Medicare Plans to Cut Specialists' Payments

[surag]

Competitiveness among specialties is cyclical and is based on several factors such as reimbursement, prestige, lifestyle etc. All of these factors can and will change with time. Radiology was not always competitive, nor was derm, rad-onc, anesthesia. At one time psych was a competitive and prestigious specialty so I hear. What happens if the coin flips and the "lowly" fields you mentioned become more attractive and hence become competitive. Should we then increase reimbursement in said specialty since more AOA students are gunning for them?

Chances are we won't even have to do much to make them higher paying depending on how long they are competitive.

Also, you should consider the fact that competitiveness may be a direct result not cause of salary...perhaps psychiatrists made considerable salaries before and thus the profession was competitive.

Back in the 70s and early 80s Internal medicine was one of the most competitive fields due to lifestyle and the fellowship opportunities. many of the best went into it whereas rads/derm were not. Thing is, payment schemes changed, from paying a standard rate and salary to a medicare based pay for procedure. Thus, while some specialties didn't change in terms of income power(neurosurg/plastics) others did...thoracic surgery dropped because of a reduction in number of operations/procedures compared to cards and dermatology went up for similar reasons.

Likewise, neurology isn't so high paying...but its possible that if the system doesnt change, and with the advances being made it could become the next rads/derm.

Back to what you said... 1 of 2 things is possible. That payment is the cause of competitiveness...not the other way around. and 2. even if payment IS CAUSED or created by competitiveness then it most likely will take place on its own...there's no need for anyone to step in. But I suspect you asked this as a rhetorical question to stump me.

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[Winged Scapula]

I think you underestimate the hassle of being a primary care. They work long hours, deal with endless BS. There is stress to operating, but ask how many surgeons want to deal with annoying patients and their pain meds, etc. Answer, not many.

Uhmmm..who do you think IS managing post-operative pain? While I may not like annoying patients and pain mgt any more than anyone else, I don't know any surgeons who palm off these patients and their pain med management to PCPs. Pain management IS a surgeon's job.

I entirely agree. In fact, for me personally, the reason why I would never go into family practice isn't even the pay. 150k isn't bad income especially after 2 year residency. Granted making 200k would be nice and is actually about what a physician in UK makes.

FM is a 3 year residency.

For me, its all the endless BS paperwork and getting shafted by the insurance companies. At least the surgeons are fighting for higher dollars...primary care physicians are trying to get money for their work and aren't really being paid appropriately. They're not rewarded for spending time with patients and to me thats the biggest reason I would go into family care...

That would be VASTLY overestimating the fight. General surgeons are in the position they are with lower reimbursement because of the lack of fighting in previous generations. There's a old joke that I am paraphrasing but it goes something like this:

In the old days of the fight over Medicare reimbursement rates:

Radiologists showed up with a knife

Orthopedic surgeons showed up with a gun

and General Surgeons didn't show up at all. They were in the ER taking care of patients.

But its true...GS RVUs were underestimated and the 90 day global period BS was the result of not enough GS fighting/participating in the discussions.

I and others are doing what we can, but there aren't enough doing the same.

Have you read what Winged Scapula (a general surgeon) said? She gets paid less than the anesthesiologist for a mastectomy. She gets paid more for an US-guided biopsy than for the mastectomy. Something is wrong here!

It was for an excisional biopsy, not a mastectomy...but the reimbursement for a mastectomy without axillary staging (around $850) is just slightly less than what anesthesia will charge for the GA.

First..replying to your previous statement. 500,000 a year is not a reality at this time in the rad onc market with the exception being some very good private practice jobs. Most academic positions and early private practice positions pay in the 250-300 range so not really the 2-3X pay you seem to continue to quote.

While you are correct in terms of the role Rad Onc plays in oncology and the technical components of billing, please be aware that there are regional differences in pay. Academic medicine should not be used as a measure of the "average" of what any specialty pays; everyone knows that academics make less, except in the upper echelons, than private practice.

Rad Oncs here (of whom I am quite friendly socially) DO make $400-$500 and right out of the box. We have several large groups in town, with a few "famous" Rad Oncs, and a lot of brachy...perhaps this is the reason for the difference, but it would be incorrect to say that making $500K is not a reality for Rad Onc. It certainly is, at least in our market.

 

[radslooking]

Uhmmm..who do you think IS managing post-operative pain? While I may not like annoying patients and pain mgt any more than anyone else, I don't know any surgeons who palm off these patients and their pain med management to PCPs. Pain management IS a surgeon's job.

.

wingy, you know what i mean. once the postoperative period is over, there is the rest of their lives where PCP's get to deal with their pain, their fibromyalgia, their somatizization, their headaches, their blah blah blah. im not saying you don't have some chronic issues, especially with wound healing, pain, etc etc, but on the whole PCP's deal with definitely more chronic complaints.

