Medicare proposed rates for the 2015 physician fee schedule

Burrell College of Osteopathic Medicine
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Frazier

Frazier

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Proposed changes not as big as last year's overall.

Chiropractors didn't get another ~10% boost this year.

Swings at RadOnc as big loser with -4% and -8% for freestanding centers (their lobby is good at dodging this every year during 11th hour).

http://www.ofr.gov/OFRUpload/OFRData/2014-15948_PI.pdf

Tables on 546-547.

Remember a 0% or +1% change, while better than a cut, is not necessarily a win. Inflation is not our friend.
 
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more cuts than anything else. nice to see that we will spend unlimited resources on war, but can't seem to find any money to pay providers fairly. at least we have the money keep comatose grandma on a respirator until she does of bacteremia in the hospital.
 
Frazier said:
Proposed changes not as big as last year's overall.

Chiropractors didn't get another ~10% boost this year.

Swings at RadOnc as big loser with -4% and -8% for freestanding centers (their lobby is good at dodging this every year during 11th hour).

http://www.ofr.gov/OFRUpload/OFRData/2014-15948_PI.pdf

Tables on 546-547.

Remember a 0% or +1% change, while better than a cut, is not necessarily a win. Inflation is not our friend.
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Ophtho and Radiology aren't going to be happy.
 
What is max allowed charges? Is that basically how much they can charge all their patients in a year?
 
BestDoctorEver said:
No change in Psych 👎.
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In the last 3 yrs I believe psych has been 0%, +6%, +2%. Not necessarily in that order.

At this point I guess radiology should be happy its not -8% like the good ol' days of 2007 (ish).

Ive seen jobs for psych with 240 base for M-F 8-5 schedules in CA with 8 weeks vacation. Rads jobs advertised (when you can find them) for roughly 300K starting with 8 weeks vacation. Except you have 120 studies to read in a day...

Psych is looking good...If only I could love it.
 
FIREitUP said:
more cuts than anything else. nice to see that we will spend unlimited resources on war, but can't seem to find any money to pay providers fairly. at least we have the money keep comatose grandma on a respirator until she does of bacteremia in the hospital.
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Yes, doctor. Do everything you can to save her!
 
qwerty89 said:
In the last 3 yrs I believe psych has been 0%, +6%, +2%. Not necessarily in that order.

At this point I guess radiology should be happy its not -8% like the good ol' days of 2007 (ish).

Ive seen jobs for psych with 240 base for M-F 8-5 schedules in CA with 8 weeks vacation. Rads jobs advertised (when you can find them) for roughly 300K starting with 8 weeks vacation. Except you have 120 studies to read in a day...

Psych is looking good...If only I could love it.
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Psych is not probably for everyone, but I think I will enjoy it... 200K+/year M-F and 40 hrs/wk with 2 months paid vacation is a great deal...
 
the EM hype died real quick ... i remember when any specialty discussion would turn into a EM, shift work, adrenaline junkie, love fest.
 
Sikkunt said:
the EM hype died real quick ... i remember when any specialty discussion would turn into a EM, shift work, adrenaline junkie, love fest.
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Why is that? It seems like many of my classmates are still into it just for the reasons you stated...
 
If Psych is that good, why would anyone in their right mind become a surgeon and work almost twice as much for maybe 60K more? It's madness, plain and simple.
 
Arkangeloid said:
If Psych is that good, why would anyone in their right mind become a surgeon and work almost twice as much for maybe 60K more? It's madness, plain and simple.
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Loving surgery somehow makes up for working 60-70 hours a week for the rest of your life. I don't get it either.
 
Arkangeloid said:
If Psych is that good, why would anyone in their right mind become a surgeon and work almost twice as much for maybe 60K more? It's madness, plain and simple.
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It takes a certain personality to enjoy interacting with depressed/anxious/suicidal/manic patients all the time. Need a lot of patience, empathy, and a nurturing personality.

Also, I have nothing but respect for psych, but let's face it: Their patient population includes some of the worst that medicine has to offer. I was routinely conversing with murderers and rapists on my psych rotation, many of whom likely only had cluster B traits and no true psych issue. As my attending would say, their only diagnosis was "As s hole-ism."

circulus vitios said:
Loving surgery somehow makes up for working 60-70 hours a week for the rest of your life. I don't get it either.
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Plenty of surgeons in all of the subspecialties work less than 60 hrs a week. I personally know neurosurgeons clocking in under 60 hrs/wk and still getting to do one of the coolest, most revered, and best paying jobs on the planet.
 
