Are Specialists Over-Worked?

[zut212]

It's a known fact that we have too many specialists in the USA: 70% of our MDs are specialists and the rest are PCPs.

The specialists make significantly more money than PCPs.

Here are my questions:
1. Are specialists over-worked?
2. Is there too much demand for their services?

Something doesn't make sense to me, given that I'm viewing all this from the lense of supply-and-demand.

Another question that I have concerns the shortage of PCPs that I've asked in another post.

3. If there is such a shortage of PCPs in the USA, why is their compensation much lower than that of specialists?

If there is a shortage of plumbers (which there seems to be), their salary goes UP, and here in Boston, it's more than $80K/year!

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[MOHS_01]

It's a known fact that we have too many specialists in the USA: 70% of our MDs are specialists and the rest are PCPs.

The specialists make significantly more money than PCPs.

Here are my questions:
1. Are specialists over-worked?
2. Is there too much demand for their services?

Something doesn't make sense to me, given that I'm viewing all this from the lense of supply-and-demand.

Another question that I have concerns the shortage of PCPs that I've asked in another post.

3. If there is such a shortage of PCPs in the USA, why is their compensation much lower than that of specialists?

If there is a shortage of plumbers (which there seems to be), their salary goes UP, and here in Boston, it's more than $80K/year!

Jesus, son, why do you do this to yourself?

1. It is impossible to rationally apply market economics to a non-market system.
2. Your first statement in no way represents "a fact" -- learn to discern the difference between "fact" and "opinion".
3. Your demonstration of cognitive dissonance is truly impressive. You decry the "fact" that there are "too many specialists" in one moment.... and then, in the same breath, question if there are enough present to satisfy the demand?

Physician compensation is multifactorial. We, for the most part, are not salaried employees competing on the basis of relative demand. We are compensated based upon a multitude of factors including, but not limited to:
- procedure mix
- payer mix
- volume
- geographic costs of practice differences
- individual costs of practice differences
- any non-traditional CPT based revenue streams

That's about it. [money in] - [money out] = pretax income. "Supply & demand" really only enter the picture in terms of the volume allowed. Given that our cost -- and pricing -- structures are largely fixed, the relative composition of the procedure / payer mix and the volume of services rendered are the largest determinants of physician compensation. A busy FP/IM/Peds with an advantageous payer mix can easily outperform a neurosurgeon, orthopod, dermatologist, or radiologist who is not busy.

 

[zut212]

Jesus, son, why do you do this to yourself?

1. It is impossible to rationally apply market economics to a non-market system.
2. Your first statement in no way represents "a fact" -- learn to discern the difference between "fact" and "opinion".
3. Your demonstration of cognitive dissonance is truly impressive. You decry the "fact" that there are "too many specialists" in one moment.... and then, in the same breath, question if there are enough present to satisfy the demand?

I'm frankly quite surprised that you're not aware that we have an acute shortage of PCPs and too many specialists. In the USA, 70% of our doctors are specialists and the remaining 30% are PCPs, but it should be the other way around.

Now, it's possible that we have an absolute shortage of BOTH (i.e., we need 2,000,000 total MDs: 600K PCPs and 1400K Specialists, but instead, we have 240K PCPs and 560K Specialists ----> I'm pulling out numbers randomly, but hopefully, you understand what's going on).

By the way, of course I asked if specialists were overworked given that their numbers were too high. I WAS CONFUSED AS THIS DOESN'T MAKE SENSE TO ME. I WAS HOPING THAT SOMEONE COULD CLARIFY IF SPECIALISTS are over-worked given that their numbers are quite high.

What part of question asking do you not understand? Sorry to see your MD degree isn't working out for you.

 

[VA Hopeful Dr]

I'm frankly quite surprised that you're not aware that we have an acute shortage of PCPs and too many specialists. In the USA, 70% of our doctors are specialists and the remaining 30% are PCPs, but it should be the other way around.

Now, it's possible that we have an absolute shortage of BOTH (i.e., we need 2,000,000 total MDs: 600K PCPs and 1400K Specialists, but instead, we have 240K PCPs and 560K Specialists ----> I'm pulling out numbers randomly, but hopefully, you understand what's going on).

By the way, of course I asked if specialists were overworked given that their numbers were too high. I WAS CONFUSED AS THIS DOESN'T MAKE SENSE TO ME. I WAS HOPING THAT SOMEONE COULD CLARIFY IF SPECIALISTS are over-worked given that their numbers are quite high.

What part of question asking do you not understand? Sorry to see your MD degree isn't working out for you.

Wow, you're quite the jackass. I'll try and help you out, although I don't know why I bother since you obviously know more than us doctors.

Pay - Medicare (which is what everyone bases their fee schedule on) pays better for procedures than for thinking. PCPs don't do many procedures, specialists do.

Specialists seeming overworked - Part of the problem (though certainly not all of it) lies in us PCPs not having the time to deal with complicated patients. If I have a choice between spending 40 minutes on a patient with 5 different chronic diseases and spending 20 minutes on 2 patients each with 2 chronic conditions, which do you think most PCPs would choose?

PCP Shortage - As mohs explained, doctors are not plumbers nor do we follow anything close to a free market.

 

[MOHS_01]

I'm frankly quite surprised that you're not aware that we have an acute shortage of PCPs and too many specialists. In the USA, 70% of our doctors are specialists and the remaining 30% are PCPs, but it should be the other way around.