 

[Winged Scapula]

wingy, you know what i mean. once the postoperative period is over, there is the rest of their lives where PCP's get to deal with their pain, their fibromyalgia, their somatizization, their headaches, their blah blah blah. im not saying you don't have some chronic issues, especially with wound healing, pain, etc etc, but on the whole PCP's deal with definitely more chronic complaints.

Actually, I didn't know you were referring to chronic pain or non-surgical pain. My bad...

Yeah, I don't want to manage fibromyalgia, etc.

 

[Ashers]

I was trying to stay out of this, but reading interested from the sidelines. Because UK physician salaries were referenced, I finally went and looked them up, since I remember back in 2004, reading that a neurosurgeon consultant's pay was £80,000 in a non-London area.

Here are the figures from the NHS for physicians' pay at different levels. Doesn't look like the GP's make nearly $200,000 (especially since 1GBP is no longer nearly 2USD).

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

 

[radslooking]

I was trying to stay out of this, but reading interested from the sidelines. Because UK physician salaries were referenced, I finally went and looked them up, since I remember back in 2004, reading that a neurosurgeon consultant's pay was £80,000 in a non-London area.

Here are the figures from the NHS for physicians' pay at different levels. Doesn't look like the GP's make nearly $200,000 (especially since 1GBP is no longer nearly 2USD).

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

nevermind....can't substantiate my post

 

[core0]

I was trying to stay out of this, but reading interested from the sidelines. Because UK physician salaries were referenced, I finally went and looked them up, since I remember back in 2004, reading that a neurosurgeon consultant's pay was £80,000 in a non-London area.

Here are the figures from the NHS for physicians' pay at different levels. Doesn't look like the GP's make nearly $200,000 (especially since 1GBP is no longer nearly 2USD).

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

As I understand it, the money that GPs make comes over and above the salary. Disclaimer - what I know comes from discussions with NHS members while working on PA issues in the UK.

GPs in the UK are private contractors that are paid a salary by the NHS to see x amount of patients. As part of the work rules you are only allowed to work 35 hours per week. In addition GPs in the UK see patients on call after hours and on weekends. As part of the pay rules the NHS allowed the GPs to opt out of weekend and night call if they took a salary cut. They valued this very low (the amount bandied about was around $10,000). So most of the physicians opted out. This required the NHS to hire other physicians to cover the call. In remote locations there was no coverage so the NHS had to pay the physicians to take their own call. Since this was "forced" the pay was quite generous. There was also a pay for performance scheme with metrics that were easy to meet that boosted pay some. Finally if they are in a rural area most GPs run their own pharmacy out of their office which boosts income. Also they can hold "private" surgery hours outside the regular NHS hours but I really couldn't wrap my head around this.

So if the GP is in a major city the salary is probably close to listed. If they are in a remote region it can be quite generous. Here is an article from the Mail that talks about it:
http://www.dailymail.co.uk/news/article-428510/GP-salaries-rocket-118-000.html

David Carpenter, PA-C

 

[surag]

I was trying to stay out of this, but reading interested from the sidelines. Because UK physician salaries were referenced, I finally went and looked them up, since I remember back in 2004, reading that a neurosurgeon consultant's pay was £80,000 in a non-London area.

Here are the figures from the NHS for physicians' pay at different levels. Doesn't look like the GP's make nearly $200,000 (especially since 1GBP is no longer nearly 2USD).

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553

I really appreciate your efforts to go ahead and find the data....but that doesn't share the whole picture. I think basically as the above poster said, most physicians, GPs included make more money...sometimes twice as much. Basically you're looking at a base salary that physicians can expect depending on experience and years etc.

While watching a documentary that compared different salaries and policies of what is considered the 5 or 6 best health care programs in the world(note US is not included because they wanted to see how other countries manged their healthcare) the commentator basically said that UK pay was the highest at about 200k avg for GPs and higher for physicians. Germany came a close second.

 

[Mephisto]

If I am not mistaken, the lifestyle of a neurosurgeon (and that of other doctors) in the UK / Europe is quite different from the US. I lived there for a year and socialized with a few doctors (although that was prior to my interest in medicine, so I didn't really notice the things I hsould have...). It always seemed to me that the doctors there worked shorter hours overall, and that includes residency training (hours, not years). I tried finding specific info, but couldn't. Maybe someone can correct me on this??

I do think if impending changes lead to drastic changes in reimbursement that medical education, training, and practice will have to change from the lifestyle perspective. The cost of medical education will have to be reduced to ensure easier repayment of debt, publicly funded medical colleges will have to get more funding and become more numerous. More funding and higher pay for residency training, in addition to even more strict work hour restrictions and vacation time, maternity and paternity leave, and other benefits that public service workers enjoy. And I see attendings working less hours with more time off for family for the reduced SALARIED future that Atul Gawande thinks we need.

Obviously the changes above will come YEARS after the actual reform ends up necessitating it. Aren't those of us in residency now lucky to be the ones in transition who get screwed by the old system and won't be able to take full advantage of the future benefits, whatever they may be???

