CMS Proposes Primary Care Raises Funded With Specialist Cuts

[DrAwsome]

And, obviously, you don't read them.

I wasn't saying that in a negative way. I have read some of the studies, not all. And I was asking about your input into this, and posing something that has not been addressed-ie-the lack of additional residency spots.

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[deleted87716]

Increasing residency slots without payment and delivery system reform will accomplish nothing.

 

[DrAwsome]

Increasing residency slots without payment and delivery system reform will accomplish nothing.

Ok. But how will 17 or so million more patients be treated with no additional PCPs-are you suggesting that PCPs will be able to see more patients given their current workload?

 

[deleted87716]

Ok. But how will 17 or so million more patients be treated with no additional PCPs-are you suggesting that PCPs will be able to see more patients given their current workload?

I didn't say that we didn't need additional primary care physicians. The problem isn't a lack of training slots. The problem is that the current system is toxic to primary care.

And now, you're talking about workload, which relates to efficiency (or, the lack thereof) in our current problem-focused, fee-for-service payment environment, which is an entirely different subject. With payment and delivery system reform, the same number of physicians would likely be able to take better care of more people than we are able to do in the current model.

 

[Smokemont]

1) Well EM may be the same length at some programs, ie-3 years, although most programs are 4. Second, EM does not make 2x what FP makes. FP makes around 180kish and you can find many 8-5 MF jobs. EM make somewhat more, in the 230-250kish, but they do work overnight shifts, odd shifts, etc and I personally think it's more stressful so there needs to be compensation for that.
2) Completely agree with you. It's as if you say hey this is what the salary of this profession pays but oh wait next year you'll be making 1/2 that!
3) this is precisely what I have said. We can throw more $ at PCPs but given that all funded positions are filled, it won't do anything. I personally suggested redistributing some positions in specialties hwere there is a huge market saturation like path and rads.
4) Agreed
5) Agreed!!

In order to fix this, we need to take all of this into account as well as midlevels issues. I think what BlueDog posted about the midlevels was actually a great article to show that they are not really contributing all that much to solve this crisis.

And again-more money without more positions is pointless. I would imagine PCPS are pretty maxed out as far as the # of patients they can see.

180k vs. 230-250k -- let's just use these numbers for sake of argument. So you think a 33% increase in salary over a lifetime is fair for one additional year of training?

The generality that EM is more stressful than FP is completely irresponsible for a medical student to make.

 

[bigkahunaburger]

Why do you use such bogus salary figures?

"Primary care and specialty-care physicians saw varied movement in compensation levels from 2009 to 2010, according to MGMA's new Physician Compensation and Production Survey: 2011 Report Based on 2010 Data.
Total median compensation increased for doctors in:
Internal medicine *-from $197,080, to $205,379 (a 4.21 percent increase)
Cardiology - from $481,878 to $500,993 (a 3.97 percent increase)
Emergency medicine - from $262,475 to $277,297 (a 5.65 percent increase)
Compensation remained flat or declined for physicians in:
Urology - from $390,678 to $372,455 (-4.6 percent)
Ophthalmology - from $338,208 to $330,784 (-2.20 percent)
Radiology - from $478,824 to $471,253 (-1.58 percent)
OB/GYN - from $282,645 to $281,190 (-.51 percent)"

 

[bigkahunaburger]

Many many EM physicians make well over 300K

 

[Smokemont]

Why do you use such bogus salary figures?

"Primary care and specialty-care physicians saw varied movement in compensation levels from 2009 to 2010, according to MGMA's new Physician Compensation and Production Survey: 2011 Report Based on 2010 Data.
Total median compensation increased for doctors in:
Internal medicine *-from $197,080, to $205,379 (a 4.21 percent increase)
Cardiology - from $481,878 to $500,993 (a 3.97 percent increase)
Emergency medicine - from $262,475 to $277,297 (a 5.65 percent increase)
Compensation remained flat or declined for physicians in:
Urology - from $390,678 to $372,455 (-4.6 percent)
Ophthalmology - from $338,208 to $330,784 (-2.20 percent)
Radiology - from $478,824 to $471,253 (-1.58 percent)
OB/GYN - from $282,645 to $281,190 (-.51 percent)"

I was using figures that were already offered because I was challenging his/her argument.

