Future of Cardiology

[abcabc1]

Arent cardiologists making like 300-400K? Maybe i'm being naive, but is a 'drastic' paycut really that 'drastic?" A 200K+ salary isnt enough to live comfortably?

You have to ask if it's worth all the extra time, effort, debt and responsibility just to 'live comfortably,' which usually means being secure on bills, having some excess spending (dining out, modest vacation, etc.) and a small amount saved.

If you look at Cardiologists in the 1980s and 1990s, they could easily live in a nice home, drive nice cars, send their children to private schools (if they chose to do so) and pay cash for their childrens' post High School Education. Back in those days, private HS was < $ ~ 14K/annum and private College < ~ $32K/annum until around 2000. Of course, these figures were much lower than this in the 1980s and early 1990s. Now, private schools can reach $ 30 K through High School and $55-60K for College. We're talking THE SAME SCHOOLS HERE!

I went to private school my whole life and, including College, it probably set my parents back < $ 250K. Now, going to private school through High School can exceed $ 350K and, including College, that figure can easily break $ 600K. It's not that private school is necessary, but it was an option that many Physicians had back then. The cost was pretty trivial, unless you had more than 2 children. Now, the cost is anything but trivial and will be prohibitive for many Doctors.

Now, despite a much weaker currency, the same doctors will be taking in less dollars (with each dollar having less value), paying higher taxes and face higher costs on EVERYTHING (housing, food, gas, utilities, etc.).

If you adjust for inflation, stagnant salaries, higher costs and (soon) higher taxes, I wouldn't be surprised if the average Cardiologist today has only 50-60% the purchasing power the average Cardiologist had 20 Y back.

You won't be going hungry making $ 200 K but, as others have shown, you're by no means wealthy. The way I look at it is just how much harder it is for a Cardiologist to have an above average (but not extravagant) lifestlye now than in the past. It's MUCH harder. I'm not saying feel sorry for them b/c they can't purchase a Yacht, Ferrari, etc but luxury items (cars, private schools, niver homes and neighborhoods, etc) are harder to obtain.

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[Jape]

How much of this holds true for interventional cardiology? I know they probably will have a few more problems because they compete with IR Rads. I have seen some starting salaries for Interventional Cards at like 550k plus.

 

[josephf1]

big money = boonies
now that cath labs dont need onsite CT surg backup every POS hospital is opening a lab, same with EP. THe compettion alone has tanked salarie at my hospital. Guys inthe 80s who made money still ahve the 5 million dolar house and the porsche, but the new guys are starting at under 300,000 base. no free lunch. these are dedicated interventionalsit though so if you do genreal cards and cath on the side maybe things might be more stable. ep rembursemnts are now down 40% and the only real money maker is ICD/PM implnats which you compete with cCT surg and general cards for. Did you realize a 4 hour afib ablation pays the same as a 30 minute aflutter ablation, 1700 bucks. how many of those can you do a day? and they are carcking down more now on who can get an icd since they cose 20K+. not sure what the way to the 500K salary is but its gonna get harder, also once fee for service is gone next couple of years and bindled payments start it could be another big hit. becasue of this most of my PGY3s are going for hospitalist.

 

[Taurus]

big money = boonies
now that cath labs dont need onsite CT surg backup every POS hospital is opening a lab, same with EP. THe compettion alone has tanked salarie at my hospital. Guys inthe 80s who made money still ahve the 5 million dolar house and the porsche, but the new guys are starting at under 300,000 base. no free lunch. these are dedicated interventionalsit though so if you do genreal cards and cath on the side maybe things might be more stable. ep rembursemnts are now down 40% and the only real money maker is ICD/PM implnats which you compete with cCT surg and general cards for. Did you realize a 4 hour afib ablation pays the same as a 30 minute aflutter ablation, 1700 bucks. how many of those can you do a day? and they are carcking down more now on who can get an icd since they cose 20K+. not sure what the way to the 500K salary is but its gonna get harder, also once fee for service is gone next couple of years and bindled payments start it could be another big hit. becasue of this most of my PGY3s are going for hospitalist.

