CMS Proposes Primary Care Raises Funded With Specialist Cuts

Does anyone think that PCPs may start to be paid more than some of the non-procedural IM specialists? I'm on rheum right now, and the attending mentioned the loss of "consult" visits from Medicare and that it will probably disappear from private insurance eventually as well. So, he was a bit down on the loss of the 20% bump in visit reimbursement.

Now, with some of these increases in PCP reimbursement, I could easily see efficient FM docs earning more than rheum, endocrine, ID, and probably some others. Any thoughts on this?

Should be interesting to see if this goes.

When are they going to realize the huge cut is a really, really, really bad idea?

Blue Dog said:

I don't have any heartburn about consult codes being phased out. IMO, they were an abuse of the system to begin with.

Why should you get paid more just because somebody else asked you to see a patient? I never got paid more when I was forced to admit patients to the hospital for specialists who refused to take them onto their own service, but they got paid more to "consult" the following day.

As for outpatient consults, why should anyone be paid more to see a patient who has already been worked up and basically just needs a procedure or follow-up care?

Good riddance.

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Pardon my ignorance, but how were you being "forced" to admit the patient for the specialists?

In residency, this happens all the time and we don't have much choice, but I'm curious how it works in the "real world".

Blue Dog said:

I was a resident. My attending was actually the one who was being (under)paid.

Same thing happens to my colleagues in hospital medicine today, though. How can you be "forced?" By hospital bylaws.

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Ah...Thank you. Sounds like another in a long line of reasons to not do hospital medicine.

To echo GoodmanBrown, does the primary care field look like it's going to drastically change in the future? As in, seeing PCP salaries being on par with most other medical specialties and being only slightly behind surgical ones? I'd like to pursue PC regardless of pay but I'm obviously not complaining about these changes either.

Thanks

Blue Dog said:

I don't have any heartburn about consult codes being phased out. IMO, they were an abuse of the system to begin with.

Why should you get paid more just because somebody else asked you to see a patient? ...As for outpatient consults, why should anyone be paid more to see a patient who has already been worked up and basically just needs a procedure or follow-up care?

Good riddance.

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A consult in the office requires a letter to be written to the referring doctor. Lawyers often charge $250 to write a letter. Reimbursement for consults were never anywhere near that much more. Now, they are expecting doctors give free work when writing this letter. Sometimes, consulting doctors have to call the referring doctor to discuss it. Again, free work demanded by Medicare and insurance companies.

For outpatient consults, if the patient has already been worke up and needs just a procedure, then the proper billing is to bill for the procedure only, as it is bundled with pre-op evaluation. Again, free work and elimination paying for consults does not change this.

Basically, politicians are trying to get FP's to help them attack specialists. Afterwards, the politicians will attack the FP's.

tiotropium said:

To echo GoodmanBrown, does the primary care field look like it's going to drastically change in the future? As in, seeing PCP salaries being on par with most other medical specialties and being only slightly behind surgical ones? I'd like to pursue PC regardless of pay but I'm obviously not complaining about these changes either.

Thanks

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You have to realize that if that happens it will eventually switch back. Who do you think will go into things like rads/rad onc/surgery/ortho/neurosurgery if they make the same PCPs do? Very few people and there will be tremendous shortages. I think an avg of 200k is pretty good for being a PCP. I don't think that paying specialists more is inappropriate, given the higher skill set and significantly longer training.

Blue Dog said:

Hopefully, the people who actually enjoy onc/surgery/ortho/neurosurgery.



I think an avg. of 200K is pretty good for being a radiologist.

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That doesnt make any sense. It is way too much effort and sacrifice to take such long training for no more $$. Are you saying that having more training and knowledge is pointless then? You think that a FM person should get paid the same as an orthopedic surgeon, a neurosurgeon, rad onc, etc? Why don't we all work for nurse wages too then?

200k is roughly what you guys make. Radiologists train double the time you guys train. why should they not get paid more? They have more knowledge, skills, and realistically add much more to patient care. Not to start a flame war, but 90% of primary care can be done by a midlevel.

