"COVID is threatening the survival of US Primary Care."

[Cranjis McBasketball]

Covid-19 is threatening the survival of US primary care

In the US, government imposed lockdowns and public fears have slashed primary care visits—and with it revenue for physicians, Bob Roehr reports This is an especially difficult time to be a GP, internist, paediatrician, or other physician providing primary care in the US. “To be honest...

www.bmj.com

This doesn't seem to be the experience of the doctors on this forum, but I am interested to hear if you have friends/family who have experiences similar to this and if this is actually the norm across the country.

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[smq123]

Covid-19 is threatening the survival of US primary care

In the US, government imposed lockdowns and public fears have slashed primary care visits—and with it revenue for physicians, Bob Roehr reports This is an especially difficult time to be a GP, internist, paediatrician, or other physician providing primary care in the US. “To be honest...

www.bmj.com

This doesn't seem to be the experience of the doctors on this forum, but I am interested to hear if you have friends/family who have experiences similar to this and if this is actually the norm across the country.

If anything, specialties that require in-person examinations are struggling. Like, it’s hard to do an ophthalmology exam over Zoom. Dentists are at highest risk of being infected and need the most PPE, and they’ve been struggling for sure.

 

[SXMMD]

Very early on I realized this article wasn't worth the time... "PCPs make far less than other US specialists, $243 000 (£192 000; €214 000) annually compared with a specialist’s average income of $346 000, according to Medscape’s Physician Compensation Report 2020.3 PCPs often work in rural and other underserved populations and rely primarily on fee-for-service payments. Like most Americans, they are only a few missed pay days away from a financial crisis."

any clown that can suggest that we are a few missed paydays short of financial crisis like most Americans, whose income is like 5 times less than ours on avg, is delusional.

 

[VA Hopeful Dr]

Very early on I realized this article wasn't worth the time... "PCPs make far less than other US specialists, $243 000 (£192 000; €214 000) annually compared with a specialist’s average income of $346 000, according to Medscape’s Physician Compensation Report 2020.3 PCPs often work in rural and other underserved populations and rely primarily on fee-for-service payments. Like most Americans, they are only a few missed pay days away from a financial crisis."

any clown that can suggest that we are a few missed paydays short of financial crisis like most Americans, whose income is like 5 times less than ours on avg, is delusional.

Actually I'd be surprised if that wasn't true. Physicians are notoriously bad with money.

 

[SXMMD]

Actually I'd be surprised if that wasn't true. Physicians are notoriously bad with money.

Being bad with money isn't the same thing as living in poverty though...we make good money!

 

[VA Hopeful Dr]

Being bad with money isn't the same thing as living in poverty though...we make good money!

yes but if you live paycheck-to-paycheck and then all of a sudden your paycheck gets cut by 30% then you aren't able to cover your expenses and that's the issue.

 

[SXMMD]

Wonder if that logic has a salary maximum... does it apply to Elon Musk and Jeff Bezos too?

Let's be real here man! "Living within your means" means something totally different when you're making 50k vs 250k.

I'm not sure the technicality you cited should garner any sympathy

 

[Lurts]

Wonder if that logic has a salary maximum... does it apply to Elon Musk and Jeff Bezos too?

Let's be real here man! "Living within your means" means something totally different when you're making 50k vs 250k.

I'm not sure the technicality you cited should garner any sympathy

While I do not disagree with the idea that the money we make as physicians puts us in a totally different financial situation that most Americans, it doesn’t matter if you make PCP money or surgical specialist money if for the past 10 years you have been financially irresponsible and are currently responsible for a massive house payment, multiple car payments, kids college tuition, and high credit card bills. Once the paycheck gets cut short, those bills are still going to show up and you’re going to be screwed.

Now if you have been making wise financial decisions prior to this, sure, you should be fine.

 

[smq123]

While I do not disagree with the idea that the money we make as physicians puts us in a totally different financial situation that most Americans, it doesn’t matter if you make PCP money or surgical specialist money if for the past 10 years you have been financially irresponsible and are currently responsible for a massive house payment, multiple car payments, kids college tuition, and high credit card bills. Once the paycheck gets cut short, those bills are still going to show up and you’re going to be screwed.

Now if you have been making wise financial decisions prior to this, sure, you should be fine.

I think that the following court documents, detailing the divorce and finances of a neurosurgeon in Alaska, should be required reading for all new physicians: https://www.courts.wa.gov/content/petitions/90043-4 COA Respondents Brief.pdf

It starts to get good around page 5.

