Medicare plans to cut specialists' payments

[Charles_Carmichael]

http://online.wsj.com/article/SB124646885862181139.html#articleTabs%3Darticle

This was posted by physasst in the Topics in Healthcare forum, but I don't think it gets enough traffic there, so I thought I should post it here. The gist of the article is basically that specialists will see cuts in payments and the money saved from that will be used to increase payments to PCPs.

While good primary care is hard to provide and I do agree that PCPs don't make much compared to specialists, to me, it seems like specialists are being punished for spending extra years in training. But then again, I probably don't know enough to make a more informed comment. What do you guys think?

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[cardinal2010]

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=article

This was posted by physasst in the Topics in Healthcare forum, but I don't think it gets enough traffic there, so I thought I should post it here. The gist of the article is basically that specialists will see cuts in payments and the money saved from that will be used to increase payments to PCPs.

While good primary care is hard to provide and I do agree that PCPs don't make much compared to specialists, to me, it seems like specialists are being punished for spending extra years in training. But then again, I probably don't know enough to make a more informed comment. What do you guys think?

Interesting article, and long overdue.

PCPs need to make more money, plain and simple. On the other hand, specialists who are in training for a long period should make more than PCPs due to their expertise. Whats horrible right now is the difference between the two. A three year fellowship in cardiology shouldn't mean you earn $300,000 more per year than an internist. Something more like $20-30,000 makes much more sense.

Instead of PCPs at $160k and specialists at 350k, It would make a hell of a lot more sense to have PCPs at 220k and specialists at 250k. People would still specialize (30k a year for an entire career is a lot of money), but not in the numbers they are now, and for many the desire to work with patients in a primary setting would outweight a 30k a year difference, but not a 200k difference.

 

[Bacchus]

Exactly agree with the above. The "distribution of wealth" amongst physicians is one-sided. A fellowship should not net you $100,000+ more than a standard residency. I do not agree, however, with an idea of slashing a surgeon's/whatever pay to make it more on par with a PCP. However, if you decide on IM/Peds/FP and then do a fellowship, you should get more, but not a HUGE amount more. Don't worry, everyone will still be compensated.

 

[Narmerguy]

Interesting article, and long overdue.

PCPs need to make more money, plain and simple. On the other hand, specialists who are in training for a long period should make more than PCPs due to their expertise. Whats horrible right now is the difference between the two. A three year fellowship in cardiology shouldn't mean you earn $300,000 more per year than an internist. Something more like $20-30,000 makes much more sense.

Well, considering the strain and liability that many specialties go through in addition to the added years, i think 30,000 is a little light. I do believe it's too much now, but I also don't think a doctor who administers good rest and plenty of fluids should be only $30k shy of a doctor who has spent 3-4 additional years training and has lives on his/her hands every day. And the training for some of the surgery subspecialties are absolutely ridiculous in the length of training they require and they can't work as long as PCP because their body can't quite keep up with the demands (their hands have to be accurate and steady and they often go through very long procedures during one of the longest workdays that doctor's experience anyway).

I don't even plan on getting anywhere close to surgery but you have to acknowledge the kind of work and strain these guys endure.

 

[armybound]

What's all this fairness business? If I have a less risky and less skilled job than you, I deserve to make nearly as much as you because I went to medical school also?

You make what you can bill. Apparently seeing someone for 15 minutes to prescribe antibiotics isn't as profitable as removing a tumor from someone's brain. There's risk involved and there's an immense level of skill and practice. Of course they should be compensated many, many more times over for their extra skill, practice, and inherent risk of lawsuit.

You get paid more with extra specializing because you're the person they go to for the difficult cases. If any old surgeon could remove your kid's brain tumor effectively and without many complications, there wouldn't be a need for pediatric neurosurgeons and they wouldn't be compensated more than their general surgeon counterparts. Similarly, I don't know if I'd prefer to have a hospitalist try to diagnose or treat my dad's concurrent CHF and MI over someone who trained extra years specifically to handle those kinds of matters.

