Why Make 150k When 450k Is Out There?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
You couldn't pay me enough to be an anesthesiologist. Anesthesia used to be for the bottom of the class. If the anesthesia guys keep teaching crnas it will be again in the not to distant future in my opinion especially seeing how it is becoming an easier specialty with technologic advancements.

Members don't see this ad.
 
This bump is timely considering a news release yesterday. Not going to the case for much longer.

Legislation was just introduced to change the process in which compensation for E/M and procedures are valued by the RUC and CMS. It is worth mentioning that the author of this bill is Rep McDermott (D-WA), a psychiatrist and that it is also supported by Rep. Tom Price (R-GA), an orthopedic surgeon - bipartisan support and support by specialists. Interesting

http://www.aafp.org/online/en/home/...vernment-medicine/20110405ruclegislation.html

"The mechanism for how (Medicare payment) codes are evaluated has contributed to the devaluation of family medicine and primary care through the years," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas. He added that it doesn't seem likely the current RUC process will change this imbalance.

However, H.R. 1256, which was introduced by Rep. Jim McDermott, D-Wash., would require CMS to hire independent contractors to identify and analyze misvalued codes for medical services provided to Medicare beneficiaries and to conduct an annual review of these codes. This independent analysis would augment the work of the RUC and could result in greater accuracy and transparency, according to a March 30 press release from McDermott's office.

"Study after study has shown that primary medical care must be the foundation for a high quality, efficient health care system," said Goertz. "If we are to build up our primary care physician workforce to create this foundation, we need a system that recognizes and appropriately rewards the medical expertise and cognitive skills of primary care physicians. This legislation is an important step in that direction."

The Medicare Payment Advisory Commission has found that although the RUC tends to identify and correct undervalued codes, it does not have the same incentives to find and correct overvalued codes. "(Sub)specialists, especially those who derive the majority of their income through procedural codes, have no incentive to reduce the value of potentially overvalued codes, even though the requirements for physician work in many procedures should be generally reduced as time passes and proficiency increases," according to the text of the bill.

This is also a good read about the RUC process, also released yesterday: http://www.kevinmd.com/blog/2011/04/relative-scale-update-committee-ruc-impact-health-care.html

Wait, so in light of all the frenzy on the Hill about budget negotiations, people expect this legislation to be passed? So, basically they want to pass a bill that adds to health care spending by increasing reimbursement for primary care services but not cut reimbursement for specialist care... Even though we all know that giving PCPs some more money is really a drop in the bucket as far as total health care spending and entirely negligible when considering total federal spending, a bill like this goes entirely against the direction the government is trying to go.

I'm not saying that additional reform isn't going to happen in some form, but this kind of positive-sum game is laughable at best. The far more likely scenario is that reimbursement for expensive, high-end care will continue to drop, while primary care reimbursement will remain stagnant.
 
Wait, so in light of all the frenzy on the Hill about budget negotiations, people expect this legislation to be passed? So, basically they want to pass a bill that adds to health care spending by increasing reimbursement for primary care services but not cut reimbursement for specialist care... Even though we all know that giving PCPs some more money is really a drop in the bucket as far as total health care spending and entirely negligible when considering total federal spending, a bill like this goes entirely against the direction the government is trying to go.

I'm not saying that additional reform isn't going to happen in some form, but this kind of positive-sum game is laughable at best. The far more likely scenario is that reimbursement for expensive, high-end care will continue to drop, while primary care reimbursement will remain stagnant.