Again explain to me why all specialties would get paid the same? Then nurses should make the same we do then, as well as techs, janitors, etc.

.

Blue Dog said:

Whoever said that length of training automatically translates into more income? If that were the case, we could all just keep adding degrees until we cracked seven figures. It doesn't work that way.



Not that you are in any position to actually know that, of course. Are you doing a lot of primary care in dermatopathogy these days?



When did I ever say that?

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I'm not doing dermatopathology, but I did go through med school and pretty much managed patients on my own during my sub I and by 2 months in I managed patients entirely on my own during my medical internship. For the hours worked and the complexity, it's good pay. Besides generalists cannot practice without specialists. What do they do when they are stuck? Send to specialists. We can all send for colonoscopies, mammographies, check BP, recommend antihypertensives, etc. Few can do specialized care. Like I said, if not we should also make the same as nurses.


and you kind of did.

Well more training of course leads to higher income, and it adds to more knowledge, more possibility to add to ultimate patient care, etc. Just like with everything-with more specialization, training and expertise = more income. Further, if all specialties paid the same there would be no more incentive to do double the training a generalist makes. I'm by no means an orthopedic surgeon or a neurosurgeon, etc but I think those people deserve every penny they get. Blood sweat and tears deserves extra compensation. So yes it does work that way.

Blue Dog said:

So, you're actually suggesting that primary care physicians don't go through any "blood, sweat, and tears...?"

"Generalists cannot practice without specialists...?" Have you considered that the converse is also true?

We're all needed, and we're all valuable. But NO specialist is 3x as valuable as a primary care physician.

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I am suggesting that a PA CAN do 80+% of a primary care job, but a PA cannot do what say an orthopedic surgeon, neurosurgeon, pathologist, radiologist, rad onc, etc can do. When a PCP person is stuck they consult a specialist. I disagree with your latest statement. I think most specialists are invaluable. We could do with some less IM specialists in my opinion-rheums, endos', IDs, but overall most specialists bring a lot to the table. And I don't think a 3 year residency is much blood sweat and tears no.

Blue Dog said:

And, when a specialist is stuck, they send the patient back to their PCP.

Been doing it for ten years, pal.

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The specialist normally is the one who gives the final say in what is wrong with whatever the concern is. If one specialist thinks it's not his/her specialty and does not know they send to another specialist or tell you to send them to another specialist. Why do you think midlevels are practicing as PCPs? It's not brain surgery, and with minimal liability since the specialist is the one who really ultimately calls the shot with diagnosis and treatment.

Dermpath said:

That doesnt make any sense. It is way too much effort and sacrifice to take such long training for no more $$. Are you saying that having more training and knowledge is pointless then? You think that a FM person should get paid the same as an orthopedic surgeon, a neurosurgeon, rad onc, etc? Why don't we all work for nurse wages too then?

200k is roughly what you guys make. Radiologists train double the time you guys train. why should they not get paid more? They have more knowledge, skills, and realistically add much more to patient care. Not to start a flame war, but 90% of primary care can be done by a midlevel.

Again explain to me why all specialties would get paid the same? Then nurses should make the same we do then, as well as techs, janitors, etc.

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Blue Dog said:

So, is it 80%, or 90%? Make up your mind. If you're going to have an uninformed opinion, at least strive for internal consistency.

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I said 80+ if you look at my post. I'm not trying to offend you, but I think the fact that midlevels can practice pretty much independently and at almost the same salary says something.

Dermpath said:

I said 80+ if you look at my post. I'm not trying to offend you, but I think the fact that midlevels can practice pretty much independently and at almost the same salary says something.

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Our model of healthcare where specialists are overvalued to a multiple of what a FP earns is unsustainable and unique in the western world. Our model is also inferior. Change is inevitable and you can yell that a midlevel is equivalent to a FP all you want but you would just be tooting their horn as they drive towards parity in ALL fields of medicine.

Blue Dog said:

Actually, most midlevels work in specialties.

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I'd like to expand on this a little. For my hospital system, our midlevel breakdown by specialty is as follows...

FM - 12
Cards - 12
EM - 11
Surgery (General, CV, Ortho) - 8
Other specialists have less than that, so not worth mentioning.