 

[Charles_Carmichael]

By specialist, I assumed the article meant everything except primary care (ie. FM and IM). Sure, fellowships after IM may be 1-3 yrs longer and maybe that shouldn't get you $100k+, but what about something like subspecializing in CT surgery? I think a CT surgeon made a comment on that article about how he spent nearly a decade in graduate training; this isn't just 1-2 years longer than an IM/FM residency. I agree with Narmerguy that pay for specializing shouldn't be just $20-30k more than PCPs.

Also, how would PCPs get this extra money? My understanding is that in private practice, there's no salary and the amount you make depends on the volume of patients you see. So will PCPs get this extra money for seeing the same amount of patients (ie. make more money per visit)? Or will it be tied in to something else, like prescribing less/more, talking to patients about exercising, etc.?

Edit: I just saw armybound's post and I completely agree with it. A lot of the specialties do take on much more risk than a PCP would and this reflects in malpractice insurance, etc.

 

[VneZonyDostupa]

Also, how would PCPs get this extra money? My understanding is that in private practice, there's no salary and the amount you make depends on the volume of patients you see. So will PCPs get this extra money for seeing the same amount of patients (ie. make more money per visit)? Or will it be tied in to something else, like prescribing less/more, talking to patients about exercising, etc.

The title and content of the article clearly state that this is about Medicare reimbursement, specifically, increasing such reimbursement for primary care physicians.

 

[Charles_Carmichael]

The title and content of the article clearly state that this is about Medicare reimbursement, specifically, increasing such reimbursement for primary care physicians.

Wow, I'm an idiot! For some reason, when I wrote that, I was thinking of all reimbursements.

 

[VneZonyDostupa]

Wow, I'm an idiot! For some reason, when I wrote that, I was thinking of all reimbursements.

No worries. It's the day before a long holiday weekend, I don't think any of us are thinking too clearly right now...haha

 

[ChubbyChaser]

Why cut anybodys pay?? If they deserve it and the people want there services, then give it to them.

 

[Chuck's Right Foot]

This isn't market forces. This was decided by a panel of physicians who happened to be mostly specialists/surgeons and it caused money to flow towards doing stuff TO a patient, not FOR a patient. The problem is that there is a finite pie from which everyone is taking their payments.

 

[DrYoda]

Wow, I'm an idiot! For some reason, when I wrote that, I was thinking of all reimbursements.

The title and content of the article clearly state that this is about Medicare reimbursement, specifically, increasing such reimbursement for primary care physicians.

Insurance payments are based on a multiple of the medicare rate. So by cutting the medicare rate they are in effect cutting all reimbursments to specialists.

 

[xanthomondo]

Will any of the money being taken from specialists be given to physician assistants and nurse practitioners?

 

[Omni]

Does this only affect those doctors working in hospitals?
I don't see how this would affect private practitioners to such a huge degree since they can just have the patient pay part of their treatment up front. Or is the new HC also capping that?

 

[Parts Unknown]

While good primary care is hard to provide and I do agree that PCPs don't make much compared to specialists, to me, it seems like specialists are being punished for spending extra years in training.

"Punished" is perhaps not the right word. Relative to current earnings specialist pay will likely go down, but that does not necessarily mean that specialist physicians will not receive extra compensation for their training and work.

Frankly, there are too many specialists practicing in this country. Their overabundance has certainly contributed to the overutilization of expensive medical care with dubious benefit. Cutting reimbursement is merely a blunt instrument for dealing with it.

The best course of action would be for the individual medical boards and societies to place greater limits on the number of specialists being produced. With proper management, fewer specialists could be reimbursed at high levels commensurate with their training and skill. It would be difficult to do such a thing, but I believe it would be the most elegant solution.

 

[guestdoc]

Why cut anybodys pay?? If they deserve it and the people want there services, then give it to them.

but with "their" instead

The idea is that primary care physicians will like the increase, while specialists obviously will not. Split the doctor's ranks and the they will have no voice.

I guess I need some enlightening... In the past however many years, doctor's salaries have been pretty level, barely keeping up with inflation. Over those same years, however, the costs of health care have increased dramatically. Why does everyone point at the doctor's salaries as the culprit?

EDIT: This Grant Lynde fellow has some good comments.
http://online.wsj.com/article/SB124646885862181139.html#articleTabs=comments#comment262852

 

[NoMoreAMCAS]

Interesting article, and long overdue.