 

[InternistDO]

The problem that COVID has revealed is not about doctors who are terrible with personal finances--people who live paycheck to paycheck are always going to be one bad situation away from a financial disaster, whether that problem is getting fired, a sudden emergency expense, a divorce, or a viral pandemic.

What COVID has revealed is that a business practice completely reliant on generating a continuous stream of fee for service visits is extremely vulnerable to any disruption in that service and therefore we should ask if it's really the best way to deliver primary care in the US.

 

[Sardonix]

The problem that COVID has revealed is not about doctors who are terrible with personal finances--people who live paycheck to paycheck are always going to be one bad situation away from a financial disaster, whether that problem is getting fired, a sudden emergency expense, a divorce, or a viral pandemic.

What COVID has revealed is that a business practice completely reliant on generating a continuous stream of fee for service visits is extremely vulnerable to any disruption in that service and therefore we should ask if it's really the best way to deliver primary care in the US.

Ron Howard Narrator Voice Over: "It was not."

 

[studentxx8800]

I personally don't now why some of you are getting mad at this article. I mean this type of news is IMO a good thing for most PCPs. At best, it makes healthcare law makers more conscious of the discrepancy in the financial state of PCPs compared to specialists. At worst, it at least raises some awareness that primary care doctors are not filthy rich like most lay people think we are. It gets old + irritating when every time a person finds out that I'm a physician they automatically think I'm rolling in money and makes a ton of profit from charging people copay money

 

[futureapppsy2]

I think that the following court documents, detailing the divorce and finances of a neurosurgeon in Alaska, should be required reading for all new physicians: https://www.courts.wa.gov/content/petitions/90043-4 COA Respondents Brief.pdf

It starts to get good around page 5.

I know that court proceedings are notoriously biased and should be taken with a lump of salt, but man, that guy sounds like a massive jerk.

 

[hallowmann]

yes but if you live paycheck-to-paycheck and then all of a sudden your paycheck gets cut by 30% then you aren't able to cover your expenses and that's the issue.

Yeah, but theoretically, you could always downsize in that situation. Even if you did say squander your money away on cars, houses, and jewels, you should still be able to say sell some of that, whereas most Americans simply don't own enough to sell.

While I do not disagree with the idea that the money we make as physicians puts us in a totally different financial situation that most Americans, it doesn’t matter if you make PCP money or surgical specialist money if for the past 10 years you have been financially irresponsible and are currently responsible for a massive house payment, multiple car payments, kids college tuition, and high credit card bills. Once the paycheck gets cut short, those bills are still going to show up and you’re going to be screwed.

Now if you have been making wise financial decisions prior to this, sure, you should be fine.

I mean, again, multiple car payments means you could probably get rid of one car and carpool. Kids tuition means they could probably go to community college for a bit or even take a bit of time off from their $60k tuition at "online school" until paychecks recover. You can sell, lease, or airbnb your home and live somewhere much smaller. Its a luxury to be able to say you don't "want" to do those things and so you're living paycheck to paycheck. Most people in that situation who make less than docs don't really have other options out there, unless you count living on the street an option.

 

[VA Hopeful Dr]

Yeah, but theoretically, you could always downsize in that situation. Even if you did say squander your money away on cars, houses, and jewels, you should still be able to say sell some of that, whereas most Americans simply don't own enough to sell.



I mean, again, multiple car payments means you could probably get rid of one car and carpool. Kids tuition means they could probably go to community college for a bit or even take a bit of time off from their $60k tuition at "online school" until paychecks recover. You can sell, lease, or airbnb your home and live somewhere much smaller. Its a luxury to be able to say you don't "want" to do those things and so you're living paycheck to paycheck. Most people in that situation who make less than docs don't really have other options out there, unless you count living on the street an option.

In theory yes.

In practice, selling a too big for a doctor house can't usually be done quickly.

 

[hallowmann]

In theory yes.

In practice, selling a too big for a doctor house can't usually be done quickly.

True. I think that's the point where you do things like sublet or airbnb, but that may also be difficult.

 

[simpler2]

This article is attempting to look at short term struggles in a profession to claim how this will affect its future existence. I would also argue that it is only considering one of many flavors of primary care really. My equally possibly wrong opinion is that primary care (in the US as a whole) will be the area of medicine that remains most likely to survive through ANY social or natural disaster. I can't imagine how other more specialized areas of medicine will fair better. The practice of primary care will certainly evolve due to the pandemic but I can't see how its survival is, or will be, threatened.

