There was an interesting article in the Bulletin of the American College of Surgeons this month on the state of Emergency Services in this country. Tables 1 and 2 on page 15 in the article shows the changes in medicare reimbursement for various procedures between 1989 and 2006. Reimbursement for cataract surgery decline by 57%. Laminectomy and Coronary artery bypass surgery declined by 49 and 48%. However, reimbursement for Partial Colectomy and Mastectomy declined by only 2 and 5%. Hernia repair declined by 16%. Seems like the general surgeons know the right people For emergent procedures, reimbursement for repairing a nasal fracture declined 31%, repairing a heart wound declined only 6%. Reimbursement for orbital fracture repair declined by 20%. But, reimbursement for retinal detachment repair has declined by 50%. Currently, a retinal detachment repair doesn't pay but a few hundred dollars more than making a burr hole for a hematoma. It used to pay more than a ruptured abdominal aortic aneurysm repair. As you can see, medicare reimbursement for intraocular surgery has decreased tremendously, much more than surgical procedures done by other surgical specialties. Please be proactive in emailing your congressman as we are slated for another 5% cut. The academy's website makes this easy. Maybe I'll just pay 50% of my taxes because of the "great" job our politicians are doing. Pay for performance...it was their idea. 3 years of law school vs. 10 years of medical school/internship/residency/fellowship and WE are getting screwed.