Arkangeloid said:
If Psych is that good, why would anyone in their right mind become a surgeon and work almost twice as much for maybe 60K more? It's madness, plain and simple.
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Surgeons make more than 60K vs. Psych. And I know this will shock you, but some people like doing surgery.
 
KinasePro said:
Plenty of surgeons in all of the subspecialties work less than 60 hrs a week. I personally know neurosurgeons clocking in under 60 hrs/wk and still getting to do one of the coolest, most revered, and best paying jobs on the planet.
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Seems to be largely true in the subspecialties, but then again they aren't really equivalent to gen surg. At my institution even the senior attendings seem to put in pretty crazy hours.


Sent from my iPhone using Tapatalk
 
Arkangeloid said:
If Psych is that good, why would anyone in their right mind become a surgeon and work almost twice as much for maybe 60K more? It's madness, plain and simple.
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Because we enjoy being in the OR and some subspecialties make significantly more than Psych without having to work "twice as much ".
 
Winged Scapula said:
Because we enjoy being in the OR and some subspecialties make significantly more than Psych without having to work "twice as much ".
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i bet if you poll med students, more people would like surgery than psych

doing what you like and getting paid a higher hourly rate. win-win
 
My current Psych attending reels in 350k before taxes. Never realized it was this lucrative. If only I could actually learn to look at a psych patient and see past my own countertransference. I had a patient who wanted to punch me in the face yesterday for doing absolutely nothing besides wearing a white coat. Still got it.
 
Sikkunt said:
i bet if you poll med students, more people would like surgery than psych

doing what you like and getting paid a higher hourly rate. win-win
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I liked both, although was disappointed that my Psych rotation was mostly depressed and OCD young women rather than some major Personality disorders. The latter interest is why I went into surgery Lol.

But yes, many medical students enjoy their surgical rotation and it's a shame that we lose so many potentially good colleagues because of some of the treatment of students by current house staff and faculty.
 
Winged Scapula said:
But yes, many medical students enjoy their surgical rotation and it's a shame that we lose so many potentially good colleagues because of some of the treatment of students by current house staff and faculty.
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Just out of curiosity, do you think this has changed at all over the years? I've heard from several people that surgery has generally become less malignant than it used to be (compared to maybe 20 or 30 years ago).
 
sinombre said:
Just out of curiosity, do you think this has changed at all over the years? I've heard from several people that surgery has generally become less malignant than it used to be (compared to maybe 20 or 30 years ago).
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I think so, but then again I wasn't around 20-30 years ago. There is certainly less tolerance for such behavior amongst surgical staff. I saw a change in my residency which occurred with a new Chair and graduation of the Chiefs who'd trained under the old one. We had some residents coming out of the lab who had to be told that their attitudes needed readjusting to the new kinder (and relatively) gentler training program.

I'm not sure it will ever be as touchy feely as some other fields but the typical medical student and surgical resident is a different breed with different expectations so I am hopeful that the days of telling students, "you're too nice to be a surgeon", are waning. We've got plenty of users here who exemplify that: @southernIM (and handsome too!), @SLUser11 , @Smurfette etc.
 
Winged Scapula said:
I liked both, although was disappointed that my Psych rotation was mostly depressed and OCD young women rather than some major Personality disorders. The latter interest is why I went into surgery Lol.

But yes, many medical students enjoy their surgical rotation and it's a shame that we lose so many potentially good colleagues because of some of the treatment of students by current house staff and faculty.
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I also think it's more the hours as well, WS. On my General Surgery rotation, my residents weren't "mean" per say. Their expectations were very straightforward and we worked as a team. I remember we used to feel bad if we felt like we let our residents down. Surgery residents, in general, aren't passive-aggressive. They don't have time to be.

That being said, putting together the very long hours, faculty who would sometimes get mad at the intern/resident even during the surgery itself, etc., 5 years of training, many of us realized that training would eat us up alive. It would be nice if the Surgery establishment got that, but I also realize it's the nature of the beast. And it's not like Surgery residencies are going empty. When that happens (which will be never), and only then, will Surgery change.

I think that's why sometimes medical students don't feel it's a big deal to do well on Surgery. After all, if you're going into something like Psych, does it really matter?
 
Winged Scapula said:
I liked both, although was disappointed that my Psych rotation was mostly depressed and OCD young women rather than some major Personality disorders. The latter interest is why I went into surgery Lol.

