Anyone know if when CMS proposes changes, how likely they are to happen? These proposed changes are set to happen in 2010, and sound kind of serious for rad oncs and their business models, etc. I kinda figured CMS always proposes cuts to rad onc of some kind over the years, and it rarely gets enacted, but with this particular proposal (along with all of the other proposed changes), there seems to be a lot more press.
CMS proposed reimbursement cuts to Rad Onc by 20%?
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I posted this info in a different thread.
Look on page 716-717 of the official CMS document.
These are the worst hit fields:
rad onc (-19%)
nuc med (-13%)
cards (-11%)
rads (-11%)
IR (-10%)
Look on page 716-717 of the official CMS document.
These are the worst hit fields:
rad onc (-19%)
nuc med (-13%)
cards (-11%)
rads (-11%)
IR (-10%)
1 TOTAL $ 77,744 0% 1% 0% 1%
2 ALLERGY/IMMUNOLOGY $ 171 0% 0% -2% -3%
3 ANESTHESIOLOGY $ 1,713 0% 5% 1% 6%
4 CARDIAC SURGERY $ 371 -1% -1% 3% -2%
5 CARDIOLOGY $ 7,179 0% -10% -1% -11%
6 COLON AND RECTAL SURGERY $ 129 -1% 5% 1% 5%
7 CRITICAL CARE $ 221 0% 3% 1% 3%
8 DERMATOLOGY $ 2,504 0% 2% 0% 3%
9 EMERGENCY MEDICINE $ 2,395 0% 2% 0% 2%
10 ENDOCRINOLOGY $ 370 -1% 3% 0% 3%
11 FAMILY PRACTICE $ 5,055 2% 5% 1% 8%
12 GASTROENTEROLOGY $ 1,779 -1% 1% 0% 0%
13 GENERAL PRACTICE $ 719 1% 5% 0% 6%
14 GENERAL SURGERY $ 2,213 -1% 4% 1% 4%
15 GERIATRICS $ 167 1% 6% 1% 8%
16 HAND SURGERY $ 89 -1% 4% 0% 3%
17 HEMATOLOGY/ONCOLOGY $ 1,888 0% -5% -1% -6%
18 INFECTIOUS DISEASE $ 549 -1% 4% 1% 3%
19 INTERNAL MEDICINE $ 10,061 1% 4% 1% 6%
20 INTERVENTIONAL PAIN MANAGEMENT. $ 352 -1% 7% 0% 6%
21 INTERVENTIONAL RADIOLOGY $ 227 0% -10% 0% -10%
22 NEPHROLOGY $ 1,789 0% 1% 1% 2%
23 NEUROLOGY $ 1,417 -2% 6% 0% 3%
24 NEUROSURGERY $ 586 -1% 3% 1% 2%
25 NUCLEAR MEDICINE $ 72 0% -12% -2% -13%
26 OBSTETRICS/GYNECOLOGY $ 615 0% 1% 0% 1%
27 OPHTHALMOLOGY $ 4,736 0% 11% 0% 11%
28 ORTHOPEDIC SURGERY $ 3,257 0% 4% 0% 3%
29 OTOLARNGOLOGY $ 926 -1% 3% -1% 1%
30 PATHOLOGY $ 985 0% -1% 0% 0%
31 PEDIATRICS $ 64 1% 4% 0% 4%
32 PHYSICAL MEDICINE $ 816 0% 7% 0% 7%
33 PLASTIC SURGERY $ 278 -1% 5% 1% 5%
34 PSYCHIATRY $ 1,071 0% 2% 1% 3%
35 PULMONARY DISEASE $ 1,753 -1% 3% 1% 3%
36 RADIATION ONCOLOGY $ 1,799 0% -17% -1% -19%
37 RADIOLOGY $ 5,254 0% -10% -1% -11%
38 RHEUMATOLOGY $ 494 0% 0% 0% -1%
39 THORACIC SURGERY $ 389 -1% 0% 3% 2%
40 UROLOGY $ 1,989 0% -6% 0% -7%
41 VASCULAR SURGERY $ 685 -1% -1% 0% -1%
42 AUDIOLOGIST $ 35 0% -4% -7% -10%
43 CHIROPRACTOR*** $ 700 0% 4% 1% 5%
44 CLINICAL PSYCHOLOGIST $ 533 0% -7% 0% -7%
45 CLINICAL SOCIAL WORKER $ 353 0% -6% 1% -6%
46 NURSE ANESTHETIST $ 772 0% 2% 0% 2%
47 NURSE PRACTITIONER $ 1,004 1% 5% 1% 7%
48 OPTOMETRY $ 834 1% 11% 0% 12%
49 ORAL/MAXILLOFACIAL SURGERY $ 35 -1% 3% -1% 1%
50 PHYSICAL/OCCUPATIONAL THERAPY $ 1,857 0% 10% 0% 10%
51 PHYSICIAN ASSISTANT $ 749 0% 4% 0% 5%
52 PODIATRY $ 1,656 1% 7% -1% 6%
53 DIAGNOSTIC TESTING FACILITY $ 1,044 0% -19% -5% -24%
54 INDEPENDENT LABORATORY $ 960 0% -4% -1% -5%
55 PORTABLE X-RAY SUPPLIER $ 85 0% -8% -2% -11%
2 ALLERGY/IMMUNOLOGY $ 171 0% 0% -2% -3%
3 ANESTHESIOLOGY $ 1,713 0% 5% 1% 6%
4 CARDIAC SURGERY $ 371 -1% -1% 3% -2%
5 CARDIOLOGY $ 7,179 0% -10% -1% -11%
6 COLON AND RECTAL SURGERY $ 129 -1% 5% 1% 5%
7 CRITICAL CARE $ 221 0% 3% 1% 3%
8 DERMATOLOGY $ 2,504 0% 2% 0% 3%
9 EMERGENCY MEDICINE $ 2,395 0% 2% 0% 2%
10 ENDOCRINOLOGY $ 370 -1% 3% 0% 3%
11 FAMILY PRACTICE $ 5,055 2% 5% 1% 8%
12 GASTROENTEROLOGY $ 1,779 -1% 1% 0% 0%
13 GENERAL PRACTICE $ 719 1% 5% 0% 6%
14 GENERAL SURGERY $ 2,213 -1% 4% 1% 4%
15 GERIATRICS $ 167 1% 6% 1% 8%
16 HAND SURGERY $ 89 -1% 4% 0% 3%
17 HEMATOLOGY/ONCOLOGY $ 1,888 0% -5% -1% -6%
18 INFECTIOUS DISEASE $ 549 -1% 4% 1% 3%
19 INTERNAL MEDICINE $ 10,061 1% 4% 1% 6%
20 INTERVENTIONAL PAIN MANAGEMENT. $ 352 -1% 7% 0% 6%
21 INTERVENTIONAL RADIOLOGY $ 227 0% -10% 0% -10%
22 NEPHROLOGY $ 1,789 0% 1% 1% 2%
23 NEUROLOGY $ 1,417 -2% 6% 0% 3%
24 NEUROSURGERY $ 586 -1% 3% 1% 2%
25 NUCLEAR MEDICINE $ 72 0% -12% -2% -13%
26 OBSTETRICS/GYNECOLOGY $ 615 0% 1% 0% 1%
27 OPHTHALMOLOGY $ 4,736 0% 11% 0% 11%
28 ORTHOPEDIC SURGERY $ 3,257 0% 4% 0% 3%
29 OTOLARNGOLOGY $ 926 -1% 3% -1% 1%
30 PATHOLOGY $ 985 0% -1% 0% 0%
31 PEDIATRICS $ 64 1% 4% 0% 4%
32 PHYSICAL MEDICINE $ 816 0% 7% 0% 7%
33 PLASTIC SURGERY $ 278 -1% 5% 1% 5%
34 PSYCHIATRY $ 1,071 0% 2% 1% 3%
35 PULMONARY DISEASE $ 1,753 -1% 3% 1% 3%
36 RADIATION ONCOLOGY $ 1,799 0% -17% -1% -19%
37 RADIOLOGY $ 5,254 0% -10% -1% -11%
38 RHEUMATOLOGY $ 494 0% 0% 0% -1%
39 THORACIC SURGERY $ 389 -1% 0% 3% 2%
40 UROLOGY $ 1,989 0% -6% 0% -7%
41 VASCULAR SURGERY $ 685 -1% -1% 0% -1%
42 AUDIOLOGIST $ 35 0% -4% -7% -10%
43 CHIROPRACTOR*** $ 700 0% 4% 1% 5%
44 CLINICAL PSYCHOLOGIST $ 533 0% -7% 0% -7%
45 CLINICAL SOCIAL WORKER $ 353 0% -6% 1% -6%
46 NURSE ANESTHETIST $ 772 0% 2% 0% 2%
47 NURSE PRACTITIONER $ 1,004 1% 5% 1% 7%
48 OPTOMETRY $ 834 1% 11% 0% 12%
49 ORAL/MAXILLOFACIAL SURGERY $ 35 -1% 3% -1% 1%
50 PHYSICAL/OCCUPATIONAL THERAPY $ 1,857 0% 10% 0% 10%
51 PHYSICIAN ASSISTANT $ 749 0% 4% 0% 5%
52 PODIATRY $ 1,656 1% 7% -1% 6%
53 DIAGNOSTIC TESTING FACILITY $ 1,044 0% -19% -5% -24%
54 INDEPENDENT LABORATORY $ 960 0% -4% -1% -5%
55 PORTABLE X-RAY SUPPLIER $ 85 0% -8% -2% -11%
D
deleted4401
This sounds horrible.
I looked at the document.
What does PE RVU represent? It says "practice expenses, not including malpractice," but I can't determine what this represents as far as the work we do. Of the 20% cut, 17% comes from this value.