It might all be good...

 

[maceo]

reducing the pay disparity is going to happen one way or another. if you have another way of solving the problem let us know.

there's no objective reason why a specialist should get paid 3x-5x what a PCP is. There just isn't.

you get paid according to the risk you take. specialists are doing riskier things than primary care physicians. Its harder to get sued when you prescribe a antihypertensive than if you cut someone's chest open, you put a whale to sleep, ... get my drift so there is a reason why specialists get paid more than pcp's

 

[HCE]

you get paid according to the risk you take. specialists are doing riskier things than primary care physicians. Its harder to get sued when you prescribe a antihypertensive than if you cut someone's chest open, you put a whale to sleep, ... get my drift so there is a reason why specialists get paid more than pcp's

I'm thinking that it is more your opinion that you should be paid more because of the risk involved in your specialty, as opposed to there being a rule that dictates this. I was always under the impression that supply and demand dictated the market-place, including salaries. Why isn't the guy washing windows outside a 78 story skyscraper making megabucks....it seems very risky. I appreciate the extreme risk of opening someone's chest but, in terms of potential malpractice claims, isn't a missed diagnosis which leads to death just as risky to the family practitioner?

 

[mercaptovizadeh]

you get paid according to the risk you take. specialists are doing riskier things than primary care physicians. Its harder to get sued when you prescribe a antihypertensive than if you cut someone's chest open, you put a whale to sleep, ... get my drift so there is a reason why specialists get paid more than pcp's

We highlighted the fact that there are tons of specialties where the compensation is absurd and the risk is not much higher (if at all) than primary care. I did not include anesthesia, surgery, or even EM. I was talking about derm, rads, rad onc, ophtho, which are raking in big bucks for not much greater risk than PCPs.

 

[asmallchild]

We highlighted the fact that there are tons of specialties where the compensation is absurd and the risk is not much higher (if at all) than primary care. I did not include anesthesia, surgery, or even EM. I was talking about derm, rads, rad onc, ophtho, which are raking in big bucks for not much greater risk than PCPs.

This is beginning to sound like a case of sour grapes.

"I couldn't get into these fields. Now let me kick them while they are on the way down"

You seriously think being a radiologist carries less risk than a PCP? I would much rather be the nightfloat medicine resident doing the admissions in the ER (where I at least have the option of consulting with my senior residents and even attendings) than the nightfloat radiology resident reading the studies and dictating management (alone).

 

[mercaptovizadeh]

This is beginning to sound like a case of sour grapes.

"I couldn't get into these fields. Now let me kick them while they are on the way down"

You seriously think being a radiologist carries less risk than a PCP? I would much rather be the nightfloat medicine resident doing the admissions in the ER (where I at least have the option of consulting with my senior residents and even attendings) than the nightfloat radiology resident reading the studies and dictating management (alone).

Look, I did not put down what these people do. I am merely saying they are paid exorbitant fees for work that is not substantially riskier than primary care.

And you are the one starting with insults. Yes, everyone who actually wants to practice the core of medicine, i.e. IM or GS or ob/gyn, couldn't do anything better. REAL medicine is about the skin, eyes, ears, breast implants, and reading images. Maybe there are people who could do derm or rads but chose not to because they could care less about moles, pimples, and rashes or sitting in a dark room reading images all day.

 

[radslooking]

you get paid according to the risk you take. specialists are doing riskier things than primary care physicians. Its harder to get sued when you prescribe a antihypertensive than if you cut someone's chest open, you put a whale to sleep, ... get my drift so there is a reason why specialists get paid more than pcp's

Maceo, for the large majority of providers, their salary is what's left over after malpractice has been factored in. They are still much higher. I don't know what malpractice has to do with it, they are still much higher paid regardless of that.

The exception is an independent provider, who is paying it him/herself. Then gross salary must be deducted from malpractice expenses.

 

[radslooking]

This is beginning to sound like a case of sour grapes.

"I couldn't get into these fields. Now let me kick them while they are on the way down"

You seriously think being a radiologist carries less risk than a PCP? I would much rather be the nightfloat medicine resident doing the admissions in the ER (where I at least have the option of consulting with my senior residents and even attendings) than the nightfloat radiology resident reading the studies and dictating management (alone).

I dont know why we are arguing about this, certainly some specialties have higher malpractice costs than others. And certain areas/states have higher malpractice than others. But again, what matters is net compensation. Not malpractice costs.

Who cares if a high risk specialty's malpractice costs 150,000 a year if they are getting paid 500,000. If a PCP pays 30,000 and gets paid 150,000, it really doesn't matter does it.

 

[radslooking]

As I understand it, the money that GPs make comes over and above the salary. Disclaimer - what I know comes from discussions with NHS members while working on PA issues in the UK.

