How 'good' can endocrinology be lifestyle and salary wise vs general IM?

[bochaw]

why in every endo thread there would be discussion also about rheum?? 😆

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[Raryn]

why in every endo thread there would be discussion also about rheum?? 😆

Because the specialties attract similar personalities and some people enjoy both sets of material - so are trying to decide.

Not that I understand it mind you. To me, all the rheumatologist diseases sound the same.

 

[bronx43]

Why heme onc is a good question. If infusions are wiped out, then heme/onc will be hit just as hard too.

It’s a bit more nuanced than that.

1. rheum drugs are predominantly going in the direction of subcutaneous or oral

2. Insurers are often refusing to cover infusions when other options are on the table

3. even if outpatient infusion profits are slashed, it’s going to be much more difficult for CMS to take away profits of hospital based infusions (Most chemo/immunotherapy)

so IF (big if) private heme onc groups become unprofitable, they will simply move to a health system who will be ecstatic to have the huge profits that cancer care brings. Their supply and demand is still in their favor and hospitals shell out big money to get oncologists.

hospitals are much less inclined to pay big for rheumatology due to the lack of the same upside

 

[bronx43]

Because the specialties attract similar personalities and some people enjoy both sets of material - so are trying to decide.

Not that I understand it mind you. To me, all the rheumatologist diseases sound the same.

Lol yes they are all just on a spectrum

 

[bochaw]

any improvement in salary wise after new CMS coding update?

 

[rokshana]

any improvement in salary wise after new CMS coding update?

Depends…if you are wRVU or productivity based, then yes …if they are using the 2021 coding.

of guarantee or salary…probably not.

 

[PikminOC]

Depends…if you are wRVU or productivity based, then yes …if they are using the 2021 coding.

of guarantee or salary…probably not.

Then hospital decreases how much each rvu is worth...

 

[VA Hopeful Dr]

Then hospital decreases how much each rvu is worth...

Mine did that, still ends up being more money assuming the same amount of work.

 

[PikminOC]

Mine did that, still ends up being more money assuming the same amount of work.

But then you can never get ahead ..

 

[danchiao]

Mine did that, still ends up being more money assuming the same amount of work.

How much extra percentage do you get with these new changes?

 

[VA Hopeful Dr]

How much extra percentage do you get with these new changes?

A shade over 6%

 

[VA Hopeful Dr]

But then you can never get ahead ..

Umm, more money for the same amount of work... that's kinda the goal isn't it?

 

[danchiao]

Umm, more money for the same amount of work... that's kinda the goal isn't it?

Is this for all outpt jobs ?(primary care, endo, rheum, heme onc) or just primary care?
6% is good enough like almost 20k per year 😬

 

[VA Hopeful Dr]

Is this for all outpt jobs ?(primary care, endo, rheum, heme onc) or just primary care?
6% is good enough like almost 20k per year 😬

I'm not privy to specialist contracts, but given that the CMS changes are for E&M codes which endo/rheum/etc use as much as I do so I'd expect they get increases as well.

 

[ICmyFuture]

My increase in income was around 7-8% after changes. I see about 50% medicare.

 

[dozitgetchahi]

I’m not afraid of audits...my documentation supports it and this year with the changes in billing time to include all work done on the same day makes it easier to bill a 5.

I would be very careful with this. Billing all 5s is a great way to draw the attention of CMS and get your ass kicked. CMS has spanked docs in the past for doing this, regardless of whether they thought that could justify it or not. And when you piss off CMS, things get ugly fast.

 

[PikminOC]

Umm, more money for the same amount of work... that's kinda the goal isn't it?

Then hospital massages the numbers to decrease bonus. House always wins.

 

[PikminOC]

6percent Is cost of living adjustment at this point.

 

[VA Hopeful Dr]

Then hospital massages the numbers to decrease bonus. House always wins.

Nope, bonus went up too.