PCPs need to make more money, plain and simple. On the other hand, specialists who are in training for a long period should make more than PCPs due to their expertise. Whats horrible right now is the difference between the two. A three year fellowship in cardiology shouldn't mean you earn $300,000 more per year than an internist. Something more like $20-30,000 makes much more sense.

Instead of PCPs at $160k and specialists at 350k, It would make a hell of a lot more sense to have PCPs at 220k and specialists at 250k. People would still specialize (30k a year for an entire career is a lot of money), but not in the numbers they are now, and for many the desire to work with patients in a primary setting would outweight a 30k a year difference, but not a 200k difference.

Take on an extra 2-4 years of **** to make an extra 20-30K a year, i'll pass. A bunch of angelic pre-meders will probably say they wouldn't though. At least someone will do the job.

 

[SteinUmStein]

You make what you can bill. Apparently seeing someone for 15 minutes to prescribe antibiotics isn't as profitable as removing a tumor from someone's brain. There's risk involved and there's an immense level of skill and practice. Of course they should be compensated many, many more times over for their extra skill, practice, and inherent risk of lawsuit.

And since this is Medicare we are currently talking about (the topic of the article in question), you make what you can bill Medicare, which is naturally going to learn toward cost-effective solutions like preventative medicine and primary care medicine, which are currently being crushed under the weight of a system that emphasizes procedures (and thus payment) over actual patient outcomes.

A brilliant, hard-working cardiovascular surgeon does no more good doing triple bypass surgery on an overweight, middle-aged man than a family physician who is able to get through to the person the message to stop saturating their arteries in fatty foods and start exercising regularly years earlier. But guess who gets more of taxpayer's money? (this is Medicare, remember)

As an aside to those opposed to the public insurance option due to the threat of increased taxes - News Flash: less money paid to specialists to perform highly technical procedures and more money paid to primary care physicians to prevent the necessity for as many of these procedures will result in enormous savings to the American taxpayer.

This nation's obesity problem cannot be solved with a scalpel. It will bankrupt the nation first. I have no problem with specialists; we absolutely need their talents. However, primary care is highly undervalued and underpaid in this country, in my opinion they should be as desired of specialties as derm/radiology/surgery, because they are just as necessary.

 

[Narmerguy]

A brilliant, hard-working cardiovascular surgeon does no more good doing triple bypass surgery on an overweight, middle-aged man than a family physician who is able to get through to the person the message to stop saturating their arteries in fatty foods and start exercising regularly years earlier. But guess who gets more of taxpayer's money? (this is Medicare, remember)

You forget that if the family physician was able to accomplish this the hard-working cardiovascular surgeon would never do the surgery in the first-place. The surgeon receives more money because obviously the other initial physicians were unable to assist and now this patient is looking at their last resort, an extremely challenging job for the surgeon.

 

[NoMoreAMCAS]

You forget that if the family physician was able to accomplish this the hard-working cardiovascular surgeon would never do the surgery in the first-place. The surgeon receives more money because obviously the other initial physicians were unable to assist and now this patient is looking at their last resort, an extremely challenging job for the surgeon.

Exactly, and he's not going to. Doctors always give their mandatory little "you shouldn't be eating blah blah blah" or "you know smoking is bad for you" crap when they talk to patients. But the patients already know this, they just don't care. You aren't going to change their mind during your 30 second conversation on it.

 

[SteinUmStein]

You forget that if the family physician was able to accomplish this the hard-working cardiovascular surgeon would never do the surgery in the first-place. The surgeon receives more money because obviously the other initial physicians were unable to assist and now this patient is looking at their last resort, an extremely challenging job for the surgeon.

No, that's the point. Obviously there will always be cases that cannot be prevented; there are too many genetic factors and people will continue to smoke/overeat. The point is that with better access and better care from more primary care physicians (the shortage of physicians leans much more to the primary care side than the specialist side, as you probably know), we can prevent many of these surgeries from happening, saving everyone a huge amount of money, and resulting in better patient outcomes. I agree that surgery should be a last resort, but our current health system is not putting nearly enough investment in any of the other "resorts".