I'd be much more worried if I were a cardiologist who didn't do interventional. After all, without caths, what can they do that a PA couldn't? God knows they would do it much cheaper.

The simple fact that this poster above seems to think that FM docs are somehow or weren't capable of training to do what some specialists do is pretty silly.

Any monkey can learn to do procedures and most surgeries...and there are days I WISH I only had to know one organ system frontwards and backwards.

And, I wish someone was pre-screening all my patients for me...working them up, sometimes having already ordered and interpreted tests for them, and pretty much telling me what is needed...before they ever set foot in my door. But, then I'd be a "specialist".

Our specialty is one which requires one to look at the WHOLE picture, and know when to refer and when it's not necessary.

In my experience, it's the specialists that rely on NP's. I will say that referring a patient to a "specialist" only to have said patient seen by a mid-level is maddening. As a patient myself, it will be a cold day in hell when I pay specialist money to see a PA or NP. People aren't stupid, and will demand more. They even demand to see physicians for their primary care more often than not, in my experience.



I should add that I don't think increasing PCP pay by taking away from specialists is the right approach, but the fact is, many specialties are way way over-valued.

MJB said:

The simple fact that this poster above seems to think that FM docs are somehow or weren't capable of training to do what some specialists do is pretty silly.

Any monkey can learn to do procedures and most surgeries...and there are days I WISH I only had to know one organ system frontwards and backwards.

And, I wish someone was pre-screening all my patients for me...working them up, sometimes having already ordered and interpreted tests for them, and pretty much telling me what is needed...before they ever set foot in my door. But, then I'd be a "specialist".

Our specialty is one which requires one to look at the WHOLE picture, and know when to refer and when it's not necessary.

In my experience, it's the specialists that rely on NP's. I will say that referring a patient to a "specialist" only to have said patient seen by a mid-level is maddening. As a patient myself, it will be a cold day in hell when I pay specialist money to see a PA or NP. People aren't stupid, and will demand more. They even demand to see physicians for their primary care more often than not, in my experience.



I should add that I don't think increasing PCP pay by taking away from specialists is the right approach, but the fact is, many specialties are way way over-valued.

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Well I guess my intent was misinterpreted, I did not mean to insult/offend anyone. My apologies if anyone has been offended.

Mind you, I'm not offended. You gave the impression that you think these folks in fields like Rads, Surgery, GI, etc...are more talented or are somehow in a different class of physician than PCP's.

The simple fact is there are a LOT of PCP's that could have easily chosen to go into those fields and didn't for various reasons, and I got the impression you thought otherwise.

To be a GOOD PCP, you have to be pretty damned good..and smart. I hope to be a GOOD PCP with proper training and experience because my mentor was and is one of the most talented physicians I know and is a big reason I got into the field.

MJB said:

Mind you, I'm not offended. You gave the impression that you think these folks in fields like Rads, Surgery, GI, etc...are more talented or are somehow in a different class of physician than PCP's.

The simple fact is there are a LOT of PCP's that could have easily chosen to go into those fields and didn't for various reasons, and I got the impression you thought otherwise.

To be a GOOD PCP, you have to be pretty damned good..and smart. I hope to be a GOOD PCP with proper training and experience because my mentor was and is one of the most talented physicians I know and is a big reason I got into the field.

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Unfortunately we dont agree completely. I don't think that's necesarily true, but it's difficult to get a point across an internet forum and my intention is not to offend others, so i'll leave it at that.

I don't disagree that primary care can be underpaid, but if you think the way to fix that is to equalize the system by cutting specialist pay, then y'all have bought the socialist bull****. We physicians produce all the work and subsequent needed care, yet only account for 4-10%% of totle heathcare costs......even the jack ass CEO who ran my hospital into soon to be bankruptcy was paid significantly more than any of the docs in the hospital. The clipboard nurse administrators make more than the IM docs in my hospital and they do nothing but hand down stupid ass dictates that oly cause me more grief by increasing my paperwork

Making gains by cutting your peers throats will only comeback to haunt you when it's your necks on the block

Blue Dog said:

"Better to remain silent and be thought a fool than to speak out and remove all doubt."