Actually, it's quite the contrary. This bill would create an independent committee to help take out the politics involved in the RUC to evaluate overvalued services and undervalued services. Please take the time out to learn about the RUC and how its recommendations from the 90s and early part of 2000s have contributed to the current state of primary care:
http://www.familymedicine.medschool.ucsf.edu/pdf/cepc/0406_pres/BodenhPPTslides.pdf
 
Members don't see this ad :)
Actually, it's quite the contrary. This bill would create an independent committee to help take out the politics involved in the RUC to evaluate overvalued services and undervalued services. Please take the time out to learn about the RUC and how its recommendations from the 90s and early part of 2000s have contributed to the current state of primary care:
http://www.familymedicine.medschool.ucsf.edu/pdf/cepc/0406_pres/BodenhPPTslides.pdf

Interesting concept.... the creation of a politically appointed body "to help take out the politics"... Yes, I am sure that will work. :rolleyes:
 
156be6x.jpg


349cguh.jpg
 

Obviously given the current trends in reimbursement, PCPs feel slighted that their services aren't as "valued" as those of other fields. But, that, in itself, makes no judgment on the intrinsic value of the specialty, which I believe is far more valuable than some rather arbitrary value assignment by an external entity. The sentiments echoed in these surveys may change (and rapidly at that) given the impending shifts in policy and economic/financial conditions.
 
With our economy in it's current state and healthcare looking at even more cuts due to Obama's re-election, I think this thread is

MORE IMPORTANT CURRENT DAY THAN WHEN I INITIALLY COMPOSED IT.

I believe med schools DO NOT CONVEY TO MED STUDENTS THE BREVITY OF STUDENT LOAN DEBT
and how much said debt will run their lives.

CHOOSE YOUR SPECIALTY WISELY.
 
With our economy in it's current state and healthcare looking at even more cuts due to Obama's re-election, I think this thread is

MORE IMPORTANT CURRENT DAY THAN WHEN I INITIALLY COMPOSED IT.

I believe med schools DO NOT CONVEY TO MED STUDENTS THE BREVITY OF STUDENT LOAN DEBT
and how much said debt will run their lives.

CHOOSE YOUR SPECIALTY WISELY.

Heh, yup. Pretty much.
 
I owed nearly 200K in student loans when I graduated from med school.

After deferring said loans in residency, that amount was a solid 200K.

Now 11 years into private practice.....student loans paid off years ago....money no longer an issue...

I'M A MED STUDENT....I OWE 200K or 300K....WTF???

THREE HUNDRED GRAND IN THE HOLE.

So, first post states he's paid off student loans and is 11 years into practice. Now, recent post states he's a medical student and is 300k in the hole with student loans.

There's a troll in our midst. And judging by the way she writes, likely years away from being able to apply to medical school.

Enjoy the thread.

P.S. You might want to look up the definition of "brevity"...
 
So, first post states he's paid off student loans and is 11 years into practice. Now, recent post states he's a medical student and is 300k in the hole with student loans.

He's an anesthesia attending.

As for the "trolling" part, I leave you to your own conclusions. ;)
 
Members don't see this ad :)
So, first post states he's paid off student loans and is 11 years into practice. Now, recent post states he's a medical student and is 300k in the hole with student loans.

There's a troll in our midst. And judging by the way she writes, likely years away from being able to apply to medical school.

Enjoy the thread.

P.S. You might want to look up the definition of "brevity"...

He's not a troll, but he does have an interesting writing style, so quoting him out of context is problematic.
His point definitely deserves some consideration.
 
So, first post states he's paid off student loans and is 11 years into practice. Now, recent post states he's a medical student and is 300k in the hole with student loans.

There's a troll in our midst. And judging by the way she writes, likely years away from being able to apply to medical school.

Enjoy the thread.

P.S. You might want to look up the definition of "brevity"...

Lol, pssstt, your ignorance is showing.
 
You couldn't pay me enough to be an anesthesiologist. Anesthesia used to be for the bottom of the class. If the anesthesia guys keep teaching crnas it will be again in the not to distant future in my opinion especially seeing how it is becoming an easier specialty with technologic advancements.