The surgeon is performing an extremely challenging job which required long, difficult training, much longer and more rigorous than the primary care physician. He should be compensated accordingly. This does NOT mean, however, than he should make 4 or 5 times the salary of the primary care physician! We will still have amazing, altruistic, caring surgeons if we pay the top specialists $250,000 rather than $400,000 or more.

 

[SteinUmStein]

Exactly, and he's not going to. Doctors always give their mandatory little "you shouldn't be eating blah blah blah" or "you know smoking is bad for you" crap when they talk to patients. But the patients already know this, they just don't care. You aren't going to change their mind during your 30 second conversation on it.

There are millions of Americans in underserved areas who don't even get that 30 second talk because of the severe shortage of primary care physicians in rural America. I'm not saying people shouldn't know better, because honestly they should. But a one-on-one talk with someone you know and respect CAN change the way you live your life, and if you deny that fact, why even bother talking to patients about their health?

 

[cudoc2014]

Specialists should be compensated much more than PCPs. I agree with NoMoreAmcas in that PCPs can't convince an obese, diabetic, hypertensive, CAD, etc. person in a 5 minute appointment to reverse their habits. These people should be required to see some sort of psychologist who can meet with them every week (however they probably won't pay for it).

So when these unhealthy people come in the ER with a heart attack, specialists must use their talent, acquired over many more years of arduous training than PCPs, to go in and fix the problem. Not to mention, specialists tend to work longer hours than PCPs as well. On another note, specialist compensation should not go down, unless malpractice insurance goes down.

This is just my $0.02. If you can't tell, I am pursuing a career in surgery, perhaps ortho, peds, or neuro. So I hope I am fairly compensated for my 5 years + of training after med school. I hope the Obamaplan doesn't **** it up for us all.

 

[Charles_Carmichael]

I just noticed that people are talking about this article in the General Residency forum as well. Anyways, here's a quote from Winged Scapula that seems pretty gloomy:

Income redistribution would be fine if all specialists made "2-5 times" what PCPs do. Not all of us do.

Be prepared to see even fewer people go into General Surgery when the overall reimbursement and reimbursement for image guided procedures (which are our biggest money makers - I make more for an US guided biopsy than I do for a modified radical mastectomy) is so low that no one is willing to do the training to make the same amount they could as an FP.

There's already a shortage of general surgeons; this isn't going to help.

Rising Cost of Malpractice
+ Rising Capital Costs
+ Increasing Litigation
+ Rising Office Supply/Staff Costs
+ Rising Medical Education Costs
+ Decreasing Reimbursement
__________________________
= Hope you can find a specialist when you need one.

I didn't think of it that way and it makes sense. It's really a few specialties that are making many times more money than PCPs. Most specialists do seem to make more than PCPs, but not by severalfold. And this Medicare cut appears to cut reimbursements for every specialty other than primary care ones.

 

[greatnt249]

The point is that with better access and better care from more primary care physicians (the shortage of physicians leans much more to the primary care side than the specialist side, as you probably know), we can prevent many of these surgeries from happening, saving everyone a huge amount of money, and resulting in better patient outcomes.

You can't help those who refuse to help themselves. Your plan only works when the majority of patients decide to get on board with their respective health regimens instead of acting as if living healthy is too much of a burden for them to deal with.

 

[niranjan162]

No, that's the point. Obviously there will always be cases that cannot be prevented; there are too many genetic factors and people will continue to smoke/overeat. The point is that with better access and better care from more primary care physicians (the shortage of physicians leans much more to the primary care side than the specialist side, as you probably know), we can prevent many of these surgeries from happening, saving everyone a huge amount of money, and resulting in better patient outcomes. I agree that surgery should be a last resort, but our current health system is not putting nearly enough investment in any of the other "resorts".

The surgeon is performing an extremely challenging job which required long, difficult training, much longer and more rigorous than the primary care physician. He should be compensated accordingly. This does NOT mean, however, than he should make 4 or 5 times the salary of the primary care physician! We will still have amazing, altruistic, caring surgeons if we pay the top specialists $250,000 rather than $400,000 or more.

who the hell are you to decide what these people should be payed? Whats your logical basis that they should not make 4 or 5 times the salary of primary care?

and where the hell do you get these number of 4 to 5 times more. Very few doctors make 500k unless they are heavily in the business side. Isnt the average salary around 180k?