 

[VA Hopeful Dr]

6percent Is cost of living adjustment at this point.

That is a pretty meaningless metric given the current economic climate.

 

[bronx43]

6percent Is cost of living adjustment at this point.

Yet it's better than 0 % increase...

 

[bronx43]

I would be very careful with this. Billing all 5s is a great way to draw the attention of CMS and get your ass kicked. CMS has spanked docs in the past for doing this, regardless of whether they thought that could justify it or not. And when you piss off CMS, things get ugly fast.

I think total amount billed is a huge factor as well. Someone who billed all 5s for a grand total of $120k isn't going to get their attention. They have FAR bigger fish to fry. For anything related to CMS billing, once you get into the 7 digits, that's when I would start to worry.

 

[sloh]

I think total amount billed is a huge factor as well. Someone who billed all 5s for a grand total of $120k isn't going to get their attention. They have FAR bigger fish to fry. For anything related to CMS billing, once you get into the 7 digits, that's when I would start to worry.

Over what timeframe?

 

[bronx43]

Over what timeframe?

Oh, yearly. I'm talking like the cardiologists who bill millions every year for PCIs on everyone with or without a pulse. Or the spine surgeons who have never seen a vertebra they wouldn't fuse.

 

[PikminOC]

Nope, bonus went up too.

That's not what I've seen with my endo friends. The metrics to get bonuses for them just got impossible.

 

[PikminOC]

That is a pretty meaningless metric given the current economic climate.

How so?

 

[VA Hopeful Dr]

How so?

Because this is the highest inflation rate in almost 40 years. Comparing changes to contracts based on CMS changes to wRVU values to that number doesn't make any sense.

 

[VA Hopeful Dr]

That's not what I've seen with my endo friends. The metrics to get bonuses for them just got impossible.

Cool, not sure what that has to do with my personal experience but whatever works for you.

 

[PikminOC]

Because this is the highest inflation rate in almost 40 years. Comparing changes to contracts based on CMS changes to wRVU values to that number doesn't make any sense.

It does in terms of buying power with the money you have now.

 

[PikminOC]

Cool, not sure what that has to do with my personal experience but whatever works for you.

Just showing you others personal experience.

 

[VA Hopeful Dr]

It does in terms of buying power with the money you have now.

Duh?

But CMS hasn't increased what an RVU is worth since changing the new rules and its a historic level of inflation, why would you expect a physician job (or really pretty much any job) to keep up this year?

 

[ICmyFuture]

That's not what I've seen with my endo friends. The metrics to get bonuses for them just got impossible.

I received a 6 percent raise this year via wrvu. How are their bonuses formulated? I see more patients, make more $$$. I'm strictly outpatient so not sure how it works on inpatient side of endo world but would assume same compensation structure.

 

[PikminOC]

Duh?

But CMS hasn't increased what an RVU is worth since changing the new rules and its a historic level of inflation, why would you expect a physician job (or really pretty much any job) to keep up this year?

Cms is running out of money

I received a 6 percent raise this year via wrvu. How are their bonuses formulated? I see more patients, make more $$$. I'm strictly outpatient so not sure how it works on inpatient side of endo world but would assume same compensation structure.

Idk I don't work for their hospital.

 

[rokshana]

I would be very careful with this. Billing all 5s is a great way to draw the attention of CMS and get your ass kicked. CMS has spanked docs in the past for doing this, regardless of whether they thought that could justify it or not. And when you piss off CMS, things get ugly fast.

When your documentation backs up your billing… it’s not a problem.

 

[rokshana]

I think total amount billed is a huge factor as well. Someone who billed all 5s for a grand total of $120k isn't going to get their attention. They have FAR bigger fish to fry. For anything related to CMS billing, once you get into the 7 digits, that's when I would start to worry.

Lol…I work 2 weeks a month and see 7-12 pts a day… 7 digits, even with lots of 5s… not getting me into 7 digits…