 

[BocephusTim]

My equally possibly wrong opinion is that primary care (in the US as a whole) will be the area of medicine that remains most likely to survive through ANY social or natural disaster. I can't imagine how other more specialized areas of medicine will fair better. The practice of primary care will certainly evolve due to the pandemic but I can't see how its survival is, or will be, threatened.

I agree wholeheartedly. Primary care can probably evolve with telemedicine much better than specialty care and therefore future pandemic shutdowns will affect them less severely. How in the hell is a dermatologist going to survive for 6+ months by looking at skin lesions over a FaceTime call? Can a cardiologist really diagnose a murmur using an Android app? I have to laugh at any article that claims specialists will thrive in the Telemedicine Age.

 

[ConfusedAboutEverything]

I have to laugh at any article that claims specialists will thrive in the Telemedicine Age.

It's weird how the author didn't consider that those who will thrive in the Telemedicine age are the ones who do the least procedures or can get by without having to do procedure. Looking at psychiatry and Family Medicine.

 

[SLC]

All I know is my volume is higher right now than at any Point in the past 2 years. By a considerable amount.

 

[Sardonix]

All I know is my volume is higher right now than at any Point in the past 2 years. By a considerable amount.

Is that resurgence after clinics started resuming after restrictions?

 

[deleted87716]

I'm pretty busy again. YTD, I'm only down $10K compared to last year as of the end of July.

 

[SLC]

Is that resurgence after clinics started resuming after restrictions?

I personally didn’t see that big a decrease with restrictions. But COVID hasn’t hit hard here. We’ve had 160’ish total cases in the county total, the entire time.

 

[calvnandhobbs68]

It's weird how the author didn't consider that those who will thrive in the Telemedicine age are the ones who do the least procedures or can get by without having to do procedure. Looking at psychiatry and Family Medicine.

Right, look what happened when they halted all those elective surgeries. Anesthesia AND surgical subspecialties were knocked on their ass (so much so that there are stories all over the place of all specialities having to take a pay cut to basically subsidize their higher salaries even though primary care or psychiatry RVUs didn't go too far off their usual). They still haven't gotten back to the volume they're usually at in many places.

Again this begs the question of if a FFS model that bases how much you're reimbursed on how much meat you can put through the door is really the best way to run a healthcare system...but whatever.

 

[deleted87716]

Meh. Procedural specialists should already know they’re dependent on facilities and technology.

 

[Sardonix]

Meh. Procedural specialists should already know they’re dependent on facilities and technology.

Their collective superiority complexes might have something to say about that.

 

[deleted87716]

Their collective superiority complexes might have something to say about that.

In my group, the non-procedural folks were barely grazed by COVID-19. We stayed open, took precautions, rapidly adopted telemedicine, and kept seeing patients. The procedural folks took a major hit. Some of them shut their practices down for a period of time. All of them had elective procedures cancelled for weeks (not by them, but by the facilities they operate in). Even when they went back to operating, they were COVID-19 tested on a weekly basis, and put out of work for weeks at a time if they tested positive, even if they were asymptomatic. This is definitely a good time to be a primary care physician.

 

[goldsummer]

I start my first attending job soon, i have a guaranteed base salary for 2 years...hopefully things will be back to normal by then.

 

[VA Hopeful Dr]

I start my first attending job soon, i have a guaranteed base salary for 2 years...hopefully things will be back to normal by then.

You'll be fine. All of the FPs in my group are back at pre-COVID numbers. Have been since June.

 

[manwelio]

I start my first attending job soon, i have a guaranteed base salary for 2 years...hopefully things will be back to normal by then.

Can I ask, how do salaries vary for doctors after residency? You speak of a base salary guaranteed for a period of time as an attending. Fellowships are handled a little differently from residency, essentially contracted for a temporary period, and not meant to be permanent. But elsewhere above I saw someone saying they were down some amount of money, but not by too much. When you hear of IM physicians making $240K, is that a salary for a certain number of hours a week like other jobs? Is it more based on scheduled procedures? Are there quotas? My own doctor has talked about how she's on a half-hour schedule when meeting her patients in outpatient facility, and I've often wondered if her salary is based on number of patients she sees rather than just pure attendance of her job.