Surgery residencies are some of the hardest residencies, and then practicing can also be just as tough.

Better access to primary care isnt gonna do **** to alleviate the obesity epidemic in the U.S. you dont need a doctor to tell your fat and you need to exercise and eat right.

You cant do this budget neutrally. Shifting money from one place to another is the same as shifting the shortage from one area to another. Since medicare sets the standard for other insurance companies will surely follow.

Good job government!

And dont worry guys by the time we're practicing you wont have to worry about making " 4 or 5 x more" than anybody let alone a PCP

 

[SteinUmStein]

who the hell are you to decide what these people should be payed? Whats your logical basis that they should not make 4 or 5 times the salary of primary care?

and where the hell do you get these number of 4 to 5 times more. Very few doctors make 500k unless they are heavily in the business side. Isnt the average salary around 180k?

Surgery residencies are some of the hardest residencies, and then practicing can also be just as tough.

Better access to primary care isnt gonna do **** to alleviate the obesity epidemic in the U.S. you dont need a doctor to tell your fat and you need to exercise and eat right.

You cant do this budget neutrally. Shifting money from one place to another is the same as shifting the shortage from one area to another. Since medicare sets the standard for other insurance companies will surely follow.

Good job government!

And dont worry guys by the time we're practicing you wont have to worry about making " 4 or 5 x more" than anybody let alone a PCP

You're absolutely right. I'm sorry for voicing my opinion. It's misguided and naive. Surgeons are better docs than primary care docs, they go through more rigorous training and deserve to make much more. So my plan to go into primary care is wrong, I should try to be the best specialist I can be because that's what will help patients the most. Everyone knows talking to patients does no good whatsoever, it's hippie bull****, right?

You're dead-on that access to primary care means absolutely nothing to patient outcomes. There are no studies showing that regular access to a family physician affects health outcomes in any way. We should do away with family practice; everyone should go directly to the emergency room whenever a health problem crops up, and the brilliant surgeons can then deal with it and cure it all in one go. It's simpler, and the best people can do the best job for the best pay. No government intervention necessary.

This isn't sarcasm. It's what some people actually believe.

 

[Pinkertinkle]

They just posted the actual proposal in the thread in the resident's forum.
Please read it over and give me the highlights.
http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf

 

[NoMoreAMCAS]

There are millions of Americans in underserved areas who don't even get that 30 second talk because of the severe shortage of primary care physicians in rural America. I'm not saying people shouldn't know better, because honestly they should. But a one-on-one talk with someone you know and respect CAN change the way you live your life, and if you deny that fact, why even bother talking to patients about their health?

Unless it's something that's not absolute common knowledge, i'd skip over it. I don't need to tell a smoker every time they come see me that smoking is bad for them, or tell an overweight person to lay off the fried foods. Unless they're a child or literally mentally ******ed, you don't need to cover these things.

 

[SteinUmStein]

Unless it's something that's not absolute common knowledge, i'd skip over it. I don't need to tell a smoker every time they come see me that smoking is bad for them, or tell an overweight person to lay off the fried foods. Unless they're a child or literally mentally ******ed, you don't need to cover these things.

That's interesting, I'd like to know from an actual physician or resident if that's the approach they teach in medical school. I highly doubt it.

 

[Parts Unknown]

That's interesting, I'd like to know from an actual physician or resident if that's the approach they teach in medical school. I highly doubt it.

Compliance with weight reduction strategies is generally poor, but it has the advantage of not costing a thing. And yes, I have seen people change their lifestyles, lose weight, quit smoking, and get healthier with a primary care physician acting as a facilitator. It is true that you can't make a horse drink, but it does not make any sense to hide the water.

Contrary to the rather odd tangent this thread has taken, the PCP's role is not to make fat people thin. More commonly his/her goal is to manage risk factors, such as blood pressure, blood sugar, and cholesterol. Anyone wanting to get a jump on med school can peruse the JNC 7 Guidelines, which you will utilize on rotations and be tested on.