GPs in the UK are private contractors that are paid a salary by the NHS to see x amount of patients. As part of the work rules you are only allowed to work 35 hours per week. In addition GPs in the UK see patients on call after hours and on weekends. As part of the pay rules the NHS allowed the GPs to opt out of weekend and night call if they took a salary cut. They valued this very low (the amount bandied about was around $10,000). So most of the physicians opted out. This required the NHS to hire other physicians to cover the call. In remote locations there was no coverage so the NHS had to pay the physicians to take their own call. Since this was "forced" the pay was quite generous. There was also a pay for performance scheme with metrics that were easy to meet that boosted pay some. Finally if they are in a rural area most GPs run their own pharmacy out of their office which boosts income. Also they can hold "private" surgery hours outside the regular NHS hours but I really couldn't wrap my head around this.

So if the GP is in a major city the salary is probably close to listed. If they are in a remote region it can be quite generous. Here is an article from the Mail that talks about it:
http://www.dailymail.co.uk/news/article-428510/GP-salaries-rocket-118-000.html

David Carpenter, PA-C

that's consistent with what i know about UK's system too

 

[asmallchild]

Look, I did not put down what these people do. I am merely saying they are paid exorbitant fees for work that is not substantially riskier than primary care.

And you are the one starting with insults. Yes, everyone who actually wants to practice the core of medicine, i.e. IM or GS or ob/gyn, couldn't do anything better. REAL medicine is about the skin, eyes, ears, breast implants, and reading images. Maybe there are people who could do derm or rads but chose not to because they could care less about moles, pimples, and rashes or sitting in a dark room reading images all day.

No, not everyone. Just those who feel the need to keep pointing out (repeatedly I might add) that others are being paid "exorbitant fees" for their work.

 

[MOHS_01]

I'm thinking that it is more your opinion that you should be paid more because of the risk involved in your specialty, as opposed to there being a rule that dictates this. I was always under the impression that supply and demand dictated the market-place, including salaries. Why isn't the guy washing windows outside a 78 story skyscraper making megabucks....it seems very risky. I appreciate the extreme risk of opening someone's chest but, in terms of potential malpractice claims, isn't a missed diagnosis which leads to death just as risky to the family practitioner?

In many walks of life, yes, but absolutely not true in medicine. A physician's earning potential varies upon his/her work ethic, capacity, patient mix, disease mix, payor mix, practice patterns, and institutional compensation structure. Supply / demand only factor in when you are an employed physician by a hospital or large institution (or when the demand simply is not there as is the case for subspecialists in areas of low population density).

 

[Taurus]

We highlighted the fact that there are tons of specialties where the compensation is absurd and the risk is not much higher (if at all) than primary care. I did not include anesthesia, surgery, or even EM. I was talking about derm, rads, rad onc, ophtho, which are raking in big bucks for not much greater risk than PCPs.

Get your facts straight. Rads is one of the highest sued specialties out there. Because everything is imaged now, the rad is usually included in the lawsuit initially and has to explain why they should be dropped from the suit. When you have to go through 100 studies a day, it's not hard to miss an incidental finding like a tumor.

 

[mercaptovizadeh]

No, not everyone. Just those who feel the need to keep pointing out (repeatedly I might add) that others are being paid "exorbitant fees" for their work.

I'm in med school still and haven't decided on a residency. My board score is enough for any residency. Get over yourself and your stupid assumptions.

 

[asmallchild]

I'm in med school still and haven't decided on a residency. My board score is enough for any residency. Get over yourself and your stupid assumptions.

There we go. Nothing more need be said.

 

[psychforme]

There we go. Nothing more need be said.

Well you didn't really need to say anything more than admitting your obsession with money and gold.

 

[Winged Scapula]

If the users here cannot be civil to one another without resorting to insults, this thread will either be closed or moved.

Thank you for your cooperation.

 

[Taurus]

It gets worse.

Obama administration officials say they are determined to stem soaring Medicare spending, arguing that it is a root cause of the broader health-care crisis that they are trying to address with Congress. Behind the scenes, Obama is pushing for a mechanism that would take Medicare payment authority out of the hands of politicians and invest it in a separate entity, possibly under the executive branch.​

I'm losing hope that Republicans can stop the Democrats from making really radical changes.

 

[Medstudentquest]

I have trouble believing that reducing payments to specialists will somehow be enough to allow for a significant increase in pay to primary care docs. I think the decision to propose a redistribution of payments is related to the desire to pit doctors against each other and thus prevent a unified medical position by physicians on the changes proposed.

By bickering about who works harder or who deserves more money, it just increases the likelihood that the proposals will go through without appropriate scrutiny by physicians, something in my opinion is in the interest of those who are writing this proposal and who are very much against discussing issues that could negatively affect the salaries of lawyers and the vast expense of time and money expended out of fear of lawsuits.

Completely agree on this. Doctors should unionize.

 

[RabbMD]

When patients complain about the cost, I make it a point to show them where the costs are.