 

[bigkahunaburger]

yes sorry, should've clarified, that wasn't directed at you

 

[DrAwsome]

Why do you use such bogus salary figures?

"Primary care and specialty-care physicians saw varied movement in compensation levels from 2009 to 2010, according to MGMA's new Physician Compensation and Production Survey: 2011 Report Based on 2010 Data.
Total median compensation increased for doctors in:
Internal medicine *-from $197,080, to $205,379 (a 4.21 percent increase)
Cardiology - from $481,878 to $500,993 (a 3.97 percent increase)
Emergency medicine - from $262,475 to $277,297 (a 5.65 percent increase)
Compensation remained flat or declined for physicians in:
Urology - from $390,678 to $372,455 (-4.6 percent)
Ophthalmology - from $338,208 to $330,784 (-2.20 percent)
Radiology - from $478,824 to $471,253 (-1.58 percent)
OB/GYN - from $282,645 to $281,190 (-.51 percent)"

I am talking starting salaries. Most of those salaries you post are biased because there are a ton of those that i'm sure involve mid career docs too. You really think that Ophthalmology starts at 338k and that rads start at 478? Get real. Those are not starting salaries. 180k for IM is real, and you are using OLD data, from 2 years ago.

 

[DrAwsome]

Many many EM physicians make well over 300K

Not to start with buddy.

 

[EdibleEgg]

Not to start with buddy.

What do you do again? 300K would actually be a little low starting in my area.

 

[DrAwsome]

What do you do again? 300K would actually be a little low starting in my area.

I'm going from derm to rad onc. So you are saying that the typical EM grad is starting out at 300k? So the averages reported are bogus? Or are you in a region of the country where salaries are high?

Because while you may be in an area where ED docs get paid a lot, most don't start at 300k. Sure with the demand there are some job postings for IM/FP that also start out at 280-300k as well in my area, but they are certainly not the norm.

If we go by anecdotal evidence, then I can say the avg for primary care is 250k+ given what some job postings are in my area. But my area does not reflect the whole story does it?

 

[bigkahunaburger]

derm to rad onc...LOL

 

[DrAwsome]

derm to rad onc...LOL

?

 

[DrAwsome]

derm to rad onc...LOL

What's so funny?

 

[bigkahunaburger]

Well, you seem to vehemently disagree with the idea of raising PCPs salary, which is funny for obvious reasons, also, you seem to have picked perhaps THE two most grossly overpaid professions.

 

[DrAwsome]

Well, you seem to vehemently disagree with the idea of raising PCPs salary, which is funny for obvious reasons, also, you seem to have picked perhaps THE two most grossly overpaid professions.

No, I did not say that at all. At no point did I say I vehemently disagree with raising PCP salaries. I clearly stated that the PCPs are at max for the # of people they can see, so throwing more $ at them won't do anything. Increasing residency positions with some more money might though. But for a 3 year residency, it makes no sense to make a ton of $. Second, the reason derm makes money is for a variety of reasons. For one, there is a large shortage of derm. Second, because of the nature of derms, they can see a ton of patients. Some derms see 60 patients a day, have a PA or 2 and you are seeing 100 patients or more a day. Even if they did not take insurance you can do the math. Add some cosmetics in there and boom you've made a ton.

Rad onc is a pretty intensive field and rad oncs are the top of the line imo. Most MD/PhD's are in rad onc, and it takes double what a primary care residency takes, not to mention the large # of patients that are treated, etc etc. So not sure that either profession is per se grossly overpaid.

If PCPs saw more patients they could make more but obviously derm visits are far shorter than PCP ones so it's not as easy. But there are a number of PCPS who are mostly cash only. One of the derms at my program had a PCP friend who charged 250$ per 1/2 hour visit, no insurance whatsover and patients had to pay upfront. He did not have any trouble having a full calendar of patients daily. So it's all about how you do things.