In fact, much of the life expectancy gain we experienced in the latter half of the 20th Century is attributable to reduced mortality from heart disease and stroke, which comes largely from pharmacologic intervention at the level of the primary care physician.

 

[SteinUmStein]

Compliance with weight reduction strategies is generally poor, but it has the advantage of not costing a thing. And yes, I have seen people change their lifestyles, lose weight, quit smoking, and get healthier with a primary care physician acting as a facilitator. It is true that you can't make a horse drink, but it does not make any sense to hide the water.

Contrary to the rather odd tangent this thread has taken, the PCP's role is not to make fat people thin. More commonly his/her goal is to manage risk factors, such as blood pressure, blood sugar, and cholesterol. Anyone wanting to get a jump on med school can peruse the JNC 7 Guidelines, which you will utilize on rotations and be tested on.

In fact, much of the life expectancy gain we experienced in the latter half of the 20th Century is attributable to reduced mortality from heart disease and stroke, which comes largely from pharmacologic intervention at the level of the primary care physician.

Thank you.

 

[niranjan162]

You're absolutely right. I'm sorry for voicing my opinion. It's misguided and naive. Surgeons are better docs than primary care docs, they go through more rigorous training and deserve to make much more. So my plan to go into primary care is wrong, I should try to be the best specialist I can be because that's what will help patients the most. Everyone knows talking to patients does no good whatsoever, it's hippie bull****, right?

You're dead-on that access to primary care means absolutely nothing to patient outcomes. There are no studies showing that regular access to a family physician affects health outcomes in any way. We should do away with family practice; everyone should go directly to the emergency room whenever a health problem crops up, and the brilliant surgeons can then deal with it and cure it all in one go. It's simpler, and the best people can do the best job for the best pay. No government intervention necessary.

This isn't sarcasm. It's what some people actually believe.

Youre totally entitled to your opinion, but when you base it on BS numbers youre gonna get called out. Yea theres the doctors that pull in millions and theres also docs that pull in less than 100k.

The average salary of a physician is 170K. The average salary of a family practice doc is 120k-130k. So 5 times that is 650k. Dont worry naive one you'll never make that much unless you start getting into the business side of medicine.

I know what youre thinking "What! I dont want to earn a living, I want to be a slave to the government so I can do their endless paperwork but think im helping people. I cant do that if im making money." Dont worry the current administration will continue their bungling of important and complex issues by rushing through things without properly understanding them or thinking them through.

By the way good luck trying to find out where I say PC is useless. Like I said you dont need a doctor to tell you youre fat. You dont need a PhD to know fast food is bad for you.

 

[SteinUmStein]

Youre totally entitled to your opinion, but when you base it on BS numbers youre gonna get called out. Yea theres the doctors that pull in millions and theres also docs that pull in less than 100k.

The average salary of a physician is 170K. The average salary of a family practice doc is 120k-130k. So 5 times that is 850k. Good thing you don't want to be a mathematician. Dont worry naive one you'll never make that much unless you start getting into the business side of medicine.

I know what youre thinking "What! I dont want to earn a living, I want to be a slave to the government so I can do their endless paperwork but think im helping people. I cant do that if im making money." Dont worry the current administration will continue their bungling of important and complex issues by rushing through things without properly understanding them or thinking them through.

By the way good luck trying to find out where I say PC is useless. Like I said you dont need a doctor to tell you youre fat. You dont need a PhD to know fast food is bad for you.

Are you serious? Patients are going to have to deal with this?

 

[hopefuldoc87]

. The average salary of a family practice doc is 120k-130k. So 5 times that is 850k. Good thing you don't want to be a mathematician.

120k-130k x 4 = 480k-520k
120k-130k x 5 = 600k-650k

Where are you getting 850? No offense, but you shouldn't be saying "Good thing you don't want to be a mathematician."

Like I said you dont need a doctor to tell you youre fat. You dont need a PhD to know fast food is bad for you.

I like your wisdom on how to practice when you've never taken a medical school course or treated a patient yet.

You do realize that not every patient you see will be as educated as you seem to believe the public is.

 

[Charles_Carmichael]

They just posted the actual proposal in the thread in the resident's forum.
Please read it over and give me the highlights.
http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf

Wow, 1128 pages? Jeez...