Excisional Biopsy of the Breast

Surgeon Fee (Medicare Allowable): $362 (which includes a global period of 90 days where all related care is free)

Facility Fee: $2400 (varies)

OR time; $47/minute (varies)

Opening the OR/Set-Up Fee: $1300

Anesthesiologist: $1000

Pre-Op/PACU/Medications/Supplies: I have no idea

but all in all, the charges come out to be around $10,000 of which I make
very little.

What you haven't recognized is that insurance companies don't pay hospitals what they hospitals bill. So while the hospital may bill $35,000 for the lap chole, they will get less than 25% for it from the insurer. When I had surgery, the surgeon waived his fee as did the anesthesiologist but BC/BS paid less than 25% of the hospital charges for an emergency surgery.

I just found this thread... Try again on anesthesiology here. If you are talking a medicare patient then our rates are horrible too (in fact medicare pays anesthesia 67% less than what average private payers do). Medicare is around $20/unit in anesthesiology (this varies geographically, but not by a lot). A breast biopsy surgery is 3 base units plus an additional unit per 15 minutes surgical time. Lets say the OR time (anesthesia time here) is 90 minutes, which I think our surgeon would agree is fairly typical. That means 3 base + 6 time units = 9 units. For a medicare patient that is 9 x $20 = $180... Now for a non medicare patient that is more like 9 x $50 = $450, but still not $1000.

 

[Winged Scapula]

I just found this thread... Try again on anesthesiology here. If you are talking a medicare patient then our rates are horrible too (in fact medicare pays anesthesia 67% less than what average private payers do). Medicare is around $20/unit in anesthesiology (this varies geographically, but not by a lot). A breast biopsy surgery is 3 base units plus an additional unit per 15 minutes surgical time. Lets say the OR time (anesthesia time here) is 90 minutes, which I think our surgeon would agree is fairly typical. That means 3 base + 6 time units = 9 units. For a medicare patient that is 9 x $20 = $180... Now for a non medicare patient that is more like 9 x $50 = $450, but still not $1000.

You are correct - the $1,000 is for a mastectomy non-Medicare patient (most of my patients are not Medicare). I got the above figure from several of my friends who quoted $60/unit.

 

[Medmal]

I wonder if we'll see a swing towards primary care if the money is being redistributed in that arena.

After all, who would put themselves through a neurosurgery residency (or any grueling surgical residency for that matter) if their pay isn't significantly better than that of a PCP?

Even if there was a cut in surgical reimbursement and as long as the hours are reasonable (i.e. <90/week), there will still be more people wanting these positions than spots available because the work is more prestigious and quite frankly more fun. Wait until you start seeing 30-35 patients a day in clinic and are ethically bound to address every complaint, you will wish you had gone into a field that was just fun to do.

However, any surgical field is riskier in that you may lose the ability to use your hands with adequate dexterity, such as the development of a tremor, trigger finger, or accidental trauma. Then you will end up in general practice real fast. Also if you lose or settle several seven figure lawsuits, you could effectively be priced out of practicing due to loss of malpractice coverage. However, this could be overcomed by working for the military as a civilian.

 

[Winged Scapula]

Even if there was a cut in surgical reimbursement and as long as the hours are reasonable (i.e. <90/week), there will still be more people wanting these positions than spots available because the work is more prestigious and quite frankly more fun. Wait until you start seeing 30-35 patients a day in clinic and are ethically bound to address every complaint, you will wish you had gone into a field that was just fun to do.

Uhmmmm....surgeons actually see patients in the office as well.

 

[RabbMD]

You are correct - the $1,000 is for a mastectomy non-Medicare patient (most of my patients are not Medicare). I got the above figure from several of my friends who quoted $60/unit.

First, I think surgeons are vastly underpaid, but I think the inclusion of a surgical fee for a medicare breast biopsy listed next to the anesthetic fee for a private mastectomy patient for the purposes of this thread was fairly misleading when comparing fees. $60 is fairly high for most private payers in most parts of the country, but not unheard of for sure.

 

[MOHS_01]

Even if there was a cut in surgical reimbursement and as long as the hours are reasonable (i.e. <90/week), there will still be more people wanting these positions than spots available because the work is more prestigious and quite frankly more fun. Wait until you start seeing 30-35 patients a day in clinic and are ethically bound to address every complaint, you will wish you had gone into a field that was just fun to do.

However, any surgical field is riskier in that you may lose the ability to use your hands with adequate dexterity, such as the development of a tremor, trigger finger, or accidental trauma. Then you will end up in general practice real fast. Also if you lose or settle several seven figure lawsuits, you could effectively be priced out of practicing due to loss of malpractice coverage. However, this could be overcomed by working for the military as a civilian.

The first thing that jumps out at me is the fact that you are attempting to generalize internal and personal presumptions and bias to the physician pool at large -- which is neither applicable nor likely true. The next thing that strikes me as funny is your definition of "reasonable" work hours. Given the commonly tossed out (by non-attendings) "200k is a good salary" nonsense, that would work out to a little over $33/hr. Another (erroneous) belief is that you are obligated to address every issue at every visit -- simply not true. That is why they created the established patient CPT series. Lastly, as pointed out by Winged, surgeons carry a fairly sizable office component as well.