Is specific services being de-valued? I.e. IMRT being decreased and 3D-CRT staying stable or increased? Or is it across the board cuts?
What can be done? We are probably the smallest population of physicians, and we're getting hit the hardest. Maybe because they know our lobby can't do very much.
-S
I looked at the document.
What does PE RVU represent? It says "practice expenses, not including malpractice," but I can't determine what this represents as far as the work we do. Of the 20% cut, 17% comes from this value.
Is specific services being de-valued? I.e. IMRT being decreased and 3D-CRT staying stable or increased? Or is it across the board cuts?
What can be done? We are probably the smallest population of physicians, and we're getting hit the hardest. Maybe because they know our lobby can't do very much.
-S
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See the news blurbs from ASTRO below. I don't understand the breakdown of the cuts completely but I think I have a vague sense. As best as I can tell a big chunk of the cuts comes from the technical component, with the change in the "equipment usage assumption." This would affect the technical component for pretty much everything that we do. (I think it will also affect diagnostic radiology, and is probably what CMS is really targeting.) I think the change in consultation codes will affect the professional component for us and every other specialty but we are getting hit twice and therefore are the worst off. I think the best we could hope for is to have our equipment considered differently than the diagnostic machines, but that's probably a long shot.
The final version of the CMS rules are usually different than the initial proposal, but I'm pretty sure they will be very painful for us this year even under the best case scenarios....
CMS proposes significant cuts to radiation oncology reimbursement
On July 1, CMS announced proposed changes to the Medicare policies and payment rates for physician services including radiation oncology that may go into effect January 1, 2010. There are proposals within the proposed CMS regulation that will significantly impact radiation oncology reimbursement. Our preliminary analysis shows a close to 20 percent reduction to radiation oncologists' payments.
CMS believes the equipment usage assumption – part of the formula CMS uses to calculate Medicare payments – of 50 percent is significantly understated. CMS cited the March 2009 MedPac report to Congress on this issue. Therefore, within the regulation, CMS is proposing to change the equipment usage assumption from the current 50 percent usage rate to a 90 percent usage rate for equipment priced over $1 million. This proposed change will reduce payments for radiation oncology procedures, including brachytherapy, conventional 3D treatments, IMRT, SRS, SBRT and IGRT.
CMS is also proposing to use the recently collected AMA Physician Practice Information (PPI) survey data to establish Medicare payments starting January 1, 2010. The PPI survey was conducted by the AMA in conjunction with more than 30 medical specialties to collect data on physician practice expenses. Using the survey data will result in significant redistributive effects on Medicare payments. And although the radiation oncology practice expense per hour is proposed to increase from the current radiation oncology rate, a reduction in payment is scheduled.
Also within the regulation, CMS proposed to remove drugs from the SGR calculation, a big win for ASTRO and the entire house of medicine. Although CMS estimates the physician update will result in a calendar year 2010 conversion factor of $28.3208 and a PFS update of –21.5 percent, this action will substantially reduce the legislative cost of congressional proposals to reform physician payments and lessen the forecast SGR cuts in future years.
These proposed reductions in radiation oncology Medicare payments are not appropriate or sustainable. ASTRO will work to prevent these dramatic cuts from being implemented January 1, 2010. ASTRO will conduct a complete analysis of the regulations and provide a more detailed analysis to ASTRO members. A rule briefing will also be held for ASTRO members in early August. If you have any questions, please contact the ASTRO Health Policy Department by e-mail or at 1-800-962-7876.
House releases draft health reform bill
House Democrats released a draft health reform bill June 19 to reform the sustainable growth rate formula while providing physicians with a payment update tied to medical inflation for 2010. In future years, payment rates for primary care services would be allowed to grow by 2 percent while all other services would be limited to a 1 percent increase. One important provision would also require entities that bill Medicare to report ownership interests by physicians, which could help with our arguments on self-referral. The draft increases the equipment utilization rate from 50 percent to 75 percent for imaging services, described as X-ray, ultrasound, nuclear medicine, magnetic resonance imaging, computed tomography and fluoroscopy, but excludes diagnostic and screening mammography. This provision dealing with utilization is far better for radiation oncology than the CMS proposal. ASTRO continues to work with Congress to ensure that radiation therapy is not included in these cuts targeting diagnostic imaging. The bill also prevents health insurers from excluding coverage for patients with pre-existing conditions. As the House bill moves forward, ASTRO continues to push lawmakers to include language addressing ASTRO's legislative priority of closing the self-referral loophole for radiation therapy. For more information, contact Dave Adler, assistant director of government relations.
The final version of the CMS rules are usually different than the initial proposal, but I'm pretty sure they will be very painful for us this year even under the best case scenarios....
CMS proposes significant cuts to radiation oncology reimbursement
On July 1, CMS announced proposed changes to the Medicare policies and payment rates for physician services including radiation oncology that may go into effect January 1, 2010. There are proposals within the proposed CMS regulation that will significantly impact radiation oncology reimbursement. Our preliminary analysis shows a close to 20 percent reduction to radiation oncologists' payments.
CMS believes the equipment usage assumption – part of the formula CMS uses to calculate Medicare payments – of 50 percent is significantly understated. CMS cited the March 2009 MedPac report to Congress on this issue. Therefore, within the regulation, CMS is proposing to change the equipment usage assumption from the current 50 percent usage rate to a 90 percent usage rate for equipment priced over $1 million. This proposed change will reduce payments for radiation oncology procedures, including brachytherapy, conventional 3D treatments, IMRT, SRS, SBRT and IGRT.
CMS is also proposing to use the recently collected AMA Physician Practice Information (PPI) survey data to establish Medicare payments starting January 1, 2010. The PPI survey was conducted by the AMA in conjunction with more than 30 medical specialties to collect data on physician practice expenses. Using the survey data will result in significant redistributive effects on Medicare payments. And although the radiation oncology practice expense per hour is proposed to increase from the current radiation oncology rate, a reduction in payment is scheduled.
Also within the regulation, CMS proposed to remove drugs from the SGR calculation, a big win for ASTRO and the entire house of medicine. Although CMS estimates the physician update will result in a calendar year 2010 conversion factor of $28.3208 and a PFS update of –21.5 percent, this action will substantially reduce the legislative cost of congressional proposals to reform physician payments and lessen the forecast SGR cuts in future years.
These proposed reductions in radiation oncology Medicare payments are not appropriate or sustainable. ASTRO will work to prevent these dramatic cuts from being implemented January 1, 2010. ASTRO will conduct a complete analysis of the regulations and provide a more detailed analysis to ASTRO members. A rule briefing will also be held for ASTRO members in early August. If you have any questions, please contact the ASTRO Health Policy Department by e-mail or at 1-800-962-7876.
House releases draft health reform bill
House Democrats released a draft health reform bill June 19 to reform the sustainable growth rate formula while providing physicians with a payment update tied to medical inflation for 2010. In future years, payment rates for primary care services would be allowed to grow by 2 percent while all other services would be limited to a 1 percent increase. One important provision would also require entities that bill Medicare to report ownership interests by physicians, which could help with our arguments on self-referral. The draft increases the equipment utilization rate from 50 percent to 75 percent for imaging services, described as X-ray, ultrasound, nuclear medicine, magnetic resonance imaging, computed tomography and fluoroscopy, but excludes diagnostic and screening mammography. This provision dealing with utilization is far better for radiation oncology than the CMS proposal. ASTRO continues to work with Congress to ensure that radiation therapy is not included in these cuts targeting diagnostic imaging. The bill also prevents health insurers from excluding coverage for patients with pre-existing conditions. As the House bill moves forward, ASTRO continues to push lawmakers to include language addressing ASTRO's legislative priority of closing the self-referral loophole for radiation therapy. For more information, contact Dave Adler, assistant director of government relations.
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From what I can tell, PE RVU is separate from the professional fees. I think it's probably part of the technical component (perhaps a facility fee for the overhead of the practice).
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Robin Hood aka Obama will guarantee this will go down because of the disproptionate income of specialists vs generalists. Lets put it this way as someone put on the forums at auntminnie.com
New Presidential Administration with Clout + Poor Economy + Soaring Cost of Medical Imaging (i.e. this is why Cardiologists, Radiologists, and Radiation Oncologists were singled out) + Primary Care Physicians that have clamored for equal pay + AMA is on board + Medicare is on board = Done DEAL.
Anyone notice that specialties such as Anesthesiology, Dermatology, and Neurology actually get a bump in the new medicare plan?
I'll put it this way. With all of these specialties that hate Cardiologists and Radiologists this will be a laydown. Cardiology has strong political clout but their membership number dwarfs the internal medicine, pediatric, and family medicine physicians combined.
The sad thing is that Radiation Oncology got wrongfully lumped with the hated duo of Radiology and Cardiology. There are not enough radiation oncologists to fight this.
If you add it all up. The most competitive specialties in the next 5-10 years will be Dermatology, Plastic Surgery, Anesthesiology, and the new specialty known as Pain Medicine.
Radiology and Radiation Oncology will no longer attract the same caliber of students because of the huge medicare cuts. If I was attracted to Oncology I would rather go via the hematology-oncology route because of the ability to effectively medically treat the patient and take care of the patient in the hospital.
New Presidential Administration with Clout + Poor Economy + Soaring Cost of Medical Imaging (i.e. this is why Cardiologists, Radiologists, and Radiation Oncologists were singled out) + Primary Care Physicians that have clamored for equal pay + AMA is on board + Medicare is on board = Done DEAL.
Anyone notice that specialties such as Anesthesiology, Dermatology, and Neurology actually get a bump in the new medicare plan?