 

[deleted4401]

What do you think I should get paid as a radiation oncologist near a metro area? And why do you think that? I don't know how much I'm worth, but by treating a surely fatal larynx cancer making it disappear for good or adding a 5% survival benefit to breast cancer patients with an economically efficient treatment modality or using external beam and brachytherapy to cure a cervical cancer patient in her mid 30s with 3 children sure seems like a job that should be compensated fairly well. It's not just button pushing and lasers. It's actually complicated work, highly technical, with grave risks of treatment. It's emotionally demanding and draining. I earn every penny I make.

If you are talking about the millions people earn by owning cancer centers, that's a completely different situation altogether. That's a return on investment based on a capital investment. That's capitalism's problem and Medicare's problem, not because we're grossly overpaid. I'm not a big supporter of physician ownership of machines that they refer to (imaging, linacs, surgi-centers, whatever). But, even so, the fact that there is such a huge return on investment helps the other specialties at hospitals where a community or non-profit owns the equipment. Radiation oncology subsidizes a lot of the other specialties, and I'd like a thank you every now and then, but obviously that won't happen.

I'm about to see a patient right now, who had a painless, growing mass in his thigh since April and was told it was a muscle cramp multiple times. Yup, it's a 26cm sarcoma. Yesterday, I saw a guy with a tobacco history with a firm mass in his neck and was given multiple courses of antibiotics for this. Yup, it's tonsil cancer, and it would have been visible with a minimal exam of the oropharynx. I see so many cases of obvious cancer diagnoses and I could come to the conclusion that even $200k is too much for them, but that isn't really logical or fair for me to make an assessment about.

Medicine is hard work, and I don't begrudge any doctors. We should not try to slice the pie differently to pit us against each other. We should reduce overhead/inefficiency and improve outcomes to make the pie bigger.

S

Well, you seem to vehemently disagree with the idea of raising PCPs salary, which is funny for obvious reasons, also, you seem to have picked perhaps THE two most grossly overpaid professions.

 

[DrAwsome]

What do you think I should get paid as a radiation oncologist near a metro area? And why do you think that? I don't know how much I'm worth, but by treating a surely fatal larynx cancer making it disappear for good or adding a 5% survival benefit to breast cancer patients with an economically efficient treatment modality or using external beam and brachytherapy to cure a cervical cancer patient in her mid 30s with 3 children sure seems like a job that should be compensated fairly well. It's not just button pushing and lasers. It's actually complicated work, highly technical, with grave risks of treatment. It's emotionally demanding and draining. I earn every penny I make.

If you are talking about the millions people earn by owning cancer centers, that's a completely different situation altogether. That's a return on investment based on a capital investment. That's capitalism's problem and Medicare's problem, not because we're grossly overpaid. I'm not a big supporter of physician ownership of machines that they refer to (imaging, linacs, surgi-centers, whatever). But, even so, the fact that there is such a huge return on investment helps the other specialties at hospitals where a community or non-profit owns the equipment. Radiation oncology subsidizes a lot of the other specialties, and I'd like a thank you every now and then, but obviously that won't happen.

I'm about to see a patient right now, who had a painless, growing mass in his thigh since April and was told it was a muscle cramp multiple times. Yup, it's a 26cm sarcoma. Yesterday, I saw a guy with a tobacco history with a firm mass in his neck and was given multiple courses of antibiotics for this. Yup, it's tonsil cancer, and it would have been visible with a minimal exam of the oropharynx. I see so many cases of obvious cancer diagnoses and I could come to the conclusion that even $200k is too much for them, but that isn't really logical or fair for me to make an assessment about.

Medicine is hard work, and I don't begrudge any doctors. We should not try to slice the pie differently to pit us against each other. We should reduce overhead/inefficiency and improve outcomes to make the pie bigger.

S

Thank you. Excellent post.

 

[Substance]

I'm about to see a patient right now, who had a painless, growing mass in his thigh since April and was told it was a muscle cramp multiple times. Yup, it's a 26cm sarcoma. Yesterday, I saw a guy with a tobacco history with a firm mass in his neck and was given multiple courses of antibiotics for this. Yup, it's tonsil cancer, and it would have been visible with a minimal exam of the oropharynx. I see so many cases of obvious cancer diagnoses and I could come to the conclusion that even $200k is too much for them, but that isn't really logical or fair for me to make an assessment about.

