Impact on Applicants / IM in general

[sestamibi]

http://www.nytimes.com/2008/07/21/b...dd&ei=5124&partner=permalink&exprod=permalink

Anyone think this will make a big difference in internist's salaries?

In the # / competitiveness of IM applicants?

For the field in general?

Can you imagine? The best and brightest of medical school, once again, aiming for...medicine?

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[TexasTwoStep]

Would definitely be nice to one day work at home. lol.

 

[NotAProgDirector]

Sounds good on the surface, but I still worry that the basic financial underpinning is incorrect. Like most government "magical accounting", the argument is going to be that this will somehow save money rather than cost any more. That paying me more so I see less patients (or have more time per patient, which is the same thing) will somehow generate less tests, less specialist visits, or the "holy grail" of actually preventing bad outcomes etc. They quote some Medicaid program actually saving money.

I don't buy it. Everyone gets sick. The longer you live, the more likely you are to get sick and need care. Although I can't prove it in any way, I seriously worry that this only pushes costs in the future -- i.e. save a heart attack today only to deal with cancer in the future.

Also, if you pay me more per visit (or a lump sum, same difference), the question is: do I slow down and spend more time with each patient / hire more people / etc and make the same salary, or do I keep going as fast and just pocket the difference.

So, I'm all for paying primary care more, but I think it will just bloat medicare further.

 

[orientedtoself]

i don't see how $64 rather than $60 per office visit will make any sort of difference. sure, it would be great if primary care were better paid. it would be great if every patient could have at least a 30 minute visit. but i don't see how this will make it happen.

 

[Adcadet]

I'm realizing that for some patients, four 20 minute appointments over a few months may be way more efficient than three 30 minute appointments. For some things, I am not afraid to use time to my advantage. The guy in the article having a stroke would not be one of those patients, however.

 

[dragonfly99]

sestamibi,
I think the idea that primary care docs coordinate care better and lead to less spending per patient (in the short term, at least) I think is correct. However, I doubt these ideas will go far in the USA since specialists here have quite a lot of power, and patients also are quite demanding in the sense of wanting to see a "specialist" for every little thing. Some patients, at least.

Also, I don't think the government is going to be able to find the money to pay primary care docs more. They don't have the guts to raise taxes that much, and/or to take money from someone else, such as specialists or hospitals. They cannot even find the money to fund the Medicare program in its current form.

 

[Hernandez]

There is no upside when dealing with the government. They're only concerned about the bottom line and keeping their consitutents happy. The ultimate result of these line of thinking will be that they expect that you spend and document how many minutes you spend with the pt, and if you spend less than some random number (created by either some public perception poll, or completely arbritrary) you'll only be paid at the lower rate. Then they'll censor your appointment books to make sure you're not seeing more than the 2 pts an hour you're suppose to be spending 30 minutes apiece.