Is primary care pay now "fair?"

[deltamed]

It seems that in a few short years (perhaps the last 3) the recruitment and pay of primary care providers has increased modestly. At the same time specialty care pay has dropped precipitously. There are still some older established specialists raking it in, but if you look at the specialty forums, the outlook for new grads is a fraction of what it used to be due to a variety of economic pressures. It seems ballpark new Anesthesiologists or Radiologists are looking at 250-375k, general surgeons similar, pathology and ophthalmology starting is terrible (100-200k). Orthopaedics and EM seem to be doing better. Meanwhile my colleagues in their first 5 years of primary care (or hospitalist) don't seem to be making much less (most seem to be in the 175-300k range).

Wondering if the perception is that pay is now "fair" or do primary care providers still feel undervalued? Has the pendulum swung too far given the increased liability and extra training years of specialists?

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[SuckySurgeon7]

I'm guessing everyone is sick of comparing salaries, and thus there hasn't been a reply lately.

As far as perception goes, I'll give you the opinion of two primary docs I got to know after shadowing for a couple weeks. Both are family practice guys, both were a bit older (upper fifties for one and 65 for the other one). They felt like the EHR system screwed over primary care providers more than the surgeons. It sucked the productivity out of their workday and consequently deflated their paychecks. The numbers ranged from 150-250 on average, but both of them could have done better earlier in their careers from a volume/reimbursement standpoint. Specialist lifestyles can be much better depending on the practice setup of both the primary care doc and of the specialist. There are too many variable to give a general answer, but one could say that primary care may have more lifestyle flexibility.

My opinion as a medical student who has done some research on salaries/lifestyles is that the pendulum is far from in the primary care docs' favor. The committee that divides up the medicare pie is made up of an equal number of representatives from each specialty, similar to the senate. This is in stark contrast to the much larger proportion of primary care docs in practice. The specialists want higher reimbursements for imaging and procedures that they do day in and day out, but in order to inflate their own procedures, the compensation for regular old office visits must be decompensated proportionately. Unless the system is changed, the only way that a primary care doc will have the same financial compensation as a specialist is by doing a direct care or concierge practice, or by starting their own clinic/urgent care center.

 

[MOHS_01]

Cannot comment on "fairness" as that is a nebulous abstract metric... but I can state that I perform 42% more wRVU's now per month 2012-current than I did 2006-9 for less compensation. Sounds fair to me.

 

[letsdoit]

Yep, fair.

 

[FrustratedFamDoc]

Fair isn't really the word I would use. Competitive among other specialists? Debatable. I've been out of residency since 2012. Signed a contract with a reasonable guarantee for the first 2 years then put on a base + production contract. Year 3 of my contract really, really sucked as I was still building my practice. This past year has been my best and I am still just at the national average among family docs. I'm seeing 85-105 patients a week, typically.

Yes, procedures and other ancillary things can help generate additional income but by and large in the standard FFS setting, we are a volume based business. The more butts you can move in and out, the more revenue you generate. We don't have any of the juicy procedures on our turf that make the boat and beach house payments. This automatically put us at a revenue disadvantage to the specialists because in the amount of time that it takes us to see 1 moderately complicated 4 month follow up, an orthopod has already seen 2 knees, GI has seen an IBS and a Chron's pt, Cards has seen 3 CHF-ers, Derm has seen 2 eczema and 1 funny-looking mole, and Peds has had 3 ADD f/Us. God help you if it's one of 'those days' and you've got a couple schedule busters (we all have them) or a few complicated hospital F/Us lined up. Looks like a short lunch and/or you're getting home a little late. 40 is a slow day in ortho. 40 would have me looking for another line of work.

Do I see this changing/improving in any way? Sadly, I don't. The current billing structure really hurts us, comparatively. If we could bill per problem addressed instead of a standard 213/4/5, 202/03, annual wellness then ok but we don't have that kind of lobbying power. They lob quality standards our way and advertise that as a way that compensation can improve but my finely tuned BS meter knows that's it's really only a tool to pay docs less. If it were truly an incentive system, then it would be purely a bonus based system, not one that came with penalty as well. Over the last several years, does anyone truly believe that things are vastly more complicated in a scheme to pay family docs (and all docs, for that matter) MORE money? There will never be any public outcry to pay those rich doctors more and it's certainly poor taste to complain.

DPC is a wonderful movement that has been happening and has been great for patient and doc satisfaction and cost control, but most of us are graduating with lots of dept, families and the need to make hay NOW. It's a deep sacrifice to try to make DPC work fresh out of residency.

Now, do I make BAD money? No way Jose. But I sure with I had more each month to kick in to those dang student loans....

 

[deleted87716]

Just FYI, this is a two-year-old zombie thread. The OP is probably long gone.