I'll put it this way. With all of these specialties that hate Cardiologists and Radiologists this will be a laydown. Cardiology has strong political clout but their membership number dwarfs the internal medicine, pediatric, and family medicine physicians combined.
The sad thing is that Radiation Oncology got wrongfully lumped with the hated duo of Radiology and Cardiology. There are not enough radiation oncologists to fight this.
If you add it all up. The most competitive specialties in the next 5-10 years will be Dermatology, Plastic Surgery, Anesthesiology, and the new specialty known as Pain Medicine.
Radiology and Radiation Oncology will no longer attract the same caliber of students because of the huge medicare cuts. If I was attracted to Oncology I would rather go via the hematology-oncology route because of the ability to effectively medically treat the patient and take care of the patient in the hospital.
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Just want to put this out there as no one seems to see this coming:
If doctors do not band together and instead fight for the scraps on obama's medicare table, we will be our own undoing. PCPs are so excited to take 5-8% from the specialists, but that just highlights how this is all about the money. Mark my words - when a study comes out and shows that a PA or NP can do the same job with similar outcomes but for less, the day of the PCP will be finished. Furthermore, the day tort reform happens is the end of radiology since tort reform is all that prevents outsourcing to India, Mexico, etc (the lawyers here have to have someone to hold liable for bad reads). While we fight for scraps from Obama's table, he and his lawyer legislature buddies reap the benefits....
Obama gets paid 400,000 plus everything is covered annually for him - so he walks out of the presidency with 1.2mil in the bank for each term.
Senators according to wikipedia:
The annual salary of each senator, as of 2009, is $174,000;[8] the President pro tempore and party leaders receive $193,400.[9] In June 2003, at least 40 of the then-senators were millionaires.[10] In addition to their salaries, senators' retirement and health benefits are identical to other federal employees, and are fully vested after five years of service.[9]
House of Rep According to wikipedia:
As of January 2009, the annual salary of each Representative is $174,000.[7] The Speaker of the House and the Majority and Minority Leaders earn more, $223,500 for the Speaker and $193,400 for their party leaders (the same as Senate leaders). A cost-of-living-adjustment (COLA) increase takes effect annually unless Congress votes to not accept it. Congress sets members' salaries; however, the Twenty-seventh Amendment to the United States Constitution prohibits a change in salary (but not COLA[8]) from taking effect until after the next general election. Representatives are eligible for lifetime benefits after serving for five years, including a pension, health benefits, and social security benefits.[9]
Where are their salary and benefit cuts like the rest of the country??? They go to law school for 3 years - three years people and then set the laws regarding our profession! They dont care about how hard we work to get into and through medical school, to get into and through residency and during work - nor do they care about our massive med school debt. You think increasing a family doc's salary from 135,000 to 150,000 will make people want to go into family med despite 200-300K in loans???? Where is our incentive to work more hours than any other profession out there?
People get paid for how much training they go through - that and supply and demand. This is why taxi drivers get paid less than PhD engineers and why docs with extensive postgrad training get paid more than PhD engineers - etc. The point is that if we do not band together as a profession and point the blame back in the direction where is belongs, we will be scape goated and sent to the slaughter.
Where does blame truly lie?
1. American people: there are consequences to your actions. In an ideal world, the government would pay for you pneumonectomy, XRT, chemo and hospice for your lung cancer (despite years of pleading with you to help you to try to quit), but the reality is that we have a limited amount of resources. For the low income, welfare lady who is G8P9, well, I am not trying to punish the kids, but get a job and stop with the kids. We all have to be smart, responsible adults. You want that flat screen TV or that house you cannot afford, but you dont think you have to pay for healthcare - well that is not how the economy works. You pay for goods and services or else you are stealing. You want your treatment for diabetic neuropathy/nephropathy/retinopathy/CAD? OK fine, but you need to make the effort to take your meds, eat right and exercise. We need to say, look well will pay for you assuming you keep you HbA1c in this range -we are not miracle workers and money does not grow on trees.
2. Insurance Companies: they are a necessary part of the system, but would have to jack prices up less if people paid for their bills. This is where number 1 plays in. You are a drunk who comes in for detox, DTs, cirrhosis every month, well, insurance cannot pay for this. In reality, insurance does not pay for this - the working population does. All insurance companies do is pool funds to allocate them when people need them. They do not make money out of thin air.
3. Drug companies - they are the only ones who do the R and D. If you want cheap drugs, taxes must be raised to support government funded R and D. People do not work for free - especially highly trained people such as the PhDs involved in R and D.
4. Lawyers - They are a necessary part of the system, but those ambulance chasers must be stopped. There needs to be legislation to disbar all lawyers found to bring frivolous suits against docs. Furthermore, people need to realize the same thing I said earlier about this - when you award a patient 14 million dollars for something that is not truly worth that cost, the rest of the working population will have to pay for this. Malpractice insurance rises, which makes hospitals, docs and insurance raise prices which makes premiums for hard working people go up. Money is not made out of thin air despite what Obama seems to say/do.
I was somewhat in the middle about Obama at the start, but this socialism and scape goating has got to stop! We need to take control of this problem NOW. He has inserted some government control into the banking, auto, housing and insurance industries - now he is proposing what is ultimately a complete take-over of medicine.
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I am sure this will generate plenty of discussion. Just one comment- a law degree is not a requirement for senators, representatives, VPs or presidents.
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Good - I hope this generates discussion - one way or the other. I know that a law degree is not a prereq for government, but very few docs go into government to make policy and so by default, the policy makers are lawyers with envy of docs. Many of them see docs as targets and pockets for income. That said, there are many situations where lawyers are crucial and are able to make money for themselves/their firm, while not harming the innocent. I am not implying that all docs are innocent, but the lack of efficient tort reform does push defensive medicine and lawsuits which harm docs, insurance companies and hard working patients. There are certainly cases of malpractice that deserve litigation, but the legal problems are out of control and unjustified.
One of the things that would help immensely would be if the AMA or someone made incentive to train MDs to go into policy and provided them with the tools to fight back against politicians. The reality is Obama and all the politicians are just trying to keep their job. Look all throughout history - every person in power has to appeal to the masses, make up an us against them scenario and polarize the population in a way that keeps them in power. That is all Obama is doing and we are the scape goats in this case.
One of the other things that I love is how everyone raves about how great Canadian healthcare is and how wonderful European socialized med is, but the thing that they always always leave out of this discussion is just how high their taxes are. The American people hear "free quality healthcare for all" and think that somehow the government worked out a deal where providers work for free, supplies are given by free, buildings run themselves, etc. They forget how high taxes are there - nothing is free people! That said, the last thing Americans want here is a tax hike. If opposition would come out and say it - perhaps there would be less of a problem here. It is simple:
1. The economy was bad and we were already in debt
2. Obama borrowed more money for bailouts and stimulus packages increasing the debt further
3. Obama promised to only raise taxes on the "rich" to pay for all this crap
4. There is now much more debt, the economy is still not bouncing back, the car companies are still in bankruptcy and now we are talking about ADDING BILLIONS of dollars in spending to provide universal healthcare. Where is this money going to come from - continuing to tax the rich? Perhaps from the massively in debt new doctors? No - that will not work and what will happen down the road is TAX INCREASES FOR ALL. These tax increases will come in a time with high unemployment and massive debt. All we are doing is the same old thing - digging ourselves deeper and deeper into debt. Someone has got to stop this NOW.
- Everyone is in this for themselves. Lets take one of the men who really pushed this idea into the mind of the public...Michael Moore. What do we think his BMI is? I wonder if Michael takes his own advice and subjects himself to an improved diet, exercise and any meds he may need for problems he may have (maybe metabolic syndrome)? Is it fair for him to potentially get "free" coverage for his stent or CABG if he refuses to participate in preventative medicine and lose weight/reduce risk factors in order to cut costs for the greater good? So he made this case and may or may not subject himself to his own medicine, but his film grossed 36 million worldwide - he is laughing all the way to the bank - and then maybe to McDonalds.
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Here's the latest from ASTRO
random thoughts:
* if this prevents med students from going into our field, i would be happy. too many kids picking fields based solely on lifestyle.
* any reduction on technical fees are a good thing. it goes into the pockets of either a hospital or private docs who are making too much money or urologists who shouldnt own linacs.
* http://www.asco.org/ASCOv2/Press+Ce...ng,+Leading+Cancer+Groups+Study+New+Solutions
medicine survived and thrived after the creation of medicare. we can get through this blimp on the radar.
* if this prevents med students from going into our field, i would be happy. too many kids picking fields based solely on lifestyle.
* any reduction on technical fees are a good thing. it goes into the pockets of either a hospital or private docs who are making too much money or urologists who shouldnt own linacs.
* http://www.asco.org/ASCOv2/Press+Ce...ng,+Leading+Cancer+Groups+Study+New+Solutions
medicine survived and thrived after the creation of medicare. we can get through this blimp on the radar.
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The drivel below is why we should ban medical students from posting on any topic other than the f*cking Krebs cycle. This was clearly written by someone who has NEVER experienced what it's like to practice medicine in a modern community hospital---where the vast majority of this country receives their inpatient care.
There are a variety of reasons that current health care expenditures are unsustainable. Almost none of them are listed by this individual. One of the primary drivers of increased premiums is the desire by insurance companies to turn a profit. Because their administrative costs are so high , insurance companies are forced to jack up their premiums in order to satisfy their shareholders; approximately 15-20% of the premium price goes towards these unnecessary expenditures, especially when we consider the fact that the medicare administrative costs are only a fraction of private insurance (hence the need for a public option available to all).