Now, it's possible that we have an absolute shortage of BOTH (i.e., we need 2,000,000 total MDs: 600K PCPs and 1400K Specialists, but instead, we have 240K PCPs and 560K Specialists ----> I'm pulling out numbers randomly, but hopefully, you understand what's going on).

By the way, of course I asked if specialists were overworked given that their numbers were too high. I WAS CONFUSED AS THIS DOESN'T MAKE SENSE TO ME. I WAS HOPING THAT SOMEONE COULD CLARIFY IF SPECIALISTS are over-worked given that their numbers are quite high.

What part of question asking do you not understand? Sorry to see your MD degree isn't working out for you.

I hope, for your sake, that you have connections on an admissions committee....

Later, when I have a little more time, I will walk you through this s-l-o-w-l-y.

Until that time, why don't you occupy yourself with finding us all some data that cardiologists, urologists, orthopods, neurosurgeons -- hell, anyone other than pathology -- who decry not having enough work to do. Perhaps you can start with the average hours in clinical duties per week. After that you can research the number of visits per week. You can then look at RVUs performed. An easy place to start would the the AMA's socioeconomic survey book that is published annually (at least it used to be). Please be kind enough to come back and report your empirical evidence supporting "we have too many specialists" political propaganda/talking points. Thanks.

 

[zut212]

I hope, for your sake, that you have connections on an admissions committee....

Later, when I have a little more time, I will walk you through this s-l-o-w-l-y.

Until that time, why don't you occupy yourself with finding us all some data that cardiologists, urologists, orthopods, neurosurgeons -- hell, anyone other than pathology -- who decry not having enough work to do. Perhaps you can start with the average hours in clinical duties per week. After that you can research the number of visits per week. You can then look at RVUs performed. An easy place to start would the the AMA's socioeconomic survey book that is published annually (at least it used to be). Please be kind enough to come back and report your empirical evidence supporting "we have too many specialists" political propaganda/talking points. Thanks.

In your opinion:
a. Do we have too few specialists and too few PCPs?
b. Do we have too few specialists and too many PCPs?
c. Do we have too too many specialists and too few PCPs?
d. Do we have too too many specialists and too many PCPs?

 

[MOHS_01]

In your opinion:
a. Do we have too few specialists and too few PCPs?
b. Do we have too few specialists and too many PCPs?
c. Do we have too too many specialists and too few PCPs?
d. Do we have too too many specialists and too many PCPs?

How about:

(e). No way to answer the question with the information available.

You are asking a question that has layers upon layers of underlying variables... and simply cannot be answered definitively. If, however, we make some simple assumptions:

1. Healthcare financing structures remains frozen in time as they exist today.
2. Coverage remains the same as today.
3. Covered services remain frozen as they are today.
4. Insurance remains "as affordable" as it is today.
etc.

Hopefully you are beginning to see that these are unrealistic assumptions... but, given those, and being forced to choose between the options listed above -- I would still have to say (e) Not enough information.

We probably have enough providers in the system, just a maldistribution of them. We have too many providers in some locations that predictably leads to an increased utilization and/or intensity of services. We have a relative shortage in some specialties and some locations that results in long wait times and much popularized complaints.

Beyond that, any effort to answer this question is one of central planning -- something that I am not particularly fond of. You need to understand that the need for healthcare services is a function of funding, demographics, disease burden, and probably any number of other factors that I have not even considered. Any change in any of these factors will have a consequential effect on the perceived need.



By what metric are you going to make your decision? Appointment wait times?

 

[zut212]

How about:

(e). No way to answer the question with the information available.

You are asking a question that has layers upon layers of underlying variables... and simply cannot be answered definitively. If, however, we make some simple assumptions:

1. Healthcare financing structures remains frozen in time as they exist today.
2. Coverage remains the same as today.
3. Covered services remain frozen as they are today.
4. Insurance remains "as affordable" as it is today.
etc.

Hopefully you are beginning to see that these are unrealistic assumptions... but, given those, and being forced to choose between the options listed above -- I would still have to say (e) Not enough information.

We probably have enough providers in the system, just a maldistribution of them. We have too many providers in some locations that predictably leads to an increased utilization and/or intensity of services. We have a relative shortage in some specialties and some locations that results in long wait times and much popularized complaints.

Beyond that, any effort to answer this question is one of central planning -- something that I am not particularly fond of. You need to understand that the need for healthcare services is a function of funding, demographics, disease burden, and probably any number of other factors that I have not even considered. Any change in any of these factors will have a consequential effect on the perceived need.



By what metric are you going to make your decision? Appointment wait times?

I invite others who are more brave to answer this question.

 

[MOHS_01]

I invite others who are more brave to answer this question.

Ugh... trying to discuss anything with you is like playing cards with my brother's kids.

I am going to make another attempt at helping you out, however -- consider it a primer to remedial economics for mental giants such as yourself: your attempt to answer a supply / demand equation can neither be empirically determined nor quantitatively derived without taking pricing into consideration.

We have plenty of providers if the pricing the payer employs is adequate. You do not hear a ton of complaints coming from those with high paying private insurances. Adding supply to the equation without addressing the pricing disparity does precious little to shift the supply/demand curve; all that is accomplished is increased (supply driven) demand... and an increased competition for the better payers.