In addition, the scrutiny from the govt, district attorneys, and media regarding overutilization of stents.

Doctor Faces Suits Over Cardiac Stents

A landmark 2007 study published in The New England Journal of Medicine showed that many patients given stents would fare just as well without them...

Prosecutors, malpractice lawyers and state medical boards are only now waking up to the issue. The Texas Medical Board last month accused a widely known cardiologist in Austin of inserting unnecessary stents. In September, federal prosecutors accused a cardiologist in Salisbury, Md., of performing unnecessary stent surgeries, and last year a Louisiana doctor was sentenced to 10 years in prison for inserting unneeded stents.

J. Stephen Simms, a Baltimore lawyer who successfully pursued a federal whistle-blower lawsuit involving kickbacks for coronary procedures, said such cases were "the flavor of the month right now" with federal prosecutors.

Jay Miller, another Baltimore lawyer, said he was devoting his entire practice to unnecessary stent cases. "And I don't think this is limited to just a few Maryland hospitals," Mr. Miller said.​

 

[Jennifer07]

12yr girl was brought with dyspnea at rest and on exertion. Discontinued school because of continuing dyspnea and fatigue. Occasionally feels light headed on exertion. No actual syncope.
On examination, chubby girl with no oedema. Anemic. No cyanosis. No clubbing
BP 100/70mm rt UL
Pulse: 92 per min. Low volume
JVP slightly raised. Prominent A wave.
CVS: Precordial pulsations+ Short SM over tricuspid area, increasing with inspiration. S1 feeble. S2 normally split. P2 loud.
RS: NAD

Please post your comments on the likely diagnosis.

 

[Jennifer07]

Increasing CAD detected by cardiac CTA escalated CV event risk!!

 

[DrVanNostran]

6 months later, how is the temperature now?

 

[nope80]

bump

 

[J-Rad]

12yr girl was brought with dyspnea at rest and on exertion. Discontinued school because of continuing dyspnea and fatigue. Occasionally feels light headed on exertion. No actual syncope.
On examination, chubby girl with no oedema. Anemic. No cyanosis. No clubbing
BP 100/70mm rt UL
Pulse: 92 per min. Low volume
JVP slightly raised. Prominent A wave.
CVS: Precordial pulsations+ Short SM over tricuspid area, increasing with inspiration. S1 feeble. S2 normally split. P2 loud.
RS: NAD

Please post your comments on the likely diagnosis.

Strange place for this post. But the answer is: she's 12...send her to the pediatric cardiologist.

 

[naus]

There's no guarantee that ortho isn't going to get hit with reimbursement cuts as well.

In 2011, orthopedic surgeons saw the cost of running their practice significantly increased while reimbursement steadily declined — and 2012 promises more of the same. Meaningful use requires groups to implement expensive electronic medical records, absorb more overhead costs and spend more time filling out forms than seeing patients. At the same time, Medicare and private payors have such low rates that seeing some patients becomes unprofitable.

"There is a constant downward pressure on what we are paid to deliver care," says Frank Kolisek, MD, orthopedic surgeon and president of OrthoIndy, an Indianapolis-based orthopedic practice. "Something has got to give because it's becoming more and more difficult for us to keep our practices afloat."

In addition to his clinical work, Dr. Kolisek and his group's leadership are politically active and often meet with Congressmen and advocates for medical professionals in Washington, DC, and in the state of Indiana. One of the anecdotes he uses to illustrate the financial hardship of physicians today harkens back to his first practice, opened in 1992. At that time, his Medicare reimbursement for a hip and knee replacement procedure was 55 percent more than it was in 2011. That is a 45 percent decrease in the surgeon fee over the past 19 years. Over the same time period, overhead costs have increased about 65 percent. Therefore, it costs much more now to run a medical practice than it did 20 years ago and we get paid less for the medical care we provide. This is what is driving physicians to retire and/or seek employment by a hospital system.

"I have performed a total hip replacement for a [patient on Medicare] and received Medicare reimbursement rates," says Dr. Kolisek. "[The same patient] took her Labrador retriever to the veterinarian for a hip replacement and had to pay cash upfront for the procedure and it was more than twice what Medicare paid me. The vet made 56 percent more to replace the dog's hip than I did to replace the owner's hip. I do not mean to be critical towards the vet, but rather to point out that physicians can't withstand anymore cuts in Medicare reimbursement for medical care we deliver to patients."