Another driver of increased costs, one that is obvious to anyone that has done their internship in a community hospital, is the ridiculous number of b*ll**** admissions that come through the door AND the useless diagnostic studies and treatment procedures that are performed upon them once they arrive---useless because their is absolutely no evidence to support the stated study or intervention. And of course the Republicans will carp about the ED docs fear of litigation as a primary reason for the volume of admissions. B*LL****. The reason that community EDs (and academic medical centers) have such high admission rates is because medicare, as it is currently conceived, rewards volume, not outcome. There is no incentive to turn away the "dehydrated" geriatric droves.
And finally---R&D costs at pharmaceutical companies? Are you F*CKING kidding me? Those costs are dwarfed by the damn marketing costs. Afterall, Merck needs to advertise to the ignorant masses about the benefits of Levitra.
Doctors need to realize that a good deal of this cost crisis is a result of decisions we've made and the type of care we provide. Once Loma Linda stops using Protons on prostate ca patients, once Community Hospital X stops advertising cyberknife on the side of I-76...maybe then we can complain. Ultimately, we have nothing to fear---our services are necessary and, when practiced correctly, extraordinarily effective.
The Obama administration's push for evidenced based medicine will only benefit our specialty.
There are a variety of reasons that current health care expenditures are unsustainable. Almost none of them are listed by this individual. One of the primary drivers of increased premiums is the desire by insurance companies to turn a profit. Because their administrative costs are so high , insurance companies are forced to jack up their premiums in order to satisfy their shareholders; approximately 15-20% of the premium price goes towards these unnecessary expenditures, especially when we consider the fact that the medicare administrative costs are only a fraction of private insurance (hence the need for a public option available to all).
Another driver of increased costs, one that is obvious to anyone that has done their internship in a community hospital, is the ridiculous number of b*ll**** admissions that come through the door AND the useless diagnostic studies and treatment procedures that are performed upon them once they arrive---useless because their is absolutely no evidence to support the stated study or intervention. And of course the Republicans will carp about the ED docs fear of litigation as a primary reason for the volume of admissions. B*LL****. The reason that community EDs (and academic medical centers) have such high admission rates is because medicare, as it is currently conceived, rewards volume, not outcome. There is no incentive to turn away the "dehydrated" geriatric droves.
And finally---R&D costs at pharmaceutical companies? Are you F*CKING kidding me? Those costs are dwarfed by the damn marketing costs. Afterall, Merck needs to advertise to the ignorant masses about the benefits of Levitra.
Doctors need to realize that a good deal of this cost crisis is a result of decisions we've made and the type of care we provide. Once Loma Linda stops using Protons on prostate ca patients, once Community Hospital X stops advertising cyberknife on the side of I-76...maybe then we can complain. Ultimately, we have nothing to fear---our services are necessary and, when practiced correctly, extraordinarily effective.
The Obama administration's push for evidenced based medicine will only benefit our specialty.
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I do honestly believe that doctors have suffered from a major lack of business sense that has hurt them when they get to private practice, investing, or simply being politically active. It makes no sense to simply teach X's and O's about basic sciences and then throw docs out there to the wolves to get used by financial people, legislators, etc. You need to protect the flock a little bit and impart some business knowledge. Otherwise you're just a sucker. You can be compassionate physician and still be politically active or financially aware. We treat them like they are antagonistic. They are not.
Anybody know what services might be cut by 50%? Sounds pretty intense....
And just some thoughts in reply to rad onc's post, i'm assuming by private doc, you mean someone who owns part of the machine and gets a technical component. There are docs who work in hospital settings, but get a negotiated professional component, but surely you don't feel that the "private" in-hospital docs are that overpaid? So if we are talking about private docs working in free-standing centers, it doesn't matter to me if they make a lot, because they are paying sometimes over a hundred thousand a year or more for depreciation of the capital, and have taken that risk (after all, there is a business aspect to everything). What bothers me about the cuts is that it is so significant, and happening relatively quickly, instead of over a few years. Imagine investing 8 million in a center in the last couple years, then finding out that the capital you purchased loses 20-50% of its value starting in 2010 once the insurances adjust to medicare rates. Brutal, and unsustainable for some centers if that 20-50% is realized, in my opinion. I've seen actual budgets, yearly expenditures, and proformas for new centers during my interview trail, and i don't see some of those practices that I interviewed at being able to stay afloat if they took on another doctor (which a lot of them needed to either fill holes, overlap for a soon-to-retire doc, or staff an already committed expansion).
And just some thoughts in reply to rad onc's post, i'm assuming by private doc, you mean someone who owns part of the machine and gets a technical component. There are docs who work in hospital settings, but get a negotiated professional component, but surely you don't feel that the "private" in-hospital docs are that overpaid? So if we are talking about private docs working in free-standing centers, it doesn't matter to me if they make a lot, because they are paying sometimes over a hundred thousand a year or more for depreciation of the capital, and have taken that risk (after all, there is a business aspect to everything). What bothers me about the cuts is that it is so significant, and happening relatively quickly, instead of over a few years. Imagine investing 8 million in a center in the last couple years, then finding out that the capital you purchased loses 20-50% of its value starting in 2010 once the insurances adjust to medicare rates. Brutal, and unsustainable for some centers if that 20-50% is realized, in my opinion. I've seen actual budgets, yearly expenditures, and proformas for new centers during my interview trail, and i don't see some of those practices that I interviewed at being able to stay afloat if they took on another doctor (which a lot of them needed to either fill holes, overlap for a soon-to-retire doc, or staff an already committed expansion).
"stay afloat" is too serious to say. Let's just say that the centers wouldn't hire the new doctor because it wouldn't make any financial sense, and if they are already committed to that new doctor, then, there would be significant issues.
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Everyone that reads my posts know that I have no vested interest in Radiation Oncology because I am in Radiology. The reason I posted on this thread is because radiation oncology got unfairly lumped into the same group with Radiology and Cardiology because of the ignorance of the politicians.
Unfortunately, radiation oncologists have far fewer lobbyists than radiologists and cardiologists. This situation is very unfortunate.
If I was a 3rd and 4th year medical student right now. I would think long and hard at Radiology and Radiation Oncology because of these HUGE cuts. Instead I would target specialties such as Anesthesiology and Pain Medicine.
For those that are interested in Cardiology, you can always fall back onto your internal medicine training.
The scary thing is that the huge cuts for radiology and radiation oncology will lead to a brain drain out of imaging and therapeutic radiation. With so much debt, medical students have to be practical.
Ask yourself this question. Why would you train 5 years in Radiology or Radiation Oncology when you can make the same money in ER in 3 years?
P.S. Anyone that downplays the huge medicare cuts should read the articles in radiation oncology and radiology. When one of the major organizations for Radiation Oncology calls the cuts Disastrous. The leaders are extremely pessimistic about their future.
As reported in the last ASTROgram [http://cs.astro.org/blogs/astronews/...ursement.aspx], CMS is targeting freestanding radiation oncology for immense reimbursement cuts of about 20 percent that could range as high as 50 percent for certain services. These proposed cuts would likely have a devastating impact on many radiation oncology practices across the country and would limit cancer patients access to quality radiation therapy.
ASTRO has already begun waging a massive regulatory and legislative offensive to combat these cuts, and we need your help! In addition to policy arguments and data supporting our position, we need to make federal policymakers aware of how these painful cuts would affect your practice and cancer care in America. Please go to this online survey at http://www.zoomerang.com/Survey/?p=WEB229DWL6RR9T to tell us precisely what these cuts will mean to you, your practice, and, most importantly, your patients. We'll use this information in our advocacy efforts, so it's important that every freestanding center participate in this survey.
Stay tuned for many more updates and requests for your help in our efforts to block the cuts over the next few weeks. The time to act is now!
Unfortunately, radiation oncologists have far fewer lobbyists than radiologists and cardiologists. This situation is very unfortunate.
If I was a 3rd and 4th year medical student right now. I would think long and hard at Radiology and Radiation Oncology because of these HUGE cuts. Instead I would target specialties such as Anesthesiology and Pain Medicine.
For those that are interested in Cardiology, you can always fall back onto your internal medicine training.
The scary thing is that the huge cuts for radiology and radiation oncology will lead to a brain drain out of imaging and therapeutic radiation. With so much debt, medical students have to be practical.
Ask yourself this question. Why would you train 5 years in Radiology or Radiation Oncology when you can make the same money in ER in 3 years?
P.S. Anyone that downplays the huge medicare cuts should read the articles in radiation oncology and radiology. When one of the major organizations for Radiation Oncology calls the cuts Disastrous. The leaders are extremely pessimistic about their future.
Disastrous Radiation Oncology Payment Cuts Proposed: Tell ASTRO How It Will Affect You
As reported in the last ASTROgram [http://cs.astro.org/blogs/astronews/...ursement.aspx], CMS is targeting freestanding radiation oncology for immense reimbursement cuts of about 20 percent that could range as high as 50 percent for certain services. These proposed cuts would likely have a devastating impact on many radiation oncology practices across the country and would limit cancer patients access to quality radiation therapy.
ASTRO has already begun waging a massive regulatory and legislative offensive to combat these cuts, and we need your help! In addition to policy arguments and data supporting our position, we need to make federal policymakers aware of how these painful cuts would affect your practice and cancer care in America. Please go to this online survey at http://www.zoomerang.com/Survey/?p=WEB229DWL6RR9T to tell us precisely what these cuts will mean to you, your practice, and, most importantly, your patients. We'll use this information in our advocacy efforts, so it's important that every freestanding center participate in this survey.
Stay tuned for many more updates and requests for your help in our efforts to block the cuts over the next few weeks. The time to act is now!
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Stop whining. Even though your salaries just got halved after overhead you still make a six figure income. You're not going to suffer because you make $125k/year instead of 250k/year.
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Psychforum, are you kidding? How would you like to have graduated top of your class from medical school, worked your a** off to get into one of the most competitive fields, only to find that your pay will be cut in half!! I am not saying that you did not graduate from the top of your class also, but you have to understand where we are coming from!!
