 3 weeks. There ya go.....instead of getting paid $2,000 for stenting two arteries at the same time you get to bill twice. First, its good medicine, Who wants to stent the right system and left system at the same time? ISR anyone? So you lose both right and left...now you have a dead patient.

After that read their echo to see if their EF is down and bill a consult fee. Theres a reason why MGMA numbers are so high. Best part is all of what I just explained in my opinion is good medicine. Do what you love to do and get paid? Life is perfect.

Theres ways to make a decent living and get paid. People need to move on.

 

[sacrament]

People bitch about cuts but there are ways to make money. Two lesions? Okay, stent one and bring them back for a second one in 3 weeks. There ya go.....instead of getting paid $2,000 for stenting two arteries at the same time you get to bill twice. First, its good medicine, Who wants to stent the right system and left system at the same time? ISR anyone? So you lose both right and left...now you have a dead patient.

After that read their echo to see if their EF is down and bill a consult fee. Theres a reason why MGMA numbers are so high.

$2000 would be generous. Medicare pays a professional fee of around $800 for single-vessel and another couple hundred for an additional vessel. If you did a left and right, and ventriculogram, and IVUS, and pharmacologic hemodynamic measurements... the full meal deal, you MIGHT get up to $2000.

 

[IMDoc607]

$2000 would be generous. Medicare pays a professional fee of around $800 for single-vessel and another couple hundred for an additional vessel. If you did a left and right, and ventriculogram, and IVUS, and pharmacologic hemodynamic measurements... the full meal deal, you MIGHT get up to $2000.

Okay sorry I was off by $300-400. My point is taking care of people and saving their life along with doing something you love is awesome. I love my job. I realize I won't be making high six figures or maybe even mid six figures but at least I can say I love what I do. I do not blame the "old timers" one bit when they feel jaded or pissed off at what has happened. If I was used to being paid a certain amount and some dbag politician told me otherwise I would get pissed to. Thats why I am happy I am in a specialty that has already been hacked. I know people say its going to get worse but I disagree.

I also dabble in investing and side gigs that people usually shun but can actually increase your income significantly.

 

[Weinberg Angle]

...

 

[dragonfly99]

I am not sure why ppl keep posting about cardiologists making 500k . I have been in practice several years - pay is more like 270k which is still good but nowhere near 500k...invasive but noninterventional salary, in a high tax state (but not otherwise that high cost of livignin my area). The reason for reimbursement costs is not enough $ in the system, to pay what was paid in the past. Nobody cares that you feel entitled to X salary or that I trained for 12 years to do this (counting med school, residency, research fellowhsip, fellowhsip, but not counting undergrad). The politicians don't care. Most patients don't care. The primary care docs, who already got hacked and screwed years ago, don't care. The nurses unions don't care- they will still scream and sue and strike and do whatever they need to do to preserve the 100k+ salaries that they have. My fiancee is a board certified subspecialist who does medical research and some patient care and is trying to save ppl from death from cancer. there are nurses on the oncology ward making 140k, which is orders of magnitude more than his salary b/c nobody gets paid to do medical research unless you are an endowed faculty member. What people "should" morally get paid doesn't have much to do what they *are* paid in medicine. I don't have a problem with the salary I am paid but I do think that people like CT surgeons, and interventionalists doing high risk procedures, should be paid a LOT. Brain surgeons shoudl be paid A LOT. I'm sorry, but for the liability risk, the mental and emotional distress, and the long years of trainign and the critical nature of what they do, these people need to be paid. And we should think about what else we can do to decrease costs in the system besides cutting doctor reimbursements more. We have RN's and nuclear med techs at the hospital who make 90 k , 100k+, and I'm not talking about in SF or Manhattan. So doctors are not the only ones being paid and increasing the costs in the entire medical system. We are just some of the easiest targets.

 

[P Diddy]

I am not sure why ppl keep posting about cardiologists making 500k . I have been in practice several years - pay is more like 270k which is still good but nowhere near 500k...invasive but noninterventional salary, in a high tax state (but not otherwise that high cost of livignin my area). The reason for reimbursement costs is not enough $ in the system, to pay what was paid in the past. Nobody cares that you feel entitled to X salary or that I trained for 12 years to do this (counting med school, residency, research fellowhsip, fellowhsip, but not counting undergrad). The politicians don't care. Most patients don't care. The primary care docs, who already got hacked and screwed years ago, don't care. The nurses unions don't care- they will still scream and sue and strike and do whatever they need to do to preserve the 100k+ salaries that they have. My fiancee is a board certified subspecialist who does medical research and some patient care and is trying to save ppl from death from cancer. there are nurses on the oncology ward making 140k, which is orders of magnitude more than his salary b/c nobody gets paid to do medical research unless you are an endowed faculty member. What people "should" morally get paid doesn't have much to do what they *are* paid in medicine. I don't have a problem with the salary I am paid but I do think that people like CT surgeons, and interventionalists doing high risk procedures, should be paid a LOT. Brain surgeons shoudl be paid A LOT. I'm sorry, but for the liability risk, the mental and emotional distress, and the long years of trainign and the critical nature of what they do, these people need to be paid. And we should think about what else we can do to decrease costs in the system besides cutting doctor reimbursements more. We have RN's and nuclear med techs at the hospital who make 90 k , 100k+, and I'm not talking about in SF or Manhattan. So doctors are not the only ones being paid and increasing the costs in the entire medical system. We are just some of the easiest targets.