Just from glancing at it really quickly, it looks like some specialties (such as cards, rads, etc.) will be hit pretty hard. Radiation oncology's looking at a nearly 20% cut in reimbursements? Am I reading that right? It's on the table on page 717.

From what I've been reading on this forum, it seems that most of the money from a procedure, surgery, etc. is going towards administrative costs and not to the physician. Is there any way to reduce these administrative costs? To me it seems like that might save more money than cutting reimbursements.

 

[NoMoreAMCAS]

That's interesting, I'd like to know from an actual physician or resident if that's the approach they teach in medical school. I highly doubt it.

I wasn't saying it was. I've shadowed several doctors and seen them all have their mandatory little "smoking is bad mmmmkay" or "you're too fat" speech with patients. I'm sure you're taught to do this, it's just pointless.

 

[niranjan162]

120k-130k x 4 = 480k-520k
120k-130k x 5 = 600k-650k

Where are you getting 850? No offense, but you shouldn't be saying "Good thing you don't want to be a mathematician."




I like your wisdom on how to practice when you've never taken a medical school course or treated a patient yet.

You do realize that not every patient you see will be as educated as you seem to believe the public is.

sorry I took the average salary of doctors and multiplied by 5. Even so 4-5x is an exaggeration. I dont want to be a mathematician either. The point was people think these specialists are grossing ridiculous amounts more than PCP. Yea they make more but if they average of doctors salaries is 170k its easy to see that most specialists are not making 4-5x PCP or that average would be much closer to this magical 4-5x the PCP salary rather than closer to it. I think PCPs are very valuable and ti would save the country alotta money to goto their PCP rather than the ER, but the problem is the government is just fixing one problem by creating another. Why was there a PCP shortage, because people didnt deem it worth the effort and sacrifice for the lower pay. Whats to stop this from happening to the specialties now?

Its common knowledge that being fat is bad and its common knowledge that fastfood is bad for you. You dont even need a high school education to know this.

I didnt look at it from the side of practicing i looked at it from the side of the patient. I dont do everything im told. I love fast food. If someone told me not to eat it anymore, Id say ok, think about it, but say ehh one more time isnt gonna hurt. And the cycle continues.

 

[BTC]

Wow, 1128 pages? Jeez...

Just from glancing at it really quickly, it looks like some specialties (such as cards, rads, etc.) will be hit pretty hard. Radiation oncology's looking at a nearly 20% cut in reimbursements? Am I reading that right? It's on the table on page 717.

From what I've been reading on this forum, it seems that most of the money from a procedure, surgery, etc. is going towards administrative costs and not to the physician. Is there any way to reduce these administrative costs? To me it seems like that might save more money than cutting reimbursements.

Why are clinical pyschologists and clinical social workers taking such a hit if that table is correct?

And its good to see that a mammogram costs less than a woman's haircut.

 

[hopefuldoc87]

Its common knowledge that being fat is bad and its common knowledge that fastfood is bad for you. You dont even need a high school education to know this.

It's also common knowledge that if you don't get your period for nine months, your body goes through alot of hormone changes, AND you sort of start to show, chances are you might be pregnant. But you'd be surprised of all the stories of patients who went nine months without knowing they were pregnant.

Look I'm just trying to say that while we may know this common stuff, we can't expect everyone to know. If they don't know, is it our fault? No. Is it their fault? Maybe. (We don't know their circumstances, though) Maybe the problem isn't in PCP's, but in health education. Maybe the government should take away money from all those overpaid, mercedes-benz driving, golf-playing principals and guidance counselors, and give it to gym teachers/health education teachers in our school system.

 

[ChubbyChaser]

There are millions of Americans in underserved areas who don't even get that 30 second talk because of the severe shortage of primary care physicians in rural America. I'm not saying people shouldn't know better, because honestly they should. But a one-on-one talk with someone you know and respect CAN change the way you live your life, and if you deny that fact, why even bother talking to patients about their health?

Idk about yall, but iwas preached at....in public schools all the way from K to 12 that smoking and eating **** all day was bad.....Are there actually many ppl out there that really dont know that? I doubt it, i just think too many of them are too ****ing lazy to even care.