And just an FYI, if any Rad Onc attending at the free standing Rad Onc clinics (the ones actually targeted) was making 250k something was off already in their billing. Its more like when our salaries go from 500 in the private setting, to 400 (following the likely 20% cut) we wont be in the poor house. Don't be bitter that another specialty is getting hit hard, thats an aweful thing to do. After all its not like salary was a secret when graduating from medical school, PCP's, psych, you guys knew you got paid low in terms of doctors salarys.
Its too bad this socialist administration does not think people that literally cure cancer should get paid well for it.
Have these cuts even passed yet?
And just an FYI, if any Rad Onc attending at the free standing Rad Onc clinics (the ones actually targeted) was making 250k something was off already in their billing. Its more like when our salaries go from 500 in the private setting, to 400 (following the likely 20% cut) we wont be in the poor house. Don't be bitter that another specialty is getting hit hard, thats an aweful thing to do. After all its not like salary was a secret when graduating from medical school, PCP's, psych, you guys knew you got paid low in terms of doctors salarys.
Its too bad this socialist administration does not think people that literally cure cancer should get paid well for it.
Have these cuts even passed yet?
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lmao.
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If medicine was a free market we would import indian rad oncs and the avg salary would be like a resident salary.
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My only criticism about these cuts is that they are not broad enough. All specialists should pay equally across the board rather than targeting just a few. Preventative care, which PCPs can do well, has been deincentivized in favor of hideously expensive end-stage therapies.
A homeless person won't go and see a PCP to help prevent heart disease but will be admitted to the ER with severe angina and be taken to CABG. Of course, the hospitals/insurers profit handsomely from this arrangement.
Clearly, these CMS cuts are not some panacea but reimbursements for sub-specialists are not sustainable. It's time for the gravy train to end.
For applicants/med students, here's a piece of advice. Go into a field that you enjoy doing and don't select one purely on reimbursement. You never know what will happen by the time you are practicing. Personally, I would be happy to be a radiation oncologist even at a fraction of our current median salaries.
A homeless person won't go and see a PCP to help prevent heart disease but will be admitted to the ER with severe angina and be taken to CABG. Of course, the hospitals/insurers profit handsomely from this arrangement.
Clearly, these CMS cuts are not some panacea but reimbursements for sub-specialists are not sustainable. It's time for the gravy train to end.
For applicants/med students, here's a piece of advice. Go into a field that you enjoy doing and don't select one purely on reimbursement. You never know what will happen by the time you are practicing. Personally, I would be happy to be a radiation oncologist even at a fraction of our current median salaries.
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While I am not thrilled about these cuts, I feel similarly. Rad onc is a terrific job, and I cannot imagine getting the same satisfaction from treating HTN, DM, and COPD all day as a a PCP.
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With all due respects to you who laughs at the ever wise attending and you the ever wise attending, I am not as foolish as you think.
Yes, there are two sides to the arguments we both present (and each of us seems to arrogantly cling to our side of the story as truth). While I do not have the time to go into everything I think and have seen in the hospitals even further I will say this...
I am not as experienced as you wise attending person (I assume you are an attending by the condescending way you speak - that or you like being anonymous), but in the very very short time I have been on the wards - 1 year - I have clearly seen MAJOR MAJOR problems with waste. I am not talking only about docs ordering extra procedures (whether to cover the butts or not is speculation that I will not get into), but I am talking about COUNTLESS examples of patient noncompliance and ignorance despite every intervention imaginable and yet still they come to the ER, ICU, etc and have to be admitted and treated. American people MUST MUST MUST accept responsibility for SOMETHING. We are responsible for our actions. Just as the doctors the generations before us are responsible for overbilling (if that is the case), American people are responsible for their smoking, drug abuse, diet, sedentary life styles, risky behavior, non-compliance with medications or medical recommendations etc. If you are as experienced as you say, you know this to be true. There is NOT an endless supply of resources and that is reality.
Next, you slam the pharma and insurance industries. Perhaps you do this rightfully so as they are making a lot of money. That said, there need to be changes in the system to fix this. You dont like the profit drug companies make, open your own firm to create drugs, push them through FDA trials and market them. Then sell the drugs for cheaper and force those companies to lower prices or go out of business. If you really want this to happen, the government MUST take a stake in this area and pay for R and D and the FDA trials. This is not a question of experience in medicine, this is common sense. Drug companies are not kept "honest" by the government to lower prices (as the government plans to do with insurance) thus this allows drug companies to collectively have a monopoly and charge what they want for their drugs until they go generic. This is how business works - look at Apple - they make an iPhone and charge a few hundred bucks for it, make a deal with ATT to allow only them to carry it for a price and then people still buy them (as you can only Apple makes the iPhone).
Lastly, I am not speaking on my own personal situation. I do not care what you or more liberal people have to say about this - you dont want me to make a good salary because it is unfair to others - fine. Then pay off my medical school debt and do NOT expect me to work 80+ hours a week. This is not expected of Americans in other professions and it should not be expected of you, me or any other US physician - period.
If you think that last statement is unfair, then you, good sir, need to "talk only of the Krebs cycle" because your thinking is as idealistic, unrealistic, stupid and blatantly wrong as can be.
If it's true that most of these cuts come from the technical component of billing, then it underscores the substantial risk any newly-graduating resident undertakes when looking for practices with any ownership/technical fee garnering component.
While they have long been considered the "holy grail" of private practice jobs, you never know what your buy-in (one practice quoted me a number in the $2 million range) will be worth in several years, especially given the uncertain times in which we now live.
The good news behind all this is this: Even if you, like me, take a "lowly" job that only reimburses based on the professional component, AND even if we assume the ENTIRE 20% cut comes out of that professional take...you'll still find nothing to complain about once you make partner. Believe it. No full partner in a busy practice is making $250k a year. Hell, $250k would be considered a low to mid-range starting salary coming right out of residency.
My personal opinion: Treating 40 prostate cancer patients a day with IMRT ain't worth $1.2 million a year, and most of that money comes from the technical side of things. Hate to come down on my own kind, but let's be honest with ourselves. If these cuts keep coming year after year, that would be one thing, but we're not there yet.
For the med students, the lesson is and always will be: don't pick a job based on salary alone, because there's always a chance you'll end up unhappy based on no fault of your own. That, and please don't bring up the Krebs cycle. I've successfully forgotten that one several times over.
While they have long been considered the "holy grail" of private practice jobs, you never know what your buy-in (one practice quoted me a number in the $2 million range) will be worth in several years, especially given the uncertain times in which we now live.
The good news behind all this is this: Even if you, like me, take a "lowly" job that only reimburses based on the professional component, AND even if we assume the ENTIRE 20% cut comes out of that professional take...you'll still find nothing to complain about once you make partner. Believe it. No full partner in a busy practice is making $250k a year. Hell, $250k would be considered a low to mid-range starting salary coming right out of residency.
My personal opinion: Treating 40 prostate cancer patients a day with IMRT ain't worth $1.2 million a year, and most of that money comes from the technical side of things. Hate to come down on my own kind, but let's be honest with ourselves. If these cuts keep coming year after year, that would be one thing, but we're not there yet.
For the med students, the lesson is and always will be: don't pick a job based on salary alone, because there's always a chance you'll end up unhappy based on no fault of your own. That, and please don't bring up the Krebs cycle. I've successfully forgotten that one several times over.
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Personally, I think what we are seeing evolve in the health care arena is very similar to what has happened with the housing market. For decades, real estate has been a safe investment. This slowly ballooned into a severe over-confidence and lack of due diligence that eventually led to the downward spiral and free-fall in home prices we have today. Many are left holding the bag with homes that are worth a fraction of what they paid.
I fear the same will happen with the medical field. Becoming a doctor was considered by many a guaranteed path to prestige and wealth. Many have taken on debt they may not be able to manage as the free-fall begins in reimbursement. I am not trying to instate panic - but a 50% cut can only be considered a free-fall IMO. For those who went into medicine exclusively for the Beemer and hot chicks, they may be disappointed in a few years.
That being said, all of us went into medicine feeling we would have a secure future. I still have three years of residency ahead of me and my biggest fear right now is that I will be holding the bag with my student loans. I honestly do not think that with what the current administration is posturing, that this is out of the question. If I were a newly minted graduate walking into a 3-400+ private practice gig right now, I would live in the projects and pay every penny to my loans to unload that liability ASAP before the ship goes down.. I don't need to be rollin' in it, but after all these years of school I would at least like to have the peace of mind that I will get out of debt and live a comfortable, debt-free life.
It sucks to feel totally powerless in this situation. We are truly a ditzel on the lobbying radar screen in D.C. ASTRO's survey is going to have about the same effect on congress as a 5 year old picking up a hammer and asking his Dad if he can help build the house too..
We may not have any influence, but I do believe our PATIENTS can. Obviously I can't do this as a resident, but if I were in private practice I would literally make a petition for my patients to sign, I would hand out letters for them to sign and mail to their Congressperson, etc.
I fear the same will happen with the medical field. Becoming a doctor was considered by many a guaranteed path to prestige and wealth. Many have taken on debt they may not be able to manage as the free-fall begins in reimbursement. I am not trying to instate panic - but a 50% cut can only be considered a free-fall IMO. For those who went into medicine exclusively for the Beemer and hot chicks, they may be disappointed in a few years.
That being said, all of us went into medicine feeling we would have a secure future. I still have three years of residency ahead of me and my biggest fear right now is that I will be holding the bag with my student loans. I honestly do not think that with what the current administration is posturing, that this is out of the question. If I were a newly minted graduate walking into a 3-400+ private practice gig right now, I would live in the projects and pay every penny to my loans to unload that liability ASAP before the ship goes down.. I don't need to be rollin' in it, but after all these years of school I would at least like to have the peace of mind that I will get out of debt and live a comfortable, debt-free life.