Seriously? What did you spent a day in the Endo room to come to this conclusion? Why docs belittle each others specialties is beyond me. As a rotating MS all I have learned is the many difficulties every specialty presents from an academic standpoint. Orthopedics, derm, were once on the low end of the class so that argument is mute concerning anesthesia, especially since anesthesia only became easier in the 90s due to monetary uncertainty in the future at that time. It is right back there in the middle again and I believe the only reason it is not even more difficult is due to the relatively lack of exposure to more than a days worth of anesthesia.

I am with Jet on this one, money plays a large factor, easily top 3 in choosing a career just as it does in pretty much every other career people go into.
 
Seriously? What did you spent a day in the Endo room to come to this conclusion? Why docs belittle each others specialties is beyond me. As a rotating MS all I have learned is the many difficulties every specialty presents from an academic standpoint. Orthopedics, derm, were once on the low end of the class so that argument is mute concerning anesthesia, especially since anesthesia only became easier in the 90s due to monetary uncertainty in the future at that time. It is right back there in the middle again and I believe the only reason it is not even more difficult is due to the relatively lack of exposure to more than a days worth of anesthesia.

I am with Jet on this one, money plays a large factor, easily top 3 in choosing a career just as it does in pretty much every other career people go into.

No one is arguing that money matters. The biggest point of contention here is that FM doesn't pay enough to pay off loans.

Hogwash. I'm a PGY-3 FM resident. The lowest salary that anyone in my class has been offered so far (outside of the one person who was looking around NYC) was 175k in Charlotte.

If you avoid certain areas (basically the NE), you'll be fine with FM.
 
No one is arguing that money matters. The biggest point of contention here is that FM doesn't pay enough to pay off loans.

Hogwash. I'm a PGY-3 FM resident. The lowest salary that anyone in my class has been offered so far (outside of the one person who was looking around NYC) was 175k in Charlotte.

If you avoid certain areas (basically the NE), you'll be fine with FM.

I'm an Anesthesia Attending with 2 decades of clinical experience. I have many friends in all areas of medicine including Family Practice.

The glory days of Anesthesia, Radiology, Oncology, etc. are almost behind us. The reality of a semi-socialized model likely followed by full socialization in about ten years will soon be upon us.

Med Students should choose their specialty based on their interests, skills and desire to practice in that area for 30 years. I respect and admire Family Practice and those who choose that specialty.

But, like Anesthesia Family Medicine has a Advanced Nurse Practice Problem as they seek full autonomy and practice privileges. Of course, patients prefer seeing a Physician if possible but NPs will be part of the ObamaCare model.

The Advanced Practice Nurse issue isn't limited to Anesthesia or Family Practice as they branch out into Dermatology and Critical Care. All Physicians should stand together and oppose Independent Practice rights or full practice autonomy for Nurses.


http://www.nejm.org/doi/full/10.1056/NEJMp1012121
 
No one is arguing that money matters. The biggest point of contention here is that FM doesn't pay enough to pay off loans.

Hogwash. I'm a PGY-3 FM resident. The lowest salary that anyone in my class has been offered so far (outside of the one person who was looking around NYC) was 175k in Charlotte.

If you avoid certain areas (basically the NE), you'll be fine with FM.

To some extent you are right. I've seen some posts for FM in the mid 200's as well as IM. You likely won't be making 400k plus but you'll be making decent money. However, I personally believe that anything under 300k for a physician is peanuts. Many people make high 100s/low 200's these days. It's sad that we would only make that. I think we are too wussy to truly stand together and demand better.
 
We finally agree on something. I guess we are too stupid and too wussy to do it.

Idk if Blue Dog is endorsing a doctor strike. Seems like he's posting a joke about doctors' handwriting. I could be wrong though...
 
Idk if Blue Dog is endorsing a doctor strike. Seems like he's posting a joke about doctors' handwriting. I could be wrong though...

you_are_correct_sir.jpg


As for why doctors never agree on anything...

[YOUTUBE]Pk7yqlTMvp8[/YOUTUBE]
 
Idk if Blue Dog is endorsing a doctor strike. Seems like he's posting a joke about doctors' handwriting. I could be wrong though...

