If you’re the only outpatient provider in an huge area you absolutely can set your rate. That may mean you’re out of network, but if you’re the only provider in your specialty then there will be demand for your services regardless, and eventually insurance companies will be sued/prohibited from selling policies in your area. We see this all the time with psychiatry, but increasingly primary care too. And we see the growth of cash based telemedicine partially as a response to people being frustrated with long wait times in certain fields. If a shortage worsens you’ll see more people opting for these services and as a result increases in pay. If the alternative is waiting 2 years a lot of people will pay 200 bucks to be seen, and maybe vote for changes in reimbursement (okay that was partially a joke, but California voted to increase Medicaid reimbursement recently so it is possible I guess).
There is only one rheumatologist in my county of 120k people. The nearby counties, which are smaller have none.
Do you do outpatient medicine? Absolutely imaginary scenario you are describing there. You become oon for everyone and you'll either get a bunch of people who won't pay you or no patients except Medicare. I practice in an environment like this in the outpatient setting so I have experience with it. Have you seen the scenario you are describing where you can charge 8k consult fee and actually get paid that by anyone?
Believe it or not the Netherlands averages 1 rheumatologist per 166k people. The US averages 1 per 60k. Probably a lot of EDS clogging things up, but either way I found dozens of cash-based rheumatology practices online. If I were a rheumatologist that’s probably what I would do, and if I had reason to go to a rheumatologist I certainly wouldn’t wait 2 years, I’d pay cash.
8k consultant fee? Not sure what you are you talking about. You can get concierge rheumatologists visits for 500 an hour easily though. With chart review etc probably works out closer to 300-350 an hour.
Right a concierge practice, not a practice negotiating with insurance companies. You can't charge whatever you want and expect an insurance company to pay for it even if you have a monopoly ergo this isn't a free market.
So why not do concierge rheumatology? Plenty of people willing to pay presumably given the number of practices that pop up on Google.
Yes, perhaps this discussion is a reflection of how comparatively minor most complaints that come across a rheumatologists clinic are, or how few of them are truly debilitating.
@bronx43 can comment on this but from what I understand, this isn't really feasible for the newer attendings. Same for Heme-Onc. Nowadays, only big hospital systems have access to these sweet deals.
But in more saturated locations, there aren't enough true rheum patients to go around. Rheumatologists end up seeing a bunch of ANA+ patients with vague fibro complaints and fatigue. As @GravelRider and @PainInTheAnes mentioned, these types of patients are generally not willing to pay cash just to see a rheumatologist. They'll wait until their scheduled rheum visit through Kaiser bc their complaints aren't very urgent to begin with.
Sure, and in that case I would argue the “true demand” for rheumatological services is very low in those areas as a result. Saturated areas? Doesn’t sound like there’s much shortage then right?
Maybe, maybe not. A lot of people need cancer surgery. Gall bladders removed. Thyroids removed. CABG. Valves replaced. Possible lung cancer biopsied. I don’t do that much ortho scope ASC stuff but would be fine if 100% of those surgeries stopped being covered anyway.
Agreed. With that context, I’d say there’s really no specialty in medicine that has a shortage bc most don’t want to live in a rural town/BFE. It’s more of an issue with maldistribution of physicians. Anesthesia can capitalize on this by doing locums—essentially practicing in pockets where there is a shortage. OC, LA? Probably impossible.
I think part of that is that most regular docs refuse to prescribe sedatives, hypnotic and pain meds.
I agree unless of course this goes to an unexpected disastrous level.
The bush 43 tax cuts forever favored the lower class where 40% of them don’t pay any federal taxes. Obama kept the bush tax cut cause he love it so much
They will lose some benefits (eg., food stamps etc...); that is why they won't OVERALL benefit from the bill.
I think we do as a group. There are close to 1 million active physicians in the US. That is a big group that is in the upper and wealthy class.
Doctors were a powerful political force when most doctors were in primary care and the AMA was our main political voice. These days we’re all partitioned into specialties, completely unaligned with each other, many bickering over getting more of the pie at the expense of others.
Maybe we should advocate to abolish all the other societies and return back to the AMA fighting for ALL physicians as a goup. Make all physicians contribute $200-300 every time they are renewing their license. Therefore, the AMA would have a lot money to fight our battles.
The AMA's primary source of revenue is selling CPT code changes and have been given a functional monopoly on this by the federal government. They created the RUC which operates like a cartel for subspecialists at the expense of all cognitive specialties. Would need a total purge of administration and to bring back a physician-oriented mission instead of bull**** CPT nonsense pushed by current bloated administrative parasites to get any physician buy in on that which will absolutely never happen.
Simply means no one can predict the market. Just like no one can predict rookie of the year, who will win the Super Bowl, NBA championship, etc. I always laugh when watching ESPN or CNBC when they talk seriously about **** that no one can know.
My prediction is this latest accelerated breakout above the all time high is going to head up at a fast pace trying to merge back into the 2 year boom trendline the last 2 years of the Biden term.
The key is knowing when the implosion will happen. My guess is it will be by the end of Trump presidency.
go brrrr.Nah, Trump's got the budget balanced for this year. Didn't you hear?The money printer in the system we’re presently in always has to be on.
go brrrr.
No doubt, valuations are insane.
You don't read many of my posts then.
I disagree. I predict you'll win rookie of the year, the Yankees will win the Super Bowl, and and my high school team will win the NBA championship. See how easy that was?
Actually sticks as a percentage of net worth are near an all time high. Not a positive sign.
What’s that percentage? Home equity is or close to sky high as well.