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No, not being a "fool" but I don't want to be accused of trolling. This is a rather lengthy topic to discuss, and since the administrator said it's considered trolling to say anything negative about the specialty, then it's difficult to have a discussion.

Hernandez said:

I don't disagree that primary care can be underpaid, but if you think the way to fix that is to equalize the system by cutting specialist pay, then y'all have bought the socialist bull****. We physicians produce all the work and subsequent needed care, yet only account for 4-10%% of totle heathcare costs......even the jack ass CEO who ran my hospital into soon to be bankruptcy was paid significantly more than any of the docs in the hospital. The clipboard nurse administrators make more than the IM docs in my hospital and they do nothing but hand down stupid ass dictates that oly cause me more grief by increasing my paperwork

Making gains by cutting your peers throats will only comeback to haunt you when it's your necks on the block

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This is true, and as I have mentioned before, we should start cutting nurse salaries. Its crazy that there are no cuts there. There is no point in goign to med school to make a crappy salary when you can make a decent living as a nurse.

Dermpath said:

There is no point in goign to med school to make a crappy salary when you can make a decent living as a nurse.

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Have you considered that some people actually want to be doctors and NOT nurses? There's more to life than money, and although your perspective might be different, some people actually chose a certain career because they actually like the job itself, not just the paycheck...

BTW if you DO just want money, I think there's still a pretty good incentive to even just be a Family Practitioner over being a nurse:

Registered Nurses:
http://www.bls.gov/oes/current/oes291111.htm

Mean annual wage: $69,110
Median annual wage: $65,950

Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Mean annual wage: $177,330
Median annual wage: $167,000

Physician Assistants:
http://www.bls.gov/oes/current/oes291071.htm

Mean annual wage: $89,470
Median annual wage: $88,660

Hernandez said:

I don't disagree that primary care can be underpaid, but if you think the way to fix that is to equalize the system by cutting specialist pay, then y'all have bought the socialist bull****. We physicians produce all the work and subsequent needed care, yet only account for 4-10%% of totle heathcare costs......even the jack ass CEO who ran my hospital into soon to be bankruptcy was paid significantly more than any of the docs in the hospital. The clipboard nurse administrators make more than the IM docs in my hospital and they do nothing but hand down stupid ass dictates that oly cause me more grief by increasing my paperwork

Making gains by cutting your peers throats will only comeback to haunt you when it's your necks on the block

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I'll agree that CEOs and other executives are probably paid too much and most definitely deserve cuts (considering they have the responsibility for the hospitals financing, it makes sense that they should be the first on the chopping block) however that's not really what this thread is about.

While I understand the point about not cutting our peers' throats, we have to ask ourselves what is a reasonable salary for specialists, or any doctor for that matter. For example, let's say that hypothetically some specialty on average took home $2 million/year. Maybe you disagree, but to me that seems like an egregious amount, and cuts to that salary would definitely be justified. I'm sure however that there would still be outcries of throat-cutting, etc. just because people don't every like to see their salary cut, no matter how high it was to begin with.

That's an extreme example, but I think it illustrates the point that we have to really think objectively about what should be a reasonable salary. Taking cuts will always be hard, but right now it seems to me that the system is unsustainable in it's current form, and while just cutting in one place won't totally fix the problem, it certainly can help when added up with other things.

aerodoc said:

Have you considered that some people actually want to be doctors and NOT nurses? There's more to life than money, and although your perspective might be different, some people actually chose a certain career because they actually like the job itself, not just the paycheck...

BTW if you DO just want money, I think there's still a pretty good incentive to even just be a Family Practitioner over being a nurse:

Registered Nurses:
http://www.bls.gov/oes/current/oes291111.htm

Mean annual wage: $69,110
Median annual wage: $65,950

Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Mean annual wage: $177,330
Median annual wage: $167,000

Physician Assistants:
http://www.bls.gov/oes/current/oes291071.htm

Mean annual wage: $89,470
Median annual wage: $88,660

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I think those wages are skewed for one. And administrators make a lot more than that. Also, if we make less/the same as nurses, what does that say about our value and how we are viewed by the healthcare industry as what our value is in it? Who would pay a nurse more than a physician?