Medicine is hard work, and I don't begrudge any doctors. We should not try to slice the pie differently to pit us against each other. We should reduce overhead/inefficiency and improve outcomes to make the pie bigger.

A lot of this crap medicine you're seeing is the direct result of family medicine being lower paid and completely disrespected. If any bozo can do family, then naturally you are going to end up with a higher proportion of docs who are blatantly incompetent because 1. they are lazy 2. they are stupid 3. they lack pride in their craft.

Given that hardworking intelligent people would rather get paid more, and that primary care is seen as the lowest rung on the ladder of medical hierarchies, those unfortunate patients whom you had mentioned are probably a more commonplace occurrence than we would like to think.

 

[MOHS_01]

Get with the program, Dartmouth.

http://www.dartmouthatlas.org/downloads/reports/Primary_care_report_090910.pdf

on edit -- Doh!!!!

 

[bigkahunaburger]

Right, because PCPs never have to deal with giving bad news or making tough decisions. Just as PCPs never have to clean up the mistakes from another physician, that's why you guys deserve 3 times what they make...

"efficient treatment modality or using external beam and brachytherapy to cure a cervical cancer patient in her mid 30s with 3 children sure seems like a job that should be compensated fairly well."

Good point, but a family practice physician that effectively screens for cervical cancer so that such an extensive treatment option never has to be approached also seems pretty cost effective, and I happen to think that deserves a pay raise as well. You see, nobody on this forum is denying the amazing capabilities that a specialist can provide, we are all well aware of it, it's simply not cost effective.

 

[DrAwsome]

Right, because PCPs never have to deal with giving bad news or making tough decisions. Just as PCPs never have to clean up the mistakes from another physician, that's why you guys deserve 3 times what they make...

"efficient treatment modality or using external beam and brachytherapy to cure a cervical cancer patient in her mid 30s with 3 children sure seems like a job that should be compensated fairly well."

Good point, but a family practice physician that effectively screens for cervical cancer so that such an extensive treatment option never has to be approached also seems pretty cost effective, and I happen to think that deserves a pay raise as well. You see, nobody on this forum is denying the amazing capabilities that a specialist can provide, we are all well aware of it, it's simply not cost effective.

Unfortunately you have failed to discuss how PCPs making MORE $ will prevent the woman from getting cervical cancer. So if this patient goes to PCP and gets a pap, which diagnoses the cancer in early stages, and we prevent her from going to the rad onc since she does not develop a worse condition, that is done whether the PCP gets paid 10$ for the visit or 1000$.

So how does paying the PCP say 1000$ for the visit, vs. 10$ for the visit lead to a better outcome?

No additional residency positions = same amount of access

So let's say PCPs can see a max of 40 patients per day (i'm just making these #s up here)-we currently pay PCPs say 180k. So let's say we increase salaries to 250k for PCPs. Does that mean they can now see 80 patients a day? No, they will still see the same # of patients. So the "lack of access" situation has not been resolved or addressed. You still have the same PCP making more money for the same work.

So again = HOW will you treat more patients just by having a higher salary?

So either a) increase the # of positions so that the access situation can be addressed

OR

b) hire more midlevels who can do a number of things in the PCP role, with PCPs having more of a supervisory role and more difficult cases being referred to the PCP

I find it hard to believe that no one has yet addressed this!