 

[surftheiop]

Wow, 1128 pages? Jeez...

Just from glancing at it really quickly, it looks like some specialties (such as cards, rads, etc.) will be hit pretty hard. Radiation oncology's looking at a nearly 20% cut in reimbursements? Am I reading that right? It's on the table on page 717.

From what I've been reading on this forum, it seems that most of the money from a procedure, surgery, etc. is going towards administrative costs and not to the physician. Is there any way to reduce these administrative costs? To me it seems like that might save more money than cutting reimbursements.

how do you convert RVU's to dollars?

 

[tennischamp822]

.

 

[cudoc2014]

Wow free medical education? wouldn't that be great...but i would rather pay back the loans later in life than spend 10 years post-undergrad of education and not be guaranteed at least a 150K salary. Anyone who does that amount of training and have that much responsibility deserve their salary

 

[ninjapenguin]

how do you convert RVU's to dollars?

I believe you multiply the number of RVU's by about $38 for Medicare payments. Each procedure a physician performs is assigned a certain RVU value. The dollar value per RVU obviously changes based on area of practice and the primary payer involved.

 

[niranjan162]

It's also common knowledge that if you don't get your period for nine months, your body goes through alot of hormone changes, AND you sort of start to show, chances are you might be pregnant. But you'd be surprised of all the stories of patients who went nine months without knowing they were pregnant.

Look I'm just trying to say that while we may know this common stuff, we can't expect everyone to know. If they don't know, is it our fault? No. Is it their fault? Maybe. (We don't know their circumstances, though) Maybe the problem isn't in PCP's, but in health education. Maybe the government should take away money from all those overpaid, mercedes-benz driving, golf-playing principals and guidance counselors, and give it to gym teachers/health education teachers in our school system.

Your absolutely right, the problem is in health education. U cant rely on the government for a whole lot. Doing so increases bureaucratic and political BS, all of which costs millions of dollars. Just like doctors how doctors are people, the government is a group of people. They like getting money, they like their fancy suits, they like to twitter. The government isnt someone nameless altruistic entity that only cares about society, its people with their own feelings, thoughts and agendas. Few politicians are alright, but most of them a lawyers etc.

Someone posted above that Obama's main domestic goal is healthcare reform, but he wont take an easy major step towards saving some serious money in healthcare (torte reform), because hes a lawyer and probably gets lots of money from them. (I am aware that malpractice laws are dictated by each state, but the federal government can make incentives to encourage torte reform.)

 

[NoMoreAMCAS]

I think every doctor should make the same amount. That way I can do a cake 3 year residency and be making top dollar .

 

[Narmerguy]

Wow, 1128 pages? Jeez...

Just from glancing at it really quickly, it looks like some specialties (such as cards, rads, etc.) will be hit pretty hard. Radiation oncology's looking at a nearly 20% cut in reimbursements? Am I reading that right? It's on the table on page 717.

20% ?! That's hardcore. Show me another field where this is ok. Try to make a blanket cut this large to a large group of highly trained/educated professionals.

 

[Zoom-Zoom]

It's ironic that the overwhelming majority of medical people supported obama, and now he's going to bend us over and give the favor right back. Cutting specialist pay is socialist bull****. Nobody forced PCP's to go that route. My advice to Obama: help out the PCP's without srewing over everybody else. How is it possible we have a president who has such little faith in capitalism? That's like ronald mcdonald not having faith in french fries. And where do all the hardcore french fry eaters go now that ronald has turned their back on them? We don't have another home. We'd have to go to Burger King, and their fries suck.

I voted for this douche and I'm already so sick of his idealist nonsense. What a con artist. The good news is we'll get a little heads up before we invest a half-decade in a residency or fellowship that will in no way serve as an investment in our career success. The quality of medical care int he country is going to go kaput if this goes through. You'll see.

 

[hopefuldoc87]

I think every doctor should make the same amount. That way I can do a cake 3 year residency and be making top dollar .

People will be cutting throats for the FM and other PC residencies. Only top 2% will get into those residencies. FMG's will be forced to do surgery, ortho, neurosurgery, etc...