Of course I wanted to be a dr vs a nurse as well, but it only makes sense that doctors would be compensated better than nurses, dont you think? Or should we have paralegals making more than lawyers too?

Dermpath said:

I think those wages are skewed for one. And administrators make a lot more than that. Also, if we make less/the same as nurses, what does that say about our value and how we are viewed by the healthcare industry as what our value is in it? Who would pay a nurse more than a physician?

Of course I wanted to be a dr vs a nurse as well, but it only makes sense that doctors would be compensated better than nurses, dont you think? Or should we have paralegals making more than lawyers too?

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How are those wages skewed? Even if you look at the 90th percentile of nurses, they still don't make as much as even the 25th percentile of family/general practitioners.

The fact is, MOST nurses aren't administrators, and therefore MOST doctors make far more than MOST nurses. Sure there are exceptions like administrators, but that doesn't mean that as a whole you can say nurses make the same/more than doctors.

I agree that the doctor should be compensated better than the nurse, because they have more responsibility and need much more knowledge and training. I think the wages I posted above reflect that.

aerodoc said:

I'll agree that CEOs and other executives are probably paid too much and most definitely deserve cuts (considering they have the responsibility for the hospitals financing, it makes sense that they should be the first on the chopping block) however that's not really what this thread is about.

While I understand the point about not cutting our peers' throats, we have to ask ourselves what is a reasonable salary for specialists, or any doctor for that matter. For example, let's say that hypothetically some specialty on average took home $2 million/year. Maybe you disagree, but to me that seems like an egregious amount, and cuts to that salary would definitely be justified. I'm sure however that there would still be outcries of throat-cutting, etc. just because people don't every like to see their salary cut, no matter how high it was to begin with.

That's an extreme example, but I think it illustrates the point that we have to really think objectively about what should be a reasonable salary. Taking cuts will always be hard, but right now it seems to me that the system is unsustainable in it's current form, and while just cutting in one place won't totally fix the problem, it certainly can help when added up with other things.

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you do know that many docs are not "salaried" right? Thats one problem there. I know many out pt only pcp who do quiet well, because they know how to run a buisness and get what they are owed. why should I be penalized because the you don't have good billing people?, have a bad payer mix? Aren't efficient in seeing patients? Or whatever reason. It sounds to me that you in particular rather sit there and waller in pity that someone is doing better than you.

You wanna know who I think is over paid? Hospitalists. Especially the ones at my hospital. Base $150k/year for 26 weeks work where I get to hear them bitxh about having to actually do work and they only see ~15 patients/day. And heaven forbid a pt get sick on their service as they feel that sick PTs should either be a) in icu or b) on the services that have residents

Will I make more than a out patient IM doc. Yes, will I make more than a hospitalist yes. But I can guarantee that a) I see more patients and b) i see sicker patients and c) do riskier procedures on sick patients all day long. And by I will not be rich from what I make and I won't have a cozy laid back rheum type life/work style.

So who do you have a beef with?
Neurosurg? I know a neurosurg that likely makes multiples of what you suggested. And guess what, I'd damn near guarantee that no one on this forum works harder that he does. He earns every penny of that.

Anesthesia? Well ok, I think they're idiots at my hospital currently and am not sure they know wtf they're doing,
And theyd rather manage CRNAs than work but they're not all like that. They work long hours and do risky things and on the scheme of things dont make much more than pcp

Gen surg? - horribly under paid

Ortho? Well ok, these dumb jocks may get paid too much cause i just don't like jocks.

Radiology? - how much do they make? Well ok then, you read all your own studies if you don't like them

Derm? They could make money without accepting insurance. That's no their fault there is a huge demand for their services.

Etc etc. honestly. Just who do you think is overpaid and why?

Hernandez said:

Etc etc. honestly. Just who do you think is overpaid and why?

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I don't have a "beef" with anyone, I'm merely discussing the proposed CMS changes, which if you have the time, you can see what the changes entail:

https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-16814.pdf

The table showing changes per specialty is on page 680.