 

[deleted480308]

Can I ask, how do salaries vary for doctors after residency? You speak of a base salary guaranteed for a period of time as an attending. Fellowships are handled a little differently from residency, essentially contracted for a temporary period, and not meant to be permanent. But elsewhere above I saw someone saying they were down some amount of money, but not by too much. When you hear of IM physicians making $240K, is that a salary for a certain number of hours a week like other jobs? Is it more based on scheduled procedures? Are there quotas? My own doctor has talked about how she's on a half-hour schedule when meeting her patients in outpatient facility, and I've often wondered if her salary is based on number of patients she sees rather than just pure attendance of her job.

It’s complicated, some are straight salary and some start with a salary and transition to “production” where you get a set amount per billing unit. There are other things but that’s the two big ones

 

[manwelio]

It’s complicated, some are straight salary and some start with a salary and transition to “production” where you get a set amount per billing unit. There are other things but that’s the two big ones

Are hospitals more typically a salary and outpatient more varied, or the other way around? I'm guessing it's very particular to specialty so it's not easy to give a simple answer. I got the impression from watching Lenox Hill on Netflix that the neurosurgeons there were unique in that they divide up their cases instead of pursuing cases individually that might make one or the other doctor more or less money. They portrayed that as more unique for that specialty. So maybe the short answer is it really comes down to where you're looking to work?

For a time I lived in rural Oregon which opened my eyes more to medicine and issues in the field, particularly rural medicine and how hard it is to attract specialists. Where I was, one of my coworkers went to a doctor in town known for pediatrics, but she was equipped to handle adult cases of diabetes, which is what my colleague required, otherwise should would have had to drive two hours to Eugene, OR. It was communicated to me there that it comes down to money because specialists in a rural location won't have as many patients so they won't get paid as much, or the hospital just doesn't have the tools to support them. I knew a child who had a brain tumor behind her eye who had to go to Portland for most treatment, and eventually Eugene, OR for other treatment. They lived on the rural coast.

 

[deleted480308]

Are hospitals more typically a salary and outpatient more varied, or the other way around? I'm guessing it's very particular to specialty so it's not easy to give a simple answer. I got the impression from watching Lenox Hill on Netflix that the neurosurgeons there were unique in that they divide up their cases instead of pursuing cases individually that might make one or the other doctor more or less money. They portrayed that as more unique for that specialty. So maybe the short answer is it really comes down to where you're looking to work?

For a time I lived in rural Oregon which opened my eyes more to medicine and issues in the field, particularly rural medicine and how hard it is to attract specialists. Where I was, one of my coworkers went to a doctor in town known for pediatrics, but she was equipped to handle adult cases of diabetes, which is what my colleague required, otherwise should would have had to drive two hours to Eugene, OR. It was communicated to me there that it comes down to money because specialists in a rural location won't have as many patients so they won't get paid as much, or the hospital just doesn't have the tools to support them. I knew a child who had a brain tumor behind her eye who had to go to Portland for most treatment, and eventually Eugene, OR for other treatment. They lived on the rural coast.

Every family or internal doc should be able to handle diabetes, your friend should not have needed to drive 2 hours unless they lived 2 hrs from a Walmart

 

[Keona]

Every family or internal doc should be able to handle diabetes, your friend should not have needed to drive 2 hours unless they lived 2 hrs from a Walmart

So surprisingly I’ve found a lot of mds won’t manage type 1 diabetics. I do but have a small number of them. Our closest endorcrinologist is over an hour drive. If I get someone who is brittle or I can’t get controlled I send to endocrine but I do what I can first. Once they’re controlled again I take back over if patient and endocrine want.

 

[VA Hopeful Dr]

So surprisingly I’ve found a lot of mds won’t manage type 1 diabetics. I do but have a small number of them. Our closest endorcrinologist is over an hour drive. If I get someone who is brittle or I can’t get controlled I send to endocrine but I do what I can first. Once they’re controlled again I take back over if patient and endocrine want.

I don't do type 1. But, if I didn't have endocrine as an option I might change that practice.

 

[manwelio]

Every family or internal doc should be able to handle diabetes, your friend should not have needed to drive 2 hours unless they lived 2 hrs from a Walmart

That was my entire point. That region did not have internal medicine specialists out there. She managed to find a Family Med doctor who DID live there, and that's how she received treatment. But the lady was billed in town as a pediatrician. If that Family Med doctor had not been there, the town did not have any other internal medicine specialists that would have worked. The entire town was staffed with NPs and PAs as PCPs. But again, this is coming from her. Maybe she didn't comb through the hospital to find the one IM offering outpatient services. Who knows? But once again, there's a reason the one major medical school of Oregon is like 93% in-state attendance.