Perhaps but given that just about every hospital has electronic medical records now that's not something to worry about.
 
I'm an Anesthesia Attending with 2 decades of clinical experience. I have many friends in all areas of medicine including Family Practice.

The glory days of Anesthesia, Radiology, Oncology, etc. are almost behind us. The reality of a semi-socialized model likely followed by full socialization in about ten years will soon be upon us.

Med Students should choose their specialty based on their interests, skills and desire to practice in that area for 30 years. I respect and admire Family Practice and those who choose that specialty.

But, like Anesthesia Family Medicine has a Advanced Nurse Practice Problem as they seek full autonomy and practice privileges. Of course, patients prefer seeing a Physician if possible but NPs will be part of the ObamaCare model.

The Advanced Practice Nurse issue isn't limited to Anesthesia or Family Practice as they branch out into Dermatology and Critical Care. All Physicians should stand together and oppose Independent Practice rights or full practice autonomy for Nurses.


http://www.nejm.org/doi/full/10.1056/NEJMp1012121

That NEJM article is nauseating.....and to think an MD is one of the authors! These sell outs are also a huge part of our problem.
 
I know medical school will cost a large amount of pretty pennies, BUT I don't care if I amass half a million dollars in debt I would rather be happy as a primary care physician(internist, pediatrician, Family doctor) than do something I personally don't like such as cardiology, pulmonology etc.

If money was the only reason I would have picked something else
 
I owed nearly 200K in student loans when I graduated from med school.

After deferring said loans in residency, that amount was a solid 200K.

Yep, like alotta you out there, I had to personally pay for my education.

As a fourth year med student, I thought pragmatically....

hmmm.....

I owe X amount.

Debt is an anchor.

I wanna pay off my debt, but still be happy.

BOOM!!!

A light goes off in my head. I'm gonna specialize.

Now 11 years into private practice.....student loans paid off years ago....money no longer an issue...

I wanna hear from the med students going into primary care with 200K in student loans.

What motivates a dude/dudette to go into a specialty where monetary reimbursement is less than some nurses?

Are there really philanthropic people left out there, concerned about societal issues in medicine?

If you are a med student reading this, do you think you'll think the same way after your residency is over?

Can one be comfortable with the fact that after 4 years of college, 4 years of med school, then residency, you've selected primary care as your profession which puts you behind the eight ball financially?

BTW....one of the most conflicting issues in marriages is....MONEY.

So, again, why would a med student select primary care?

(rich family prodigies out there, you dont count)

Five years outta residency your focuses will be different.....family.....hobbies....

I read a post in this FM section about personal finance.....went something like...."its OK to rent..."

WTF?

You're gonna endure pre-med/med school....business major colleagues are sittin' out by the pool while you're in the study lounge cramming for an organic chem final...or 1st year med school biochem....2nd year pathophys... endure 3rd year clinicals......then select a career where the reimbursement suks to the point where you haffta rent?

Cummon....

This post is not for the FP people who have already selected their fate.

This post is for med students reading this who are trying to figure out what they want to do with the rest of their lives....

I'm 11 years out of residency. Specialist. Love my job. Plenty of time off. Money not an issue anymore.

My student loans are long gone.

I didnt make the rules.....

....the rules are.....

...specialists make more than twice that of primary care docs.

And pick your specialty wisely, you'll make twice-bank with 9-12 weeks vacation.

So I'm wondering why med students would want to go into primary care.

Yep, an inflammatory thread.

But I wanna know, and YOU DESERVE TO KNOW WHAT YOUR MED SCHOOL ACADEMIC "ADVISORS"

aren't telling you, which is being saddled with 200k student loans and selecting primary care is FINANCIAL SUICIDE.

P.S. : If your dad has paid for college/med school/condo during residency, your opinion doesnt count.

Why FP?

two words: cash practice
 
Top