I agree with blue dog in general that this type of change isn't going to do much on the grand scale of things with regards to healthcare cost and access, however I personally think it could help in attracting more students to primary care fields.

Blue Dog said:

It's not us. This is CMS we're talking about.

Personally, I think that just redistributing funds without comprehensive reimbursement and delivery system reform is akin to rearranging the deck chairs on the Titanic.

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I'm aware of the proposed changes and i've read them, and i know many disgruntled PCPs who applaud the rearranging the deck chairs, as frankly, I spend too much time reading SERMO and I had this very argument with likely the laziest of hospitalists in my hospital a few weeks back. He argued that he was a) primary care (bull****, he doesnt do any out patient) and that he's entitled to more pay for his 10-15 patients he sees a day without any procedures and working 26 weeks a year) because he's the primary. he didn't appreciate being called lazy and being told his meger production doesn't warrant a pay increase as his 4100 wRVUs compared to my groups average of 13000 clearly justifies the income differential.

that being said, where I'm moving to is truly a IM run hospital who do a good job of running the services, they do the bulk of the work, and specialists are consulted for every single nit-picky thing. Those are the guys who deserve the pay increase.

the problem isn't what a specialty is worth, it's what each individual physician is worth, as frankly, A PCP who sees 20 pts a day and bills level 3s on all of them should not be making the same as a pcp who does procedures, sees 40+ pts in a long office day and works weekends and covers his patients in the hospital. and of my friends who stayed in Primary care land, they set up their lives to be much more laid back,

I don't think a new mode to justify the out patient primary care who are dealing with multiple co-morbidities and lifestyle modification counseling in a single visit is unwarranted, but it should be done as an upcode to match the level of service, but it shouldn't come from the back of someone else working just as hard.

As a graduating medical student, I wish physicians of all specialties would work together more and argue less among ourselves... It just gives an opportunities for the mid-levels to slowly but surely expand their scope of practice (inappropriately imo) while we continue to fight each other, all while the patient suffers.

Sigh, such are the state of things currently I guess.

hernandez, why do you keep saying "for 26 weeks of work", ahhh ok, you mean when they're working 7 days a week for 12 hour shifts, you really think working an average of 42 hours a week for $150,000 base is overpaid (what is that, around $75/hour)? So we'll add to your list:

Hospitalist? underpaid

bigkahunaburger said:

hernandez, why do you keep saying "for 26 weeks of work", ahhh ok, you mean when they're working 7 days a week for 12 hour shifts, you really think working an average of 42 hours a week for $150,000 base is overpaid (what is that, around $75/hour)? So we'll add to your list:

Hospitalist? underpaid

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In the hospital i did my fellowship in, absolutely. 10-15 low acuity PTs a day barely justifies $150k/year much less the 200k when comparatively cc docs in the same hospital base contract was performing 7200 wRVU getting 275k/year when hospitalists are doing 4100 and getting a base of 200k/year. The value there is less than a productive out pt doc.

Where I'm at, they aren't over paid, but then again they are the back home of the hospital. Where my friends work, again not over paid but they do way more work.

But again. I don't begrudge anyone their pay, but trying to steal others pay via legislation isn't the right way to improve the disparities we see

Yeah damn, I can see how that would be frustrating, I have the utmost respect for CC physicians and hope to be one some day, can't imagine how irritating that must be having to talk to family's about discontinuing life support everyday and seeing that kind of pay discrepancy. I still think IM physicians earn their pay, it's just that perhaps the CC physicians in your example are underpaid, I mean it's hard for me to stomach a CRNA making more than an IM doc, even at a low acuity hospital.

anthroguy said:

Our model of healthcare where specialists are overvalued to a multiple of what a FP earns is unsustainable and unique in the western world. Our model is also inferior. Change is inevitable and you can yell that a midlevel is equivalent to a FP all you want but you would just be tooting their horn as they drive towards parity in ALL fields of medicine.