 

[psychforme]

The first thing that jumps out at me is the fact that you are attempting to generalize internal and personal presumptions and bias to the physician pool at large -- which is neither applicable nor likely true. The next thing that strikes me as funny is your definition of "reasonable" work hours. Given the commonly tossed out (by non-attendings) "200k is a good salary" nonsense, that would work out to a little over $33/hr. Another (erroneous) belief is that you are obligated to address every issue at every visit -- simply not true. That is why they created the established patient CPT series. Lastly, as pointed out by Winged, surgeons carry a fairly sizable office component as well.

200.000/33 = 6060 hours a year
6060/365 = 16,6 hours a day

Yeah, I am sure there are lots of people chewing out 6060 work hours a year.

 

[MOHS_01]

200.000/33 = 6060 hours a year
6060/365 = 16,6 hours a day

Yeah, I am sure there are lots of people chewing out 6060 work hours a year.

While I have thus far been unable to deduce your major (or overall scholastic level, for that matter), it is clearly evident that elementary mathematics was not it.

Assumptions: 1. Salary of 200k 2. 90 hour work week.

Salaries are on an annual basis. There are 52 weeks in a year. Vacations constitute a moot point as they are, by definition, either paid time off or paid vacation. While overtime pay is not required by law for physician employees (due to the many exemptions afforded employers by the Fair Labor Standards Act that governs such decisions), it is considered by most of the populace as a standard norm for calculating hourly wage. There is no fair and just way to reconcile the fact that employers of physicians (or anyone else, for that matter) should be exempt from fair compensation, irrespective of legalities.

90hrs week, 40 at regular pay, 50 at 1.5 regular pay equals 115 payable hours per week.

So: $200,000/(52 x 115) = $33.44 / hr

 

[surag]

dude...a 115 hours per week is still ridiculous and does nothing to change what he has said...maybe you should work on your math...lets see...

16 hours a day*5 =80 hours a week. 16 hours *7=approximately 112 hours.

the 112 is close to what you said unless you're claiming that someone is working 115 hours in 5 days....which is insanely ridiculous and doesn't reflect the average surgeon.

In any case your math is suspect.

 

[radslooking]

Am I missing something? Assuming 90 hrs a week. 90 x 52 = 4680

200,000/4680 = 43 dollars/hour.

Mohs has made the assumption that we should get overtime pay. That's neither here nor there, I am not arguing with it, but it's not industry standard. Either way, on a per hour basis without any other frills, its 43 dollars an hour. I want to know how many people are averaging 90 hrs a week though.

 

[Hernandez]

dude...a 115 hours per week

.....

In any case your math is suspect.

Only if you don't catch that he's converting the time & half overtime hours. His calculations were based on a 90 hour work week.

 

[surag]

Only if you don't catch that he's converting the time & half overtime hours. His calculations were based on a 90 hour work week.

Fine, I'm wrong...but thats ridiculous. surgeons generally dont get paid overtime. Not to mention the data is wrong...flat out.

here's a link: its from 2005 but still mostly valid: http://www.bls.gov/oes/2005/may/oes291067.htm#(8)

This is for surgeons...all surgeons(I assume as I cannot find specific data)
Also, the yearly earnings is for 40 hour work weeks. However, the hourly wage is based off industrial data collection, so you can take that as at least accurate.

Thus a surgeon here apparantly earns approximately 80 on the hour. Someone who works 70-80 hours a year or 90 as our friend above likes to state can make up to about 500k. This is the average.

 

[Medmal]

The first thing that jumps out at me is the fact that you are attempting to generalize internal and personal presumptions and bias to the physician pool at large -- which is neither applicable nor likely true. The next thing that strikes me as funny is your definition of "reasonable" work hours. Given the commonly tossed out (by non-attendings) "200k is a good salary" nonsense, that would work out to a little over $33/hr. Another (erroneous) belief is that you are obligated to address every issue at every visit -- simply not true. That is why they created the established patient CPT series. Lastly, as pointed out by Winged, surgeons carry a fairly sizable office component as well.

To say that 200k is not a good salary is kind of haughty. That salary would put you in the top 1-2% of wage earners. You will not get a lot of sympathy from most people when 200k is nonsense.

Note in my original quote I said complaint not issue. You are right. You do not have to address every issue a patient has such as chronic medical problems at every visit. But in general you should address every complaint a patient has. This is how you avoid lawsuits. Patients are not happy when you do not address all of their complaints. They say, "Well I told my doctor but he did nothing about it." One of these days, it is the complaint that you dismiss that will have an adverse event occur. Then prepare for a lawyer unleashing righteous indignation at your dereliction of duty. Fortunately most adverse events do not meet all required elements to win a lawsuit and you luck out. You learn to take every complaint seriously from experience. It's a nice feeling to dodge a bullet, but you learn not to put yourself in that situation again if at all possible.