It sucks to feel totally powerless in this situation. We are truly a ditzel on the lobbying radar screen in D.C. ASTRO's survey is going to have about the same effect on congress as a 5 year old picking up a hammer and asking his Dad if he can help build the house too..
We may not have any influence, but I do believe our PATIENTS can. Obviously I can't do this as a resident, but if I were in private practice I would literally make a petition for my patients to sign, I would hand out letters for them to sign and mail to their Congressperson, etc.
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Spoken like someone who hasn't worked a day in their life.....
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By the way, who are all the freaking trolls with the sudden interest in radonc reimbursement? Seriously guys, glad to have you, but try to keep the language clean and be civil. Most of us in this field are pretty nice, happy people..may confuse you if you are visiting from certain other specialties
D
deleted4401
I just think its very interesting that, as a specialty, we were singled out. Opthalmology, Anesthesia, and Plastics averaged a 7% increase.
I wonder what will happen when the final comes out - it never really follows the proposed cuts, from what I've heard.
Not to belabor the fringe lunacy from above, but a few things ...
Drug companies do very little R&D, in terms of novel drugs. There's a few solid books out there that explain this quite well, one from a former JAMA (or NEJM; not a liberal mouthpiece) editor that indicate that the universities are the centers of R&D, I'll find the reference later. The drug companies, as someone mentioned earlier, are far more responsible for the marketing of pharmaceuticals. Name the last 10 drugs that made a difference in medicine. I'd say that 9/10 were developed at universities and then bought/marketed by drug companies. Now, once a novel drug is approved and proves to be profitable, the R&D arms of pharm companies are very good about developing "me-too" drugs, but that hardly effects change in medicine.
Now about the lawyers/defensive medicine ... For the states that have had dramatic tort reform (for example, Louisiana - medical review boards, $250k caps), there has been no decrease in the costs of medicine - i.e. the number of tests being ordered and procedures performed continues to grow, rather than shrink. I reluctantly agree that lawyers in the past may have made led us to order tests unnecessarily, but I don't think any radiologist or cardiologist or gastroenterologist is too upset about the increase in MRIs, caths, and endoscopies that they have had to do. Not one of them is crying about it. "Defensive medicine" is something ****ty doctors hide behind, not an everyday reality. Working physicians understand that most frivolous lawsuits are because of poor communication and a litigious culture ... not because someone didn't get an MRI.
And, finally, class warfare is basically terrorism... Everyone should get rich. That's the American dream. Yeah, I can live on $125k, but I don't want to. Why the heck should anyone try to bring anyone else down?
-S
I wonder what will happen when the final comes out - it never really follows the proposed cuts, from what I've heard.
Not to belabor the fringe lunacy from above, but a few things ...
Drug companies do very little R&D, in terms of novel drugs. There's a few solid books out there that explain this quite well, one from a former JAMA (or NEJM; not a liberal mouthpiece) editor that indicate that the universities are the centers of R&D, I'll find the reference later. The drug companies, as someone mentioned earlier, are far more responsible for the marketing of pharmaceuticals. Name the last 10 drugs that made a difference in medicine. I'd say that 9/10 were developed at universities and then bought/marketed by drug companies. Now, once a novel drug is approved and proves to be profitable, the R&D arms of pharm companies are very good about developing "me-too" drugs, but that hardly effects change in medicine.
Now about the lawyers/defensive medicine ... For the states that have had dramatic tort reform (for example, Louisiana - medical review boards, $250k caps), there has been no decrease in the costs of medicine - i.e. the number of tests being ordered and procedures performed continues to grow, rather than shrink. I reluctantly agree that lawyers in the past may have made led us to order tests unnecessarily, but I don't think any radiologist or cardiologist or gastroenterologist is too upset about the increase in MRIs, caths, and endoscopies that they have had to do. Not one of them is crying about it. "Defensive medicine" is something ****ty doctors hide behind, not an everyday reality. Working physicians understand that most frivolous lawsuits are because of poor communication and a litigious culture ... not because someone didn't get an MRI.
And, finally, class warfare is basically terrorism... Everyone should get rich. That's the American dream. Yeah, I can live on $125k, but I don't want to. Why the heck should anyone try to bring anyone else down?
-S
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Amen to that.
And no, CMS is accepting comments till Aug 31. They'll prolly finalize a few months after that in the Oct/Nov CFR update. They take affect Jan 2010
I think you're worrying far too much. The housing market was a classic case of supply (housing) eventually catching up with and far outstripping demand for housing so much that the price bottomed out. No different from the Tulip Mania that gripped the Dutch Republic in 1636 (I'm sure we all remember tulpenwindhandel, right? Dr. Google does: http://www.britannica.com/EBchecked/topic/608658/Tulip-Mania)
Getting back to the topic at hand, this is NOT going to happen in medicine- in fact, the opposite will be true for your field as the population ages and (let's face it) gets cancer.While the days of ridiculous salaries may be over, you will still graduate with a skill that is valuable and necessary, and you will be reimbursed as such. You will have a job that will, yes, without a doubt, allow you to repay your student loans, buy a nice house, send your kids to college, etc. This job will be somewhat secure and not as subject to the vagaries of the "market" - the current unemployment situation should reinforce the value of this aspect. You'll be able to afford a Beemer. Maybe not the M6 like your predecessors in the glory days of the 2000s, but if you find yourself complaining about a 3 series or an X5 (if you must) you might need a reality check.
As far as the hot chick (or guy, so as to be fair to all) goes, you're on your own with that one. At least you won't have as many investment bankers in your way.
Sorry if these are getting a bit long-winded and bizarre. Anything to keep from studying for boards...
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Fair to call it that but...
1. Drug companies do participate in R and D and they even fund university research. While I am not saying the drug companies are angels fighting for patients, they are the only entities that move from a novel idea and translate it to a drug that patients can take. Furthermore, they and not university researchers, assume the risk for a recall and class action suit for side effects. Is it lunacy to say that if you want costs to come down, tax payers should pay for a government backed alternative to drug companies to bring down profit margins? How else do you suppose to bring down their profit margins - by just asking the drug companies for their money or forcing them to reduce their reimbursements for their drugs? Lunacy is to live in a dream world where we have a communist utopia and the hard workers work hard for less hard working people. This is the utopia where these self sacrificing hard workers do not expect any compensation for their hard work. I find it ironic that you seem to argue against this idea, yet the rest of your post seems to point to the fact that you are in favor of capitalism and feel your hard work deserves proper compensation. Granted, drug companies have profit margins exceeding yours, but nevertheless, the point is the same and the only way to drive down compensation for goods and services is to have competition to increase supply. Why is that lunacy?
2. Defensive medicine is a crock, huh? I dont care about people who cherry pick data to make their points. Michael Moore is great at doing that. Canada spends less on health care yet they live longer than Americans on average...therefore their healthcare is superior. In medicine, we are trained to look for confounders and bias. Michael Moore and many others tend to cherry pick data from random places in an attempt to persuade. I will not attempt to cite data because I do not have data to back up my belief that there is a lot of defensive medicine taking place today. I will say that I have seen it in action first hand in situations where the ordering attending had no financial incentive to order the test. For example, ordering an MRI head for headaches that were slightly unusual to ensure not missing a mass (the imaging took place at another center, as did the read, which was not affiliated with the practice). I also worked in the chart room before starting med school for a dermatologist and saw this in action again. He was being sued because he removed a melanoma from a man (margins were clear and depth was short) and told the guy that he was at increased risk for having additional lesions and needed to have annual skin checks (patient lost to followup). The man had a second MM at a different site with mets to brain (years down the road) and insisted that he was never told about the need for followup and was told he was cured. (It was documented that he was told in the chart). The dermatologist had to use me (instead of helping with charts and the such) to go through all of his records for the past 4 years and look for anyone lost to followup with a h/o melanoma or SCC and remind them that they need to come in for followup. The majority of patients laughed and asked me if business was that bad that we had to solicit patients for appointments. These are just 2 examples I have seen.
3. I did not want to get into full detail, but just two other cases -
Patient with a young baby, type 1 DM, given free insulin and numerous diabetic education consults to learn how to use insulin. On my month rotation, came in 3 X for DKA with minimal 1 day ICU stay per visit (thousands of dollars). This type of thing goes on all the time. How about the IVDU who comes in time after time for endocarditis and is caught shooting drugs into the PIC line multiple times during his stay in the hospital? How about the man who had cirrhosis, but keeps drinking? How about the patients who stand outside, in hospital gowns and plugged into the IV chain smoking despite no smoking permitted on hospital grounds? These stories go on and on and on - this is lunacy.
I am not saying that people do not deserve access, but there needs to be a two way agreement here. Docs can take pay cuts if this is the only way to help, but there needs to be give from others as well (patients, lawyers, drug companies, allied health, hospitals, medical school tuition, politicians, etc). Most importantly, I DO believe in universal catastrophic medical insurance. I DO NOT believe in endless treatment for self-inflicted illness. Furthermore, I think lawyers who continuously bring frivolous law suits should be disbarred. Lastly, one of the keys to a sustainable health care system is preventative medicine (for real, not just as a slogan). However, in order for this to work, patients need to be a part of the system. This means we need to provide financial incentive to patients to assume an active role in their care. For example, diabetics should be rewarded with extended coverage for their care if they keep HbA1c within range X, while others who refuse to participate and keep their HbA1c in range X+6 should have to pay more out of pocket for care. I will agree with you that this last paragraph is extreme, but I think we all need to take a hard look at what is going on and ask ourselves what our role has to be in order to have a sustainable health care system for the community as a whole in a manner that is "most fair for most people."