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I like how it's unsustainable, yet it's completely sustainable for the cash being wasted in electing these idiots into office. On top of that, it's completely sustainable for celebrities AND athletes to make the type of $$ they do. Totally sustainable. I like our priorities.

aerodoc said:

Have you considered that some people actually want to be doctors and NOT nurses? There's more to life than money, and although your perspective might be different, some people actually chose a certain career because they actually like the job itself, not just the paycheck...

BTW if you DO just want money, I think there's still a pretty good incentive to even just be a Family Practitioner over being a nurse:

Registered Nurses:
http://www.bls.gov/oes/current/oes291111.htm

Mean annual wage: $69,110
Median annual wage: $65,950

Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Mean annual wage: $177,330
Median annual wage: $167,000

Physician Assistants:
http://www.bls.gov/oes/current/oes291071.htm

Mean annual wage: $89,470
Median annual wage: $88,660



I'll agree that CEOs and other executives are probably paid too much and most definitely deserve cuts (considering they have the responsibility for the hospitals financing, it makes sense that they should be the first on the chopping block) however that's not really what this thread is about.

While I understand the point about not cutting our peers' throats, we have to ask ourselves what is a reasonable salary for specialists, or any doctor for that matter. For example, let's say that hypothetically some specialty on average took home $2 million/year. Maybe you disagree, but to me that seems like an egregious amount, and cuts to that salary would definitely be justified. I'm sure however that there would still be outcries of throat-cutting, etc. just because people don't every like to see their salary cut, no matter how high it was to begin with.

That's an extreme example, but I think it illustrates the point that we have to really think objectively about what should be a reasonable salary. Taking cuts will always be hard, but right now it seems to me that the system is unsustainable in it's current form, and while just cutting in one place won't totally fix the problem, it certainly can help when added up with other things.

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Ah, a naive med student. Wonderful. I hope you provide all sorts of pro bono care. Oh wait, soon you will be.

aerodoc said:

Have you considered that some people actually want to be doctors and NOT nurses? There's more to life than money, and although your perspective might be different, some people actually chose a certain career because they actually like the job itself, not just the paycheck...

BTW if you DO just want money, I think there's still a pretty good incentive to even just be a Family Practitioner over being a nurse:

Registered Nurses:
http://www.bls.gov/oes/current/oes291111.htm

Mean annual wage: $69,110
Median annual wage: $65,950

Family and General Practitioners:
http://www.bls.gov/oes/current/oes291062.htm

Mean annual wage: $177,330
Median annual wage: $167,000

Physician Assistants:
http://www.bls.gov/oes/current/oes291071.htm

Mean annual wage: $89,470
Median annual wage: $88,660

I'll agree that CEOs and other executives are probably paid too much and most definitely deserve cuts (considering they have the responsibility for the hospitals financing, it makes sense that they should be the first on the chopping block) however that's not really what this thread is about.

While I understand the point about not cutting our peers' throats, we have to ask ourselves what is a reasonable salary for specialists, or any doctor for that matter. For example, let's say that hypothetically some specialty on average took home $2 million/year. Maybe you disagree, but to me that seems like an egregious amount, and cuts to that salary would definitely be justified. I'm sure however that there would still be outcries of throat-cutting, etc. just because people don't every like to see their salary cut, no matter how high it was to begin with.

That's an extreme example, but I think it illustrates the point that we have to really think objectively about what should be a reasonable salary. Taking cuts will always be hard, but right now it seems to me that the system is unsustainable in it's current form, and while just cutting in one place won't totally fix the problem, it certainly can help when added up with other things.

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1. There is a reason why the US medical talents are one of the best in the world. Excellence ain't come cheap.

2. What is so great about this country is that you can be successful by your own merits.
We shouldn't be punished for being successful. We shouldn't be taxed, penalized, or whateva you wanna call it for being good at what we do and for the sacrifices that we make. It seems to me we are moving to a socialist healthcare. That is a slippery slope, Obama.

3. CEOs and other executives are well compensated because of the high stakes of their responsibilities.

Food for thought, trash collectors make 60K/year, USPS mailmen make 55K/year plus benefits and retirement. Sadly, these jobs don't even need half a brain to perform, but they do pay more than that of a school teacher....