 

[bigkahunaburger]

"Improving the care delivered by primary care clinicians holds great promise for better
patient health and well-being, but the value of primary care can be eroded by episodic
delivery that is uncoordinated with specialists and hospitals. Thus, simply increasing
access to primary care, either by boosting the number of primary care physicians in
an area or by ensuring that most patients have better insurance coverage, may not be
enough to improve the quality of care or health outcomes; nor is it likely to eliminate
racial disparities"

So basically, this article is saying that African Americans are less likely to visit their PCP in the first place("Although blacks were as little as half as likely to see a primary care clinician and up to 84% more likely to be hospitalized than whites within areas as well") as well as the idea that simply increasing PCPs doesn't equal quality, neat. So what do you suggest we do, let's saturate the market with some fat cat derm and radiology guys, so when they make that ER visit we can zip and zap them back into shape. Oh yeah, of course the "quality" may not be improved, that's a big part of this whole discussion remember? Have you ever talked to anyone that's homeless or works a blue collar job? Have you really never heard someone say "I don't have insurance and I don't have a doctor I can go to?" It's pretty much hilarious to think the answer to our healthcare crisis is either:
1. Keep things the way they are
2. Increase the amount of specialists

Without even getting into racial disparities and how this country has handled them, don't you think a better solution would be to increase PCPs to areas that are underserved while simultaneously informing the public of this availability and the benefits of them. Seems like a lot of hand holding I know, but to think that this wouldn't drastically cut costs is ludicrous.

 

[bigkahunaburger]

"Unfortunately you have failed to discuss how PCPs making MORE $ will prevent the woman from getting cervical cancer. So if this patient goes to PCP and gets a pap, which diagnoses the cancer in early stages, and we prevent her from going to the rad onc since she does not develop a worse condition, that is done whether the PCP gets paid 10$ for the visit or 1000$."

Yes because the external beam radiation therapy certainly only costs $1000, and of course PCPs make $1000 for every person they see...oh yeah, and the whole thing about the patient not having to be put through cancer therapy.

 

[bigkahunaburger]

"So let's say we increase salaries to 250k for PCPs. Does that mean they can now see 80 patients a day? No, they will still see the same # of patients."

Raising the salary increases quality and availability by increasing the amount of people interested in primary care. Seriously now, don't give me one of the same rhetorical statements you've made 60 times over, I get it.

 

[DrAwsome]

.

 

[DrAwsome]

"So let's say we increase salaries to 250k for PCPs. Does that mean they can now see 80 patients a day? No, they will still see the same # of patients."

Raising the salary increases quality and availability by increasing the amount of people interested in primary care. Seriously now, don't give me one of the same rhetorical statements you've made 60 times over, I get it.

The quality? so you are saying then that the current PCPs are slacking off?
It does NOT increase the availability of anything, bc no more funding for positions in primary care has been funded.

So either you are confused because you are a medical student and don't understand this, or you are just being difficult.

The current administration has not provided any more money to fund more residencies. All the currently funded positions - all 15000 or so FM/IM residencies have been FILLED. So unless you have MORE PCPs, or PCPS seeing MORE patients, there is still no additional access of patients to preventive medicine.

If you can't address this issue you shouldn't become involved.

 

[bigkahunaburger]

I literally didn't even read what you just posted.

 

[DrAwsome]

I literally didn't even read what you just posted.

Then why are you responding if you have not read it? Are you going into politics, and hope to act in the same was as Congress, who passed Obamacare without even reading what was in the bill?

Reading skills and comprehension, as well as attention to detail are essential in medicine. What will you tell your patients when their test results get to your office, or when specialists tell you their expert opinions, or when your patients ask you what was recommended for their treatment-oh i didn't read what the test/specialist/recommendation was, sorry!!

Talk about lazy and uninformed.

 

[elfmonkey]

Unfortunately you have failed to discuss how PCPs making MORE $ will prevent the woman from getting cervical cancer.

1. What would you say if they start paying PCP`s less ? Would there be a negative effect on the quality of care delivered to patients ?
2. Would increasing payment to specialists lead to better outcomes ?
3. Would decreasing payment to specialists lead to worse outcomes ?

I think the problem is in the system and the way PCP vs specialists being reimbursed.
So, if they are going to fix the system and increase reimbursement to PCP as a result of that, they will have to redistribute whatever they have, hence less money to specialists.

 

[DrAwsome]

1. What would you say if they start paying PCP`s less ? Would there be a negative effect on the quality of care delivered to patients ?
2. Would increasing payment to specialists lead to better outcomes ?
3. Would decreasing payment to specialists lead to worse outcomes ?