Sure surgeons have office hours, but it does not compare to PCP's who have busy clinics all day every day.

 

[Winged Scapula]

First, I think surgeons are vastly underpaid, but I think the inclusion of a surgical fee for a medicare breast biopsy listed next to the anesthetic fee for a private mastectomy patient for the purposes of this thread was fairly misleading when comparing fees. $60 is fairly high for most private payers in most parts of the country, but not unheard of for sure.

I admitted I made a mistake; I wasn't trying to intentionally mislead every one as you seem to be implying.

 

[Winged Scapula]

Sure surgeons have office hours, but it does not compare to PCP's who have busy clinics all day every day.

True that surgeons are not in the office EVERY day. But I am curious - how many patients do you think we see?

I see around 30 per day, in residency it was not unusual to have 40 on the schedule and my partner has seen as many as 50.

At any rate, I'm not sure what the number of patients seen or number of days in the office per week (I"m in the office 3 full days, alternating weeks with 2 full days. Most of the PCPs I know take at least 1 full day off per week. Then again, I have a heavily office based specialty.) has to do with anything. We all work hard but you seem to have made the assumption that surgeons only operate.

 

[michaelrack]

To say that 200k is not a good salary is kind of haughty. That salary would put you in the top 1-2% of wage earners. You will not get a lot of sympathy from most people when 200k is nonsense.

.

I wouldn't be too happy with a 200 K SALARY, but I could accept it. What I won't accept is someone telling me that I should be happy with 200k with all the business risks I took (including large loans cosigned for)and with the hours I work. But if OBama wants to pay me 200K to work 40 hours a week in a government-owned clinic (I could accept even less if the benefits are good), I could deal with that, even though the idea of being an employee is somewhat distasteful to me.

 

[Winged Scapula]

To say that 200k is not a good salary is kind of haughty. That salary would put you in the top 1-2% of wage earners. You will not get a lot of sympathy from most people when 200k is nonsense.

Sure 200K is a good salary for the average Joe. I recognize that the average income for a family is much much lower than that. But the average Joe didn't finish college, doesn't work more than 40 hrs per week, doesn't have the responsibility that I have.

So is $200K good when you consider the number of years we have trained, the hours we have worked, the malpractice we pay and the risks we take EVERY DAY?

I have sacrificed my youth, my earning potential and in many ways, my body and its a bit ingenuous to tell me that $200K is a lot of money when I have friends with 4 year college degrees, no pager, no malpractice, etc. who make nearly that much working in executive positions for utility companies, for the police department, etc. Friends who do not have over $100K in loan debt. Friends who do not lie awake at night wondering if and when they are going to be sued, most likely for something they didn't even do wrong. Friends who don't obsess over every little detail of their work life. There are plenty of other examples of careers in which you can make $200K without going into medicine and its problems.

I choose a lower paying specialty because I enjoy it and was good at it, but to tell me I'm earning too much after all I've put in (and still owe), is insulting. If average Joe wants to make $200K then he can do the time.

I will take less money for my services when the day comes that my medical education is free, I have no malpractice insurance and full protection from being sued, reasonable expectations (ie, complications happen) work no more than 40 hrs/week and am paid overtime for those rare times I do. In essence, the same things almost every one else enjoys.

As usual, Americans want something for nothing.

 

[MOHS_01]

To say that 200k is not a good salary is kind of haughty. That salary would put you in the top 1-2% of wage earners. You will not get a lot of sympathy from most people when 200k is nonsense.

Note in my original quote I said complaint not issue. You are right. You do not have to address every issue a patient has such as chronic medical problems at every visit. But in general you should address every complaint a patient has. This is how you avoid lawsuits. Patients are not happy when you do not address all of their complaints. They say, "Well I told my doctor but he did nothing about it." One of these days, it is the complaint that you dismiss that will have an adverse event occur. Then prepare for a lawyer unleashing righteous indignation at your dereliction of duty. Fortunately most adverse events do not meet all required elements to win a lawsuit and you luck out. You learn to take every complaint seriously from experience. It's a nice feeling to dodge a bullet, but you learn not to put yourself in that situation again if at all possible.

Sure surgeons have office hours, but it does not compare to PCP's who have busy clinics all day every day.

Really. Well, according to The Tax Foundation you have misspoken on the 200k being the top 1% as you would have to almost double it to get to that (388k was the cutoff for the top 1% in 2006). They do not state what the 2% cutoff is, but for 2006 the 153k landed you in the top 5%. That means 1 out of 20 people walking the street earn more than many PCP's. If I were designing the system, there would not be a decent physician who did not fall in the top 1% of wage earners -- unless everyone would be satisfied with a system where docs saw four patients an hour for 7 work hours / day 48 weeks out of the year. Talk about long wait times for appointments...