Sorry to make a repeat (i just wanted to make sure no one who reads this board knows this answer, since there's a lot of back and forth in the above posts), but does anybody know what it is that ASTRO claims is in danger of getting cut up to 50%?
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The cuts are unfortunate, but even if they end up being nearly as bad as what has been proposed they are not going to mean the end of Radiation Oncology. These changes reflect the economic reality of health care in America, and are a taste of what is to come in all areas of medicine. This year we are getting singled out, but next year it will be another specialty. For example, Dermatology was hit hard last year with the change in Moh's reimbursement (cut 20-30%)(http://www.modernmedicine.com/moder...ge-affe/ArticleStandard/Article/detail/596293) and if you count what the economic downturn is doing to the number of elective cosmetic procedures, they were hit even harder. People have not stopped and will not stop going into derm. Diagnostic Radiology got screwed by the DRA a few years back, and they are getting hit nearly as hard as us in the current proposal so are even worse off. Still, the radiologists I know are still happy with their jobs and lots of medical students remain interested.
In the case of rad onc, much of the technical fees go to hospitals, corporations, or a handful of senior partners in many practices anyway, so many rad oncs will not be drastically affected be these changes even if they pass. You'll still be able to repay your loans and live comfortably. I'm sure of it. The people in trouble are the ones who recently invested in new equipment or new free-standing centers and are facing the prospect of having their business plan go "poof". But they took that risk when they went into business in the first place, so that's how the cookie crumbles. [Along these lines, I wonder if this will affect proton reimbursement. If it does, some hallowed rad onc departments and a few private practices could be in serious financial trouble...]
I'm not saying ASTRO shouldn't lobby to have these cuts reduced, they should. But let's not pretend that the sky is falling. Plus, on the bright side, this may well mean that urologists, etc. will not be as interested in getting their own linacs. The pesty self referral issue that ASTRO is so worried about may not be as big an issue in the future...
In the case of rad onc, much of the technical fees go to hospitals, corporations, or a handful of senior partners in many practices anyway, so many rad oncs will not be drastically affected be these changes even if they pass. You'll still be able to repay your loans and live comfortably. I'm sure of it. The people in trouble are the ones who recently invested in new equipment or new free-standing centers and are facing the prospect of having their business plan go "poof". But they took that risk when they went into business in the first place, so that's how the cookie crumbles. [Along these lines, I wonder if this will affect proton reimbursement. If it does, some hallowed rad onc departments and a few private practices could be in serious financial trouble...]
I'm not saying ASTRO shouldn't lobby to have these cuts reduced, they should. But let's not pretend that the sky is falling. Plus, on the bright side, this may well mean that urologists, etc. will not be as interested in getting their own linacs. The pesty self referral issue that ASTRO is so worried about may not be as big an issue in the future...
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Well said, Zap. In terms of self interest, I'd like to see the proposed cuts eliminated or at least reduced. If the cuts are part of a package that has a reasonable chance of promoting some macroeconomic stability in the health care system, though, I'm open to the possibility. I agree that the reduction in technical reimbursement may be an effective deterrent for the propagation of urorads centers. It will also likely be a death knell for a fair number of fly-by-night treatment facilities who over-leveraged themselves to buy expensive new toys so they could be competitive in a market that was over-saturated to begin with. This will likely increase traffic in the practices who were fiscally conservative and appropriately restrained in technology utilization, thus at least partially offsetting the cuts by providing a bigger slice of the pie to begin with. Can you tell I practice in Florida?
Using a longer time horizon, these proposed cuts are probably no more than temporary roll-backs. At least, history would indicate that they are, as CMS is pretty much involved in a perpetual shell-game of taking money from one specialty and depositing it into another when it is politically expedient to do so. As rad oncs, we've been relatively lucky to be flying under the radar for years. I guess it's just our turn.
If government wants to generate meaningful health care cost reforms, they would do well to continue a push for a more comprehensive EMR system (one of the few things Bush had right), and start to whittle away at the core bureaucracy and administrative costs associated with health care. Any resident who has spent multiple hours per week filling out insurance paperwork can easily reflect upon the fact that 1) most of them are reduplicative at best, irrelevant and vaguely insulting at worst, 2) someone got paid to create them, and 3) some gets paid to process them. Coding and billing is so intentionally complicated (i.e. the slightest mistake can result in a complete denial), that an entire industry of professional coding and billing has arisen to address the issue. This is all supported by health care dollars, and none of it has to do with the actual delivery of health care. Actual reforms in this arena will be far more substantive and far-reaching than hitting us up for a fraction of our technical fees. I keep thinking back to the study a few years back where it was shown that more more was spent in oncology on one drug (Procrit) than on all the radiation treatments delivered nationwide, proton or otherwise. It's always helpful to maintain a sense of scale and proportion in these matters, but I fear things like that are lost on our legislators.
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I had heard that Universities often get their cut from a drug's profits as royalties. Moreover, a single drug can cost $500 M-$1 T to bring to market, equity that a university may not have, but that a private company can bring to the table.
Aren't companies like Genentech and Dendreon private entities?
D
deleted4401
I'm still having a hard time figuring out what the 19% cut will represent, from the CMS document and the ASTRO release. Are you guys speculating it's technical fees or is this clearly the case? If not, I'm not entirely sold on the idea that CMS is cost-cutting, as the total measure was budget-neutral (or actually, plus 1%), with certain specialties benefiting and other ones losing. Had it been an across the board decrease - i.e. 7% down for all specialties - I could appreciate it as a cost-cutting measure.
At the same time, loss of technical revenues may have indirect impact, as radiation tends to subsidize many oncology departments, and at times, the entire hospital (10% of UPMC profit was from our deparment). In many cases, it certainly is a greedy used car salesman doc doing SRS for prostate, but in many other cases its how we pay for the new children's ward or surgical equipment. As many of these specialties are not hospital based (i.e. opthalmology), that money that would have went to the hospital's general revenue now just goes to another physician.
I think most practicing (and future) rad oncs don't feel that making $1.2 million is appropriate, but at the same time, as a comparatively powerless specialty, (I mean, come on, even concierge medicine has a TV show now!) it would be nice not to be further marginalized as technicians. There is also going to be very little sympathy from the public with our salaries going down from $500k (based on NY Times last year) to $400k, but at the same time, if we are going to be perpetually targeted because of the sins of our past, I think it's important to start publishing outcomes data that show we are on the right side of a cost-benefit analysis (if in fact, we are).
I'm not saying decreasing medical costs and utilization is bad, but it should be done in a logical and ordered manner. I'm just not sure they are going about it in that way.
Isn't there a radiation oncologist that is a US Congressman?
-S
At the same time, loss of technical revenues may have indirect impact, as radiation tends to subsidize many oncology departments, and at times, the entire hospital (10% of UPMC profit was from our deparment). In many cases, it certainly is a greedy used car salesman doc doing SRS for prostate, but in many other cases its how we pay for the new children's ward or surgical equipment. As many of these specialties are not hospital based (i.e. opthalmology), that money that would have went to the hospital's general revenue now just goes to another physician.
I think most practicing (and future) rad oncs don't feel that making $1.2 million is appropriate, but at the same time, as a comparatively powerless specialty, (I mean, come on, even concierge medicine has a TV show now!) it would be nice not to be further marginalized as technicians. There is also going to be very little sympathy from the public with our salaries going down from $500k (based on NY Times last year) to $400k, but at the same time, if we are going to be perpetually targeted because of the sins of our past, I think it's important to start publishing outcomes data that show we are on the right side of a cost-benefit analysis (if in fact, we are).
I'm not saying decreasing medical costs and utilization is bad, but it should be done in a logical and ordered manner. I'm just not sure they are going about it in that way.
Isn't there a radiation oncologist that is a US Congressman?
-S
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I found this name from an old ASTRO email:
http://www.opencongress.org/person/show/412277_parker_griffith
Dwight7298--
we must have gone the same internship or something, becuase I never imagined I would meet so many crappy ER docs or do so many expensive myocardial perfusion scans. But the ridiculous interstate billboards featuring CyberKnife tips it off
we must have gone the same internship or something, becuase I never imagined I would meet so many crappy ER docs or do so many expensive myocardial perfusion scans. But the ridiculous interstate billboards featuring CyberKnife tips it off
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What about the impact on future job market?
Should our organizations have increased the number of residency spots?
We have more residents graduating, with possibly less jobs available for them.
Should our organizations have increased the number of residency spots?
We have more residents graduating, with possibly less jobs available for them.
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You are correct in that it's budget neutral. CMS generally doesn't make rules for cost cutting -- they leave that to Congress. This was, overall, an attempt to cut down on medical imaging costs while increasing reimbursement for "procedures" (in the more traditional sense. Unfortunately they consider us under the imaging category, because the folks at CMS don't know too much about medicine...trust me I used to work there).
The actual details of the RVU cuts involves the utilization rates for machines that cost over $1m. In the current formula, they assume 50% utilization. This rule would change that to 90%. While that's not the entirety of the cuts (there are additional cuts for IMRT), that's the bulk of the change. ASTRO knew this was coming for at least the last three or four years, but unfortunately our lobby is not the most powerful and couldn't really stop it.
Do you donate to ASTROPAC?
D
deleted4401
So a simpleton can understand, what does it mean that the usage assumption changes from 50% to 90%. Like an example of a prostate cancer IMRT case ... People keep saying this and I don't get what that means at all .. sort of like scatter
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Completely agree with GFUNK. Medical students and residents must go into something they truly enjoy doing. Specialties change in 5-10 years due to new technology, turf wars, reimbursement etc. Every medical specialty goes through cycles. In the 80's and early 90's surgery and internal medicine were the dermatology and plastic surgery of today.