I think the problem is in the system and the way PCP vs specialists being reimbursed.
So, if they are going to fix the system and increase reimbursement to PCP as a result of that, they will have to redistribute whatever they have, hence less money to specialists.

I find it troubling that you are also not dealing with the question. You are just repeating the same thing that others have said, with no critical thinking in this case.

What is the rationale for many poor outcomes as stated by the gov, and other pro PCP agents? LACK OF ACCESS. Not enough patients accessing primary care. Ok.
So how would you get these patients such needed ACCESS to a PCP?

Paying the PCP will not increase access.
Paying the PCP less will also not increase or decrease access.

Say you are a PCP. We are paying you 1 million dollars a year. Who is your higher pay now contributing to more patients been seen by you?

1-Are you doubling your patient load?
2-Are you suddenly becoming better at what you do? Which means you were bad before or just lazy?

More money to PCPs does nothing to address the issue of lack of access of patients to a doctor without increasing the number of such doctors. IMG/FMGs fill all of the positions that are left over by american grads. So we need more docs not just more $ to those docs.

I think getting more PCPs is expensive, and I think increasing midlevels would be more cost effective with about the same return.

 

[elfmonkey]

]I find it troubling that you are also not dealing with the question. You are just repeating the same thing that others have said, with no critical thinking in this case[/B].

What is the rationale for many poor outcomes as stated by the gov, and other pro PCP agents? LACK OF ACCESS. Not enough patients accessing primary care. Ok.
So how would you get these patients such needed ACCESS to a PCP?

Paying the PCP will not increase access.
Paying the PCP less will also not increase or decrease access.

Say you are a PCP. We are paying you 1 million dollars a year. Who is your higher pay now contributing to more patients been seen by you?

1-Are you doubling your patient load?
2-Are you suddenly becoming better at what you do? Which means you were bad before or just lazy?

More money to PCPs does nothing to address the issue of lack of access of patients to a doctor without increasing the number of such doctors. IMG/FMGs fill all of the positions that are left over by american grads. So we need more docs not just more $ to those docs.

I think getting more PCPs is expensive, and I think increasing midlevels would be more cost effective with about the same return.

Ethically speaking, more money to any physician shouldn`t change their performance, this is why I asked those questions
I`m on your side . More money to primary care physicians by itself is pointless !

Fixing the way PCP`s being reimbursed is what we should ask for. Again, fixing this problem will lead to more money to PCP`s and less money to specialists. Specialists can keep their income if we can find another source for funding PCP`s after we fix the system.
I am a "new" american. We are all in the same boat. The system is really messed up and need to be fixed soon. It`s unfair and unsustainable .

 

[bigkahunaburger]

"and we prevent her from going to the rad onc since she does not develop a worse condition, that is done whether the PCP gets paid 10$ for the visit or 1000$."

Wait a second, doesn't the ACA cover routine screening at no additional cost?

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

"If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible."

Ouch

 

[DrAwsome]

Ethically speaking, more money to any physician shouldn`t change their performance, this is why I asked those questions
I`m on your side . More money to primary care physicians by itself is pointless !

 

[elfmonkey]

HOW will MORE money to PCPs FIX the ACCESS of patients? Are you unable to understand this or what is your problem? It's like i'm talking to a wall.

I'll say it again- HOW will MORE money to PCPs FIX the ACCESS of patients and better outcomes? I think the system is more than fair. Of course specialists would make more. No reason for them to make less.

Sir, Ma`am, I never said more money to PCPs will fix the access. You are not talking to wall and you need to calm down. I said I`m on your side.

I`m done with this thread, y`all have a good one !

 

[bigkahunaburger]

Increasing reimbursement for PCPs will:
1. Increase interest in the field therefore generating higher quality applicants
2. This will subsequently increase reimbursement for midlevel providers increasing the amount of midlevels that actually stay in primary care for more than 5 years
3. Increase the amount of general internal medicine docs that choose to forego fellowship training
4. Inevitably increase the amount of residency positions

I swear it's like talking to a brick wall.