Stop being so dramatic. Your fiancé makes $14K?

Also your salary is definitely on the low end for cardiology, particularly for someone in practice several years. Are you at an academic medical center?

p diddy

 

[Boondahgle]

IMDoc607- love the enthusiasm for cards... totally agree. yeah it's hard, yeah there's a lot of call, yeah there's like way too many boards that are way too expensive, yeah you can feel underappreciated, and yeah there's like a gazillion unfavorable changes in healthcare right now, but man is cardiology an exciting field! no wonder so many people still go into it despite reimbursement cuts and whatever the heck else is happening. even old, bitter cardiologists have a love for this field that they can't deny. just look at how much joy they get when a fellow finally gets something right or when they can explain a principle to us and show us how it all fits together! how can one not be fascinated by it? do i sound biased? i'd like to think i'm not. i know i'll probably be whining about some aspect of it tomorrow or complaining about how unfair my life is or how hard i work or how many sacrifices I've made or blah, blah, blah, but it never fails to amaze me to see how directly the principles we learn can be applied and extrapolated and tweaked to see a patient get better or to make a diagnosis. i know everyone here has seen a med student look at them with complete fascination when they are explaining a patient's rhythm or the mechanism behind their presentation. to all those of you interested in cards, don't give up. if you love it, you will find a way to make it work for you and you will be great at it. ok, sorry, that was my pep talk and sort of irrelevant to this thread, but sometimes SDN needs some encouraging posts so that people don't forget that they might actually like their job! (and no, i have nothing to disclose)

 

[IMDoc607]

I am not sure why ppl keep posting about cardiologists making 500k . I have been in practice several years - pay is more like 270k which is still good but nowhere near 500k...invasive but noninterventional salary, in a high tax state (but not otherwise that high cost of livignin my area). The reason for reimbursement costs is not enough $ in the system, to pay what was paid in the past. Nobody cares that you feel entitled to X salary or that I trained for 12 years to do this (counting med school, residency, research fellowhsip, fellowhsip, but not counting undergrad). The politicians don't care. Most patients don't care. The primary care docs, who already got hacked and screwed years ago, don't care. The nurses unions don't care- they will still scream and sue and strike and do whatever they need to do to preserve the 100k+ salaries that they have. My fiancee is a board certified subspecialist who does medical research and some patient care and is trying to save ppl from death from cancer. there are nurses on the oncology ward making 140k, which is orders of magnitude more than his salary b/c nobody gets paid to do medical research unless you are an endowed faculty member. What people "should" morally get paid doesn't have much to do what they *are* paid in medicine. I don't have a problem with the salary I am paid but I do think that people like CT surgeons, and interventionalists doing high risk procedures, should be paid a LOT. Brain surgeons shoudl be paid A LOT. I'm sorry, but for the liability risk, the mental and emotional distress, and the long years of trainign and the critical nature of what they do, these people need to be paid. And we should think about what else we can do to decrease costs in the system besides cutting doctor reimbursements more. We have RN's and nuclear med techs at the hospital who make 90 k , 100k+, and I'm not talking about in SF or Manhattan. So doctors are not the only ones being paid and increasing the costs in the entire medical system. We are just some of the easiest targets.

Not sure where you are practicing but I have surveyed almost every recruiting company out there as well as cardiologists I know personally. It all is depending on the region you are in. However, 270K is very low for someone practice for a couple of years. Someone where I am (North), got offered 250K to start with a garaunteed third year salary of 500K. It is a community hospital near a major city (about 30 minutes tops). My fellowship is a non for profit academic center and they get paid >300. My close friends in NY are each making >350. I guess it depends on the business model of your group and how savy/hardworking a physician is. Furthermore, MGMA's numbers can't be DOUBLE what you are getting paid.