But yes, many medical students enjoy their surgical rotation and it's a shame that we lose so many potentially good colleagues because of some of the treatment of students by current house staff and faculty.
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The acutely psychotic are easier to deal with than many surgeons, LOL!

I love surgery and will miss a lot of fun by applying for psych but it always came back to "Could I deal with these people (and their egos) every day for five years?". 5+ years of listening to someone go on about how great they are seems a pretty high cost. I also can't stroke someone daily and tell them how pretty and special they are. 🙂
 
Winged Scapula said:
I liked both, although was disappointed that my Psych rotation was mostly depressed and OCD young women rather than some major Personality disorders. The latter interest is why I went into surgery Lol.

But yes, many medical students enjoy their surgical rotation and it's a shame that we lose so many potentially good colleagues because of some of the treatment of students by current house staff and faculty.
Click to expand...

This was me coming out of surgery. I actually really enjoyed the rotation and, in another life, could see myself as a surgeon, but going through the brutal training was a non-starter for me.
 
Winged Scapula said:
I think so, but then again I wasn't around 20-30 years ago. There is certainly less tolerance for such behavior amongst surgical staff. I saw a change in my residency which occurred with a new Chair and graduation of the Chiefs who'd trained under the old one. We had some residents coming out of the lab who had to be told that their attitudes needed readjusting to the new kinder (and relatively) gentler training program.

I'm not sure it will ever be as touchy feely as some other fields but the typical medical student and surgical resident is a different breed with different expectations so I am hopeful that the days of telling students, "you're too nice to be a surgeon", are waning. We've got plenty of users here who exemplify that: @southernIM (and handsome too!), @SLUser11 , @Smurfette etc.
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I wonder how much that has to do with:

1) Change (and continued change) in work hour restrictions by the ACGME.

2) Disruptive physicians who for decades used to be tolerated by hospital administrators, but now due to the repercussions of that in the literature -- staff leaving, patient deaths, etc. it's no longer being tolerated: https://www.google.com/?gws_rd=ssl#q=disruptive physicians

3) The theme of "professionalism" that is being interwoven starting in medical school education. It's hard for medical schools to teach their medical students "professionalism" when medical students can point directly back and say, "How dare you lecture to me about professionalism when your own faculty treat medical students unprofessionally!"

Did the ones coming out of the lab change automatically or did they need some remediation?
 
DermViser said:
3) The theme of "professionalism" that is being interwoven starting in medical school education. It's hard for medical schools to teach their medical students "professionalism" when medical students can point directly back and say, "How dare you lecture to me about professionalism when your own faculty treat medical students unprofessionally!"
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This is in vogue in Boston right now:

http://www.brighamandwomens.org/medical_professionals/career/cpps/Professionalism.aspx

I love the "Professionalism Assessment" and "Professionalism Remediation".
 
maxxor said:
This is in vogue in Boston right now:

http://www.brighamandwomens.org/medical_professionals/career/cpps/Professionalism.aspx

I love the "Professionalism Assessment" and "Professionalism Remediation".
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Professionalism Training
An interactive workshop required for all physicians. If you are a BWH physician, PA or NP click here for more information about the Professionalsim Training Sessions.

Professionalism Concerns
A confidential resource for any BWH employee to raise concerns regarding unprofessional behavior on the part of any physician.

Professionalism Assessment
360 degree evaluation to assess a clinician’s skills in teamwork and interpersonal communication with the healthcare team.

Professionalism Remediation
We help connect clinicians with reresources -- such as professional coaching -- that can be helpful in addressing professionalism stumbling blocks.
Click to expand...
Funny how the professionalism assessment at Brigham and Women's only works in one direction -- of the physician.
 
maxxor said:
Of course. Gotta tally up all those nurse administrator surveys.
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Yup. One of the benefits of having a nurses union. They're esp. powerful in the Northeast and Illinois.
 
maxxor said:
As a complete side-note and potential derailor of this thread, this is why MGH will always be better than BWH. MGH is non-union.
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And Brigham does allow unionized nurses? How can that be? They're both part of Partners aren't they?

Speaking of BWH and professionalism:
http://www.thecrimson.com/article/2009/2/26/doctor-found-guilty-in-lawsuit-the/
(of course that was ok bc it was btw a doctor and another doctor)
http://caselaw.findlaw.com/us-1st-circuit/1578745.html

I was just going to ask about Beth Israel and MGH. Of course some of them have had problems of their own.

http://www.boston.com/lifestyle/hea...r-bias-suit/zXyke5jXn2Oztrgp04KzeN/story.html
 
DrOwnage said:
My current Psych attending reels in 350k before taxes. Never realized it was this lucrative. If only I could actually learn to look at a psych patient and see past my own countertransference. I had a patient who wanted to punch me in the face yesterday for doing absolutely nothing besides wearing a white coat. Still got it.
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Maybe the Psych attending charges out-of-pocket and is able to do so bc of his clientele? Psych patients have also been restrained so maybe he thought you were going to do something.
 