"When I began my practice in 1992, my overhead was around 40 percent, so I got to keep 60 cents of every dollar collected for personal income," says Dr. Kolisek. "My overhead now is 78 percent so I get to keep only 22 cents on every dollar I collect; at the same time, I'm collecting fewer dollars than I did 20 years ago as reimbursements have decreased. The increased government regulations make it difficult to practice medicine and the overhead costs make it hard to keep our lights on."

http://www.beckersorthopedicandspin...gest-concerns-for-orthopedic-surgeons-in-2012

 

[dragonfly99]

In 2011, orthopedic surgeons saw the cost of running their practice significantly increased while reimbursement steadily declined — and 2012 promises more of the same. Meaningful use requires groups to implement expensive electronic medical records, absorb more overhead costs and spend more time filling out forms than seeing patients. At the same time, Medicare and private payors have such low rates that seeing some patients becomes unprofitable.

"There is a constant downward pressure on what we are paid to deliver care," says Frank Kolisek, MD, orthopedic surgeon and president of OrthoIndy, an Indianapolis-based orthopedic practice. "Something has got to give because it's becoming more and more difficult for us to keep our practices afloat."

In addition to his clinical work, Dr. Kolisek and his group's leadership are politically active and often meet with Congressmen and advocates for medical professionals in Washington, DC, and in the state of Indiana. One of the anecdotes he uses to illustrate the financial hardship of physicians today harkens back to his first practice, opened in 1992. At that time, his Medicare reimbursement for a hip and knee replacement procedure was 55 percent more than it was in 2011. That is a 45 percent decrease in the surgeon fee over the past 19 years. Over the same time period, overhead costs have increased about 65 percent. Therefore, it costs much more now to run a medical practice than it did 20 years ago and we get paid less for the medical care we provide. This is what is driving physicians to retire and/or seek employment by a hospital system.

"I have performed a total hip replacement for a [patient on Medicare] and received Medicare reimbursement rates," says Dr. Kolisek. "[The same patient] took her Labrador retriever to the veterinarian for a hip replacement and had to pay cash upfront for the procedure and it was more than twice what Medicare paid me. The vet made 56 percent more to replace the dog's hip than I did to replace the owner's hip. I do not mean to be critical towards the vet, but rather to point out that physicians can't withstand anymore cuts in Medicare reimbursement for medical care we deliver to patients."

"When I began my practice in 1992, my overhead was around 40 percent, so I got to keep 60 cents of every dollar collected for personal income," says Dr. Kolisek. "My overhead now is 78 percent so I get to keep only 22 cents on every dollar I collect; at the same time, I'm collecting fewer dollars than I did 20 years ago as reimbursements have decreased. The increased government regulations make it difficult to practice medicine and the overhead costs make it hard to keep our lights on."

http://www.beckersorthopedicandspin...gest-concerns-for-orthopedic-surgeons-in-2012

If this is true, then why do orthopedic surgeons make so much more that vets? I know a doc who is married to a vet, and I believe the overall average salary for a vet is around 69k/year...though there are some who make >100k if they are a subspecialist or emergency vet.

 

[bedrock]

If this is true, then why do orthopedic surgeons make so much more that vets? I know a doc who is married to a vet, and I believe the overall average salary for a vet is around 69k/year...though there are some who make >100k if they are a subspecialist or emergency vet.

Not all vets perform more complicated surgeries, because remember vets take of many different animal species after a 4 year degree.

There are Orthopedic vets who specialize in orthopedic surgeries and they make much more than the average vet

 

[nope80]

That is really sad....he brings up many good points.

 

[naus]

If this is true, then why do orthopedic surgeons make so much more that vets? I know a doc who is married to a vet, and I believe the overall average salary for a vet is around 69k/year...though there are some who make >100k if they are a subspecialist or emergency vet.

Also payer mix. That ortho guy was talking about Medicare reimbursements.