With that being said, are there cardiologists out there making 270? Yes.....are there some making >600K...yes

I know a PCP making 540K.....hospital employed. The hospital pays so well to secure his practices secondary care (caths, scopes, etc) because the practice is pretty big. Smart move by the hospital I think,

 

[IMDoc607]

IMDoc607- love the enthusiasm for cards... totally agree. yeah it's hard, yeah there's a lot of call, yeah there's like way too many boards that are way too expensive, yeah you can feel underappreciated, and yeah there's like a gazillion unfavorable changes in healthcare right now, but man is cardiology an exciting field! no wonder so many people still go into it despite reimbursement cuts and whatever the heck else is happening. even old, bitter cardiologists have a love for this field that they can't deny. just look at how much joy they get when a fellow finally gets something right or when they can explain a principle to us and show us how it all fits together! how can one not be fascinated by it? do i sound biased? i'd like to think i'm not. i know i'll probably be whining about some aspect of it tomorrow or complaining about how unfair my life is or how hard i work or how many sacrifices I've made or blah, blah, blah, but it never fails to amaze me to see how directly the principles we learn can be applied and extrapolated and tweaked to see a patient get better or to make a diagnosis. i know everyone here has seen a med student look at them with complete fascination when they are explaining a patient's rhythm or the mechanism behind their presentation. to all those of you interested in cards, don't give up. if you love it, you will find a way to make it work for you and you will be great at it. ok, sorry, that was my pep talk and sort of irrelevant to this thread, but sometimes SDN needs some encouraging posts so that people don't forget that they might actually like their job! (and no, i have nothing to disclose)

Dude....love cardiology. I can go on and on about it. Best part is....I know I will be paid very highly for it. I will find ways to make it happen and it will serve my patients well also.

 

[infarct]

I am not sure why ppl keep posting about cardiologists making 500k . I have been in practice several years - pay is more like 270k which is still good but nowhere near 500k...invasive but noninterventional salary, in a high tax state (but not otherwise that high cost of livignin my area). The reason for reimbursement costs is not enough $ in the system, to pay what was paid in the past. Nobody cares that you feel entitled to X salary or that I trained for 12 years to do this (counting med school, residency, research fellowhsip, fellowhsip, but not counting undergrad). The politicians don't care. Most patients don't care. The primary care docs, who already got hacked and screwed years ago, don't care. The nurses unions don't care- they will still scream and sue and strike and do whatever they need to do to preserve the 100k+ salaries that they have. My fiancee is a board certified subspecialist who does medical research and some patient care and is trying to save ppl from death from cancer. there are nurses on the oncology ward making 140k, which is orders of magnitude more than his salary b/c nobody gets paid to do medical research unless you are an endowed faculty member. What people "should" morally get paid doesn't have much to do what they *are* paid in medicine. I don't have a problem with the salary I am paid but I do think that people like CT surgeons, and interventionalists doing high risk procedures, should be paid a LOT. Brain surgeons shoudl be paid A LOT. I'm sorry, but for the liability risk, the mental and emotional distress, and the long years of trainign and the critical nature of what they do, these people need to be paid. And we should think about what else we can do to decrease costs in the system besides cutting doctor reimbursements more. We have RN's and nuclear med techs at the hospital who make 90 k , 100k+, and I'm not talking about in SF or Manhattan. So doctors are not the only ones being paid and increasing the costs in the entire medical system. We are just some of the easiest targets.

 

[IMDoc607]

I am not sure why ppl keep posting about cardiologists making 500k . I have been in practice several years - pay is more like 270k which is still good but nowhere near 500k...invasive but noninterventional salary, in a high tax state (but not otherwise that high cost of livignin my area). The reason for reimbursement costs is not enough $ in the system, to pay what was paid in the past. Nobody cares that you feel entitled to X salary or that I trained for 12 years to do this (counting med school, residency, research fellowhsip, fellowhsip, but not counting undergrad). The politicians don't care. Most patients don't care. The primary care docs, who already got hacked and screwed years ago, don't care. The nurses unions don't care- they will still scream and sue and strike and do whatever they need to do to preserve the 100k+ salaries that they have. My fiancee is a board certified subspecialist who does medical research and some patient care and is trying to save ppl from death from cancer. there are nurses on the oncology ward making 140k, which is orders of magnitude more than his salary b/c nobody gets paid to do medical research unless you are an endowed faculty member. What people "should" morally get paid doesn't have much to do what they *are* paid in medicine. I don't have a problem with the salary I am paid but I do think that people like CT surgeons, and interventionalists doing high risk procedures, should be paid a LOT. Brain surgeons shoudl be paid A LOT. I'm sorry, but for the liability risk, the mental and emotional distress, and the long years of trainign and the critical nature of what they do, these people need to be paid. And we should think about what else we can do to decrease costs in the system besides cutting doctor reimbursements more. We have RN's and nuclear med techs at the hospital who make 90 k , 100k+, and I'm not talking about in SF or Manhattan. So doctors are not the only ones being paid and increasing the costs in the entire medical system. We are just some of the easiest targets.

I don't mean to be disrespectful btw so I apologize if I come off that way