 

[MOHS_01]

Fine, I'm wrong...but thats ridiculous. surgeons generally dont get paid overtime. Not to mention the data is wrong...flat out.

here's a link: its from 2005 but still mostly valid: http://www.bls.gov/oes/2005/may/oes291067.htm#(8)

This is for surgeons...all surgeons(I assume as I cannot find specific data)
Also, the yearly earnings is for 40 hour work weeks. However, the hourly wage is based off industrial data collection, so you can take that as at least accurate.

Thus a surgeon here apparantly earns approximately 80 on the hour. Someone who works 70-80 hours a year or 90 as our friend above likes to state can make up to about 500k. This is the average.

Know a lot of general surgeons pulling down 500k, do you?

 

[Southpaw]

Sure 200K is a good salary for the average Joe. I recognize that the average income for a family is much much lower than that. But the average Joe didn't finish college, doesn't work more than 40 hrs per week, doesn't have the responsibility that I have.

So is $200K good when you consider the number of years we have trained, the hours we have worked, the malpractice we pay and the risks we take EVERY DAY?

I have sacrificed my youth, my earning potential and in many ways, my body and its a bit ingenuous to tell me that $200K is a lot of money when I have friends with 4 year college degrees, no pager, no malpractice, etc. who make nearly that much working in executive positions for utility companies, for the police department, etc. Friends who do not have over $100K in loan debt. Friends who do not lie awake at night wondering if and when they are going to be sued, most likely for something they didn't even do wrong. Friends who don't obsess over every little detail of their work life. There are plenty of other examples of careers in which you can make $200K without going into medicine and its problems.

I choose a lower paying specialty because I enjoy it and was good at it, but to tell me I'm earning too much after all I've put in (and still owe), is insulting. If average Joe wants to make $200K then he can do the time.

I will take less money for my services when the day comes that my medical education is free, I have no malpractice insurance and full protection from being sued, reasonable expectations (ie, complications happen) work no more than 40 hrs/week and am paid overtime for those rare times I do. In essence, the same things almost every one else enjoys.

As usual, Americans want something for nothing.

This is really just an excellent post and a perfect summation of what I believe are the thoughts of many currently working in medicine. I really wish our government could fully grasp the essence of this post and what it has cost us (physically, emotionally, financially, etc.) to get to this point in our lives. Yes, we're very fortunate to work in medicine, but damn, attending physicians have certainly paid their dues.

 

[radslooking]

This is really just an excellent post and a perfect summation of what I believe are the thoughts of many currently working in medicine. I really wish our government could fully grasp the essence of this post and what it has cost us (physically, emotionally, financially, etc.) to get to this point in our lives. Yes, we're very fortunate to work in medicine, but damn, attending physicians have certainly paid their dues.

True. I don't begrudge anyone for making a good salary. I do take issue with people who feel they should earn triple because they feel their work is more important. That kind of pisses me off.

 

[surag]

Know a lot of general surgeons pulling down 500k, do you?

wait your choosing one line to attack actual statistcal information? The data is for all surgeons...on average. With the vast majority being general surgeons...

hmm ok.

 

[medicinesux]

Sure 200K is a good salary for the average Joe. I recognize that the average income for a family is much much lower than that. But the average Joe didn't finish college, doesn't work more than 40 hrs per week, doesn't have the responsibility that I have.

So is $200K good when you consider the number of years we have trained, the hours we have worked, the malpractice we pay and the risks we take EVERY DAY?

I have sacrificed my youth, my earning potential and in many ways, my body and its a bit ingenuous to tell me that $200K is a lot of money when I have friends with 4 year college degrees, no pager, no malpractice, etc. who make nearly that much working in executive positions for utility companies, for the police department, etc. Friends who do not have over $100K in loan debt. Friends who do not lie awake at night wondering if and when they are going to be sued, most likely for something they didn't even do wrong. Friends who don't obsess over every little detail of their work life. There are plenty of other examples of careers in which you can make $200K without going into medicine and its problems.

I choose a lower paying specialty because I enjoy it and was good at it, but to tell me I'm earning too much after all I've put in (and still owe), is insulting. If average Joe wants to make $200K then he can do the time.

I will take less money for my services when the day comes that my medical education is free, I have no malpractice insurance and full protection from being sued, reasonable expectations (ie, complications happen) work no more than 40 hrs/week and am paid overtime for those rare times I do. In essence, the same things almost every one else enjoys.

As usual, Americans want something for nothing.

AMEN! This is the true crux of the matter. Couldn't have said it better myself.

 

[Proton Dense]

Don't forget, that in bribing the PCP population they will be expecting returns. That is, don't order another echo, CT, MRI... etc... Honestly. Really, they want gatekeepers. Actual gatekeepers. As in- "This person doesn't need to see a neurologist." "This chest pain doesn't require a cardiologist's evaluation." This is what the admin is trying (and Hillary attempted) to do.

If FP's and IM's think they are getting paid more for doing what they are doing now, you are naive.