 

[DrAwsome]

Increasing reimbursement for PCPs will:
1. Increase interest in the field therefore generating higher quality applicants
2. This will subsequently increase reimbursement for midlevel providers increasing the amount of midlevels that actually stay in primary care for more than 5 years
3. Increase the amount of general internal medicine docs that choose to forego fellowship training
4. Inevitably increase the amount of residency positions

I swear it's like talking to a brick wall.

-I don't think the quality of applicants is at discussion here-unless you are saying that current PCPs suck?
-Midlevels are not the question either-if we are using midlevels, then we might as well just get rid of most pcps and use more and more midlevels-they are cheaper and have same outcomes
-How would this increase the # of residency positions? The more of a type of doctor that there is, the less the system can pay them. It would cost a tremendous amoutn of $ to double residency positions, with higher pay
-Makes more sense to hire midlevels

 

[bigkahunaburger]

-I don't think the quality of applicants is at discussion here-unless you are saying that current PCPs suck? I said they suck lol, guess what and this might come as a shock, somehow the highest paying specialties have applicants with the highest board scores, see the correlation? There are a lot of very qualified and intelligent individuals that go into primary care, we need more of these people

-Midlevels are not the question either-if we are using midlevels, then we might as well just get rid of most pcps and use more and more midlevels-they are cheaper and have same outcomes--keep believing that

-How would this increase the # of residency positions? Once enough interest is garnered in primary care more will go into it, more going into it puts more pressure to generate more residency positions especially in light of the ACA



Also I believe you skipped one;
3. Increase the amount of general internal medicine docs that choose to forego fellowship training

 

[bigkahunaburger]

Posting on this board with you reminds of a quote;

"Wise men never argue with fools, because people from a distance can't tell who is who"

 

[bigkahunaburger]

now i look like a fool great, *me

 

[MOHS_01]

Right, because PCPs never have to deal with giving bad news or making tough decisions. Just as PCPs never have to clean up the mistakes from another physician, that's why you guys deserve 3 times what they make...

"efficient treatment modality or using external beam and brachytherapy to cure a cervical cancer patient in her mid 30s with 3 children sure seems like a job that should be compensated fairly well."

Good point, but a family practice physician that effectively screens for cervical cancer so that such an extensive treatment option never has to be approached also seems pretty cost effective, and I happen to think that deserves a pay raise as well. You see, nobody on this forum is denying the amazing capabilities that a specialist can provide, we are all well aware of it, it's simply not cost effective.

You keep using these words "cost effective". How cost effective do you really believe these screenings are? On what do you base these assumptions? The data will likely disappoint and surprise you... Keep in mind that is not an argument against them, just pointing out that the argument you are choosing to employ may not be the best one to be made.

 

[MOHS_01]

1. What would you say if they start paying PCP`s less ? Would there be a negative effect on the quality of care delivered to patients ?
2. Would increasing payment to specialists lead to better outcomes ?
3. Would decreasing payment to specialists lead to worse outcomes ?

I think the problem is in the system and the way PCP vs specialists being reimbursed.
So, if they are going to fix the system and increase reimbursement to PCP as a result of that, they will have to redistribute whatever they have, hence less money to specialists.

1. Yes
2. No. Well, let's hope not.
3. Yes.

 

[MOHS_01]

Increasing reimbursement for PCPs will:
1. Increase interest in the field therefore generating higher quality applicants
2. This will subsequently increase reimbursement for midlevel providers increasing the amount of midlevels that actually stay in primary care for more than 5 years
3. Increase the amount of general internal medicine docs that choose to forego fellowship training
4. Inevitably increase the amount of residency positions

I swear it's like talking to a brick wall.

So you're saying the current pool of providers and applicants are of lesser quality yet deliver greater results? And simultaneously say that improving the quality of the applicant pool (by drawing from the dumb, evil specialists with higher pay and lesser outcomes, no less) will improve the overall situation?

Yes, sound thought and logic is strong with this one.

 

[bigkahunaburger]

"lesser quality yet deliver greater results?" lol where did i say that?

