Instead, we should be satisfied to make career decisions based on an anonymous poster screaming that the sky is falling without providing any tangible evidence whatsoever. Everyone knows that Medicare reimbursements are dropping, but no one knows how this will impact individual fields in the coming years.
The PMs that you would receive from this guy are worthless anyway. If you're curious, I'll just post what he sent me.
I'm the know-it-all medical student that ruined this vat of knowledge for everyone else. My bad, yall.
Good idea.
Okay, look, we all see this "sky is falling" warning from DD214, but let us not disregard him but entertain his warnings for a moment.
The recent cuts were indeed received as a large spanking and frankly, my buttocks felt a sting or too due to this.
But here is the problem. We frankly are an under appreciated specialty. There is a shortage of us and trust me, whenever I was in the job hunt, I was highly sought after. Not because I was somebody special, but simply being a board certified neurologist is rare enough alone.
First off, I hate performing EMG!! Back in my military days, I had a technician do the NCV part and this was more cost effective and saved plenty of time. Also lead to more revenue because while he was performing and NCV, I could be seeing a new outpatient consult. But, hey, who has the money to hire their own technician? A registered technician gets paid more than a freaking RN!! Now that I am in private practice, I have to do these myself. I will admit, I dread performing NCVs on the legs of obese people and it is timely. I am not a genius, nor would I claim to be the world's smartest neurologist, but I am somewhat of a perfectionist. Thus, I will do nothing but a quality electrodiagnostic study and in this time, I would have seen at least two patients and made more money.
What this means to me is, EMG/NCV eventually being done at major centers (e.g. federal facilities, universities, rich doc offices) where they can afford a technician or pawn the study onto a fellow.
So, EMG/NCV is a necessary part of our job, whether we do it ourself or let somebody else do it for us. But what can we do to make money? Neurointervention? Okay, let's ask TN that frequents this board and is obviously in an academic center. Are the private guys really making a killing on this?
Botox!! Yeah, its $1200-1500 for a 200 unit vial but we don't get paid for that, we get paid for the chemodenervation code, which amounts to squat!!
For Botox, we have to prove that a patient failed numerous headache therapies, actually has 15 or more headaches per month, fill out gobs of paperwork, etc etc. Yet, I watch pain doctors shove an epidural into a patient without hardly any documentation and get reimbursed four figures for something that fails most of the time.
What do we get paid for exactly? Well, we get paid to think for our complex patients. This does not amount to much at the end of the day.
It is disheartening to think that I could be down at an urgent care knocking out four DOT physicals in the time that it takes to see one neurology patient and make twice as much money.
So, hey, that brings up the next point. What ever happened to the AAN's big kick to push neurology as a "primary care" specialty so that we get paid for thinking?
I believe that is part of DD214's (and most of our) frustration. We have a society that we basically have to buy off our MOC and I am frankly sick of emails and postal mailings asking to donate to BrainPAC!!! So, what are they doing for us?
Okay, so enough venting. I will come back for a moment. Neurology is an academic specialty, a thinking man's specialty if you will. It can be fun and enjoyable and I do enjoy my "victories" whenever they occur. It will never be a high paying specialty in comparison to others out there but you can make a viable living doing this. I feel that the "sky is falling" warnings that you see are because in the field of medicine as a whole, we are all uncertain as to what will happen next?
Come on, raise your hand if you are with me on this. Everybody here went to college for at least four years, medical school for four years, and there is not a medical specialty out there with a residency less than three years. You give up your 20's and 30's, the best years of your life to take out six figures in loans, live in poverty, all while enduring the costs that the other average American faces (childcare, your own medical care, mortgages, car loans, credit cards, food, clothing, etc). So someday, you are in your mid-30's to early 40's before you finally make the "big buck". Hey, I was 35 before I made my first fat paycheck. So now the government views you as "rich" and taxes the hell out of you without any consideration that over the years you racked up a large debt without defaulting.