DermViser said:
And Brigham does allow unionized nurses? How can that be? They're both part of Partners aren't they?
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Partners is a funny business entity. Largely, the hospitals function independently with a shared EMR and back office activities (billing/scheduling). Each has their own internal administration and structure. For example, BWH runs as a traditional academic medical center, while MGH is structured as a quasi-private practice academic hospital fusion with parallel "house" and "private practice" services.

BWH has union nurses. MGH steadfastly refuses unionization. Guess which hospital is Magnet accredited by ANCC? Which one has more respect for the doctors working there?

It's kind of like how NewYork Presbyterian is "merged" between Columbia and Cornell. Cornell is non-union, but Columbia has a union.
 
NickNaylor said:
Seems to be largely true in the subspecialties, but then again they aren't really equivalent to gen surg. At my institution even the senior attendings seem to put in pretty crazy hours.
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Yeah, I think gen surg and it's specialties probably have some of the worst lifestyles. But even then, the senior guys at our shop are protected to an extent by a handful of fellows/residents/mid-levels on most services. Most of them have families and live relatively balanced lives. There are definitely exceptions, though.

jakeislove said:
I love surgery and will miss a lot of fun by applying for psych but it always came back to "Could I deal with these people (and their egos) every day for five years?". 5+ years of listening to someone go on about how great they are seems a pretty high cost. I also can't stroke someone daily and tell them how pretty and special they are. 🙂
Click to expand...

I'm always somewhat perplexed by statements like this, but I guess that my institution just has a great surgery culture :shrug:. We have some "egomaniacs" in surg onc and CT, but even they are decent people if you show interest and are relatively competent in your role. I know it goes in the face of SDN stereotypes, but the internal medicine personalities are far more insufferable at my institution. The surgeons give off a grumpy dad vibe sometimes, but they're generally good people who would go to bat for anyone on their team in a heartbeat. I've seen a handful of people thrown under the bus by medicine docs, so I guess it just varies from place to place.
 
KinasePro said:
Yeah, I think gen surg and it's specialties probably have some of the worst lifestyles. But even then, the senior guys at our shop are protected to an extent by a handful of fellows/residents/mid-levels on most services. Most of them have families and live relatively balanced lives. There are definitely exceptions, though.



I'm always somewhat perplexed by statements like this, but I guess that my institution just has a great surgery culture :shrug:. We have some "egomaniacs" in surg onc and CT, but even they are decent people if you show interest and are relatively competent in your role. I know it goes in the face of SDN stereotypes, but the internal medicine personalities are far more insufferable at my institution. The surgeons give off a grumpy dad vibe sometimes, but they're generally good people who would go to bat for anyone on their team in a heartbeat. I've seen a handful of people thrown under the bus by medicine docs, so I guess it just varies from place to place.
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I have not met a single surgeon I would enjoy working with thusfar, tbh. Judging from that panel I attended, that trauma surgeon seemed somewhat deranged, to be frank.
 
Arkangeloid said:
I have not met a single surgeon I would enjoy working with thusfar, tbh. Judging from that panel I attended, that trauma surgeon seemed somewhat deranged, to be frank.
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Bc he enjoyed his job and considered it a "calling"?
 
Arkangeloid said:
That, and he spent half his speech saying anyone who disagrees with him was not really interested in medicine.
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Yes, there are always some old school doctors that are this way and use medicine as an excuse to let other parts of their lives wither away. Definitely a different era in which he went to med school. Also that's inherent to doing trauma.
 
DermViser said:
Yes, there are always some old school doctors that are this way and use medicine as an excuse to let other parts of their lives wither away. Definitely a different era in which he went to med school. Also that's inherent to doing trauma.
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Any thoughts on this?

There are roughly 2.5x the number of dermatologists in the us as neurosurgeons (8,900 vs 3,500). Allowed charges, however, are 4.3x ($3,162 million vs $733 million).
 
Dave89 said:
This consistently shocks me.
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Me too. It's one thing if all you get to do all day is the surgeries, but you don't.
That's why you REALLY have to love surgery, if you want to do it. I mean REALLY love it. :kiss:
 
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