 

[MedicineDoc]

So you're saying the current pool of providers and applicants are of lesser quality yet deliver greater results? And simultaneously say that improving the quality of the applicant pool (by drawing from the dumb, evil specialists with higher pay and lesser outcomes, no less) will improve the overall situation?

Yes, sound thought and logic is strong with this one.

So you're saying colon cancer screenings, breast cancer screenings, diabetes control, skin cancer surveillance, hypertension control ect which the lack thereof forms the basis of disease in just about every case I admit to the hospital besides the iatrogenic below mentioned numerous cases I come across (not to mention PCPs controlling endless readmissions of those who already have CHF, COPD) are wastes of time and MOHS surgery, can you say CA-CHING and yearly cardiac Caths helping to supply the nephrologists with new dye induced renal failure and cardiology NPs causing lasix induced chronic kidney disease for patients with bogus CHF diagnoses are where it's at.

 

[bigkahunaburger]

wait wait wait, i get it, you're saying that my position is that the specialists with higher board scores are producing a poorer result compared to the PCPs with lower board scores, yeah really man, that's central to what this is all about, of course that's what I think. But please teach me the way oh great pimple popper

 

[MOHS_01]

So you're saying colon cancer screenings, breast cancer screenings, diabetes control, skin cancer surveillance, hypertension control ect which form the basis of disease in just about every case I admit to the hospital are wastes of time and MOHS surgery can you say CA-CHING! As in a money making machine for dermatologists is where it's at.

If building strawmen were a marketable skill you'd be cashed out and running for Prez....

SMH. If you are going to form an argument, the very least you can do is make an effort to understand it. Saying that something is "cost effective" is making a quantifiable statement; it says nothing about whether it "should" or "should not" be undertaken. Things can be cost effective and not the most appropriate -- and some things not demonstrably cost effective can still be deemed appropriate. This is not a terribly difficult concept to grasp -- assuming you're willing to think just a little bit.

Many screenings -- and much of preventative care -- when rendered in a one on one fashion in a providers office is not cost effective across a population. More money will be spent in doing so than saved by doing so. There have been a variety pilot projects that have demonstrably failed to provide cost savings -- despite what the technocrats promised. This -- again -- is not to say that they are not worthwhile or should not be done -- just that money is not being saved in aggregate by doing so. Follow?

Since you asked about micrographic surgery -- a couple of finer points for my ill informed colleague. Yes, it has been shown time and again to be demonstrably cost effective for appropriately selected tumors. It does save money in aggregate. The cost effective benefits have been increased with recent Medicare coverage criteria, fee schedule changes, and the loss of the multiple procedure reduction exemption. Your ignorant envy aside, there is a reason that even HMO's and tightly controlled state agencies such as the VA outsource more now than in years past.

Perhaps you are wasting time and money with every case you admit to the hospital, I don't know. You would be a better judge of that... but the converse has been settled objectively several times over.

 

[MOHS_01]

"lesser quality yet deliver greater results?" lol where did i say that?

wait wait wait, i get it, you're saying that my position is that the specialists with higher board scores are producing a poorer result compared to the PCPs with lower board scores, yeah really man, that's central to what this is all about, of course that's what I think. But please teach me the way oh great pimple popper

I'm going to help you out here, mr. burger, because I'm a good guy.

bigkahuna premises:
1. PCP care good, specialist care bad
2. PCP underpaid, specialist overpaid
3. PCP need make more $, need take from specialist
4. PCP residencies need be more competitive. Need more $ from specialists to give PCP so more competitive students want to be PCP

There are a number of underlying assumptions readily apparent to anyone with an above median intellect in the above premises that should be found rather insulting to PCP's everywhere. I have said time and again, over a number of years that likely exceed the length of time you have been legal to drink (possibly drive), that the primary hurdle for PCP pay is a lack of distinct billable services for all of the **** they have to do. That's the problem. The problem with PCP pay has precious little to do with what the retina surgeon nets; it has everything to do with the amount of uncompensated work they provide.

But feel free to keep making asinine (and frankly insulting) arguments. It does make for a grand indictment of the current education system.