YOU CAN NOT CHASE A SPECIALTY BECAUSE OF MONEY AND/OR LIFESTYLE. LETS SAY YOU ARE ATTRACTED TO RADIOLOGY BECAUSE OF MONEY AND LIFESTYLE. IMAGINE IF YOU HAD 12 WEEKS VACATION IN RADIOLOGY. THAT MEANS YOU STILL HAVE TO WORK 40 WEEKS OF YOUR LIFE GOING INTO WORK THAT YOU HATE!! YOU WILL BE ABSOLUTELY MISERABLE CHASING MONEY FOR THE REST OF YOUR LIFE!!
YOU HAVE TO CHOOSE A SPECIALTY BASED ON MATURE TRUE INNER EXAMINATION OF YOURSELF TO SEE IF YOU TRULY LIKE IT!!! IF YOU LIKE CARDIOLOGY GO FOR IT!! IF YOU GET WORN OUT YOU CAN GO DOWN TO WORK PART TIME. DO SOMETHING THAT YOU CAN LOOK BACK IN 30 YEARS AND SAY I DID WHAT I WANTED TO DO. YOUR LIFE WILL HAVE MEANING.
WHO CARES IF IT TAKES 8 YEARS LONGER TO PAY BACK YOUR STUDENT LOANS? YOUR LIFE WOULD FEEL MORE COMPLETE IF YOU ARE HONEST WITH YOURSELF AND GO FOR THE SPECIALTY THAT YOU TRULY ENJOY REGARDLESS OF MONEY AND/OR LIFESTYLE.
If you don't know during 4th year of medical school do a prelim year in internal medicine or prelim surgery to get first hand exposure.
I like interventional radiology but is it worth 6 long years after medical school for the same compensation of an ER physician or an Anesthesiologist? 3 years of ER residency looks very attractive right now with balancing of physician salaries by Obama care.
I'll put it this way. I did an ER rotation as an intern and it wasn't that bad. In fact it was very interesting.
Furthermore, I know a derm resident that hates her experience becasue of all of the reading that one must do during residency to master the material. If you don't like reading about radiology or radiation oncology. It will be the worst 4 years of your life and you will absolutely HATE going into work. Who cares about future income or amount of vacation time? IT IS NOT WORTH IT.
There is tremendous amount of reading in cognitive disciplines such as dermatology, radiation oncology, and radiology. YOU MUST TRULY LOVE READING THE MATERIAL.
Bottomline
Do what you love/enjoy. If you enjoy surgery you will be much happier than a dermatologist that hates seeing patients all day in clinic. Granted, It might take 10 years longer to pay off your student loans but you will be a happier physician for the rest of your life. YOU MUST DIG DEEP INSIDE AND FIND WHAT TRULY MOTIVATES YOU. If that is family medicine so be it. Getting into medical school was your major accomplishment. Finding a specialty that you truly enjoy is what you deserve.
YOU CAN NOT CHASE A SPECIALTY BECAUSE OF MONEY AND/OR LIFESTYLE. LETS SAY YOU ARE ATTRACTED TO RADIOLOGY BECAUSE OF MONEY AND LIFESTYLE. IMAGINE IF YOU HAD 12 WEEKS VACATION IN RADIOLOGY. THAT MEANS YOU STILL HAVE TO WORK 40 WEEKS OF YOUR LIFE GOING INTO WORK THAT YOU HATE!! YOU WILL BE ABSOLUTELY MISERABLE CHASING MONEY FOR THE REST OF YOUR LIFE!!
YOU HAVE TO CHOOSE A SPECIALTY BASED ON MATURE TRUE INNER EXAMINATION OF YOURSELF TO SEE IF YOU TRULY LIKE IT!!! IF YOU LIKE CARDIOLOGY GO FOR IT!! IF YOU GET WORN OUT YOU CAN GO DOWN TO WORK PART TIME. DO SOMETHING THAT YOU CAN LOOK BACK IN 30 YEARS AND SAY I DID WHAT I WANTED TO DO. YOUR LIFE WILL HAVE MEANING.
WHO CARES IF IT TAKES 8 YEARS LONGER TO PAY BACK YOUR STUDENT LOANS? YOUR LIFE WOULD FEEL MORE COMPLETE IF YOU ARE HONEST WITH YOURSELF AND GO FOR THE SPECIALTY THAT YOU TRULY ENJOY REGARDLESS OF MONEY AND/OR LIFESTYLE.
If you don't know during 4th year of medical school do a prelim year in internal medicine or prelim surgery to get first hand exposure.
I like interventional radiology but is it worth 6 long years after medical school for the same compensation of an ER physician or an Anesthesiologist? 3 years of ER residency looks very attractive right now with balancing of physician salaries by Obama care.
I'll put it this way. I did an ER rotation as an intern and it wasn't that bad. In fact it was very interesting.
Furthermore, I know a derm resident that hates her experience becasue of all of the reading that one must do during residency to master the material. If you don't like reading about radiology or radiation oncology. It will be the worst 4 years of your life and you will absolutely HATE going into work. Who cares about future income or amount of vacation time? IT IS NOT WORTH IT.
There is tremendous amount of reading in cognitive disciplines such as dermatology, radiation oncology, and radiology. YOU MUST TRULY LOVE READING THE MATERIAL.
Bottomline
Do what you love/enjoy. If you enjoy surgery you will be much happier than a dermatologist that hates seeing patients all day in clinic. Granted, It might take 10 years longer to pay off your student loans but you will be a happier physician for the rest of your life. YOU MUST DIG DEEP INSIDE AND FIND WHAT TRULY MOTIVATES YOU. If that is family medicine so be it. Getting into medical school was your major accomplishment. Finding a specialty that you truly enjoy is what you deserve.
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Guys that is the secret to happy doctors. You must go into a field that you truly enjoy reading the material. Whatever specialty you go into it is a lifetime of learning. You have to read the literature for the rest of your life to keep up.
Just because you scored AOA and 270 Step 1 means you have earned the ability to have more options. It does not necessarily mean that you should go into a specialty because it is highly competitive.
Keep your ego in check and dig deep inside. Pick up a JAMA see what specialty literature interests you. Think back in pathology and think what organ system was the most interesting Dig deep into your 3rd year of medical school. Without thinking about the long hours, what rotation did you feel extremely comfortable? If you like surgery talk to as many surgeons about their life choice. Talk to academic attendings, private practice surgeons etc.
BEST LITMUS TEST IS THIS.... IF ALL MEDICAL SPECIALISTS WERE PAID $200,000, WHAT SPECIALTY WOULD YOU WANT TO DO BASED ON YOUR PERSONAL ENJOYMENT OF THE FIELD?
Just because you scored AOA and 270 Step 1 means you have earned the ability to have more options. It does not necessarily mean that you should go into a specialty because it is highly competitive.
Keep your ego in check and dig deep inside. Pick up a JAMA see what specialty literature interests you. Think back in pathology and think what organ system was the most interesting Dig deep into your 3rd year of medical school. Without thinking about the long hours, what rotation did you feel extremely comfortable? If you like surgery talk to as many surgeons about their life choice. Talk to academic attendings, private practice surgeons etc.
BEST LITMUS TEST IS THIS.... IF ALL MEDICAL SPECIALISTS WERE PAID $200,000, WHAT SPECIALTY WOULD YOU WANT TO DO BASED ON YOUR PERSONAL ENJOYMENT OF THE FIELD?
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Let someone inject a little bit of reality and pragmatism into this mental masturbation marathon:
1. I would go into something outside of the "salaried" world and work for cash.
2. There are drug reps who make more than that (total comp).
3. 7+ years post collegiate education, with the loss of income, compounding effects, and accrual of debt dictates higher earning potential for those who view education as an investment.
While one should not choose a specialty solely on current earning potential (because our earning potential is at the whim and fancy of political charlatans, redistributionist hacks who buy votes), one should factor in multiple variables -- including lifestyle afforded and income potential.
Students tell themselves these things to allow them to sleep better at night. When you are out and earning your way you will find that 75-80hrs/week doing this work for 200k is not a good deal after all..........
I guess Im not sure what you're saying...
Does this mean you'd suggest that every med student should go into Derm or Plastics? Maybe switch and go into dentistry? Last time I checked, those are the only health-related fields where patients routinely pay cash for procedures/care.
By your logic, all of us should probably quit and chase higher pay in industry. Let's not forget that at least a few of us went into medicine because we actually like caring for patients.
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Not saying that, although that clearly is the conclusion that I came to. You are failing to see the bigger picture, its potential problems and/or benefits. Any form of primary care has the potential to be a cash only operation. Guaranteed access, short waits, minimal hassles, good service, low overhead, decent work environment. Specialties whose services are costly to provide stand the most to lose. Surgical specialties (sans plastics) are especially at the whim and folly of CMS. High cost service providers (which would include my primary procedure as well as rad onc) are at significant risk as well.
The "like" of caring for patients should be a fairly ubiquitous trait; otherwise no one with sound judgment would undertake the gauntlet that is medical education. Like every choice there are relative utilities that can be defined and assigned to that motivating factor, and it is a simple fact that there exists a point along the curve where the risk and costs are not worth the reward... albeit at different points along the curve for every individual.
The "like" of caring for patients should be a fairly ubiquitous trait; otherwise no one with sound judgment would undertake the gauntlet that is medical education. Like every choice there are relative utilities that can be defined and assigned to that motivating factor, and it is a simple fact that there exists a point along the curve where the risk and costs are not worth the reward... albeit at different points along the curve for every individual.
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If I had to do it all over again, I would have gone to dental school and done a specialty like ortho or endo. You get the lifestyle and income of derm plus they're mostly cash-based but within reach for most people competitive enough to get into medical school.
