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I think you use the word 'naive' in this forum too much...you always write naive nonsensical stuff like this.
I think you use the word 'naive' in this forum too much...you always write naive nonsensical stuff like this.
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...will be very interesting to see how healthcare reform unfolds in coming years.
people keep saying single payer is inevitable, but is it also a foregone conclusion that the single payer's rates would not be reasonable on the whole? Canada's single payer seems to offer reasonable reimbursements...
Also, the public option that was proposed in 09 would have allowed doctors and hospitals to negotiate rates with the HHS (rather than contain medicare rates).
Wut? I guarantee you every single physician I have ever worked with or met that isn't already a federal employee would be furious about this.I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
I certainly won't be mad to become a federal employee after getting my student loan paid off...Speaking of naive.....
I hope this wasn't a serious post.
http://forums.studentdoctor.net/threads/american-anesthesiology-mednax.1139491/page-4#post-16982369Wut? I guarantee you every single physician I have ever worked with or met that isn't already a federal employee would be furious about this.
will be very interesting to see how healthcare reform unfolds in coming years.
people keep saying single payer is inevitable, but is it also a foregone conclusion that the single payer's rates would not be reasonable on the whole? Canada's single payer seems to offer reasonable reimbursements...
Also, the public option that was proposed in 09 would have allowed doctors and hospitals to negotiate rates with the HHS (rather than contain medicare rates).
Did you read my post? I said republicans have crap candidates for president, so there will be a democrat in the white house again (strike against going back to the ways of the past). IN ADDITION TO THAT: republicans have a total identity crisis! They're divided as hell. The democrats are 99% aligned. Hillary and Bernie are pretty damn similar, only difference is that Hillary is bought by wall street and Bernie is angrier. Republican party is filled with radicals/centrists and anywhere in between. What even is their stance on immigration?I don't think you understand the difference between branches of the federal government
You really think ortho-joint, PM&R and gerontology aren't likely to go up? Everyone knows that spine hit is comin, we do like ~20x the number of spine surgeries as other 1st world countries and it shows. Not saying it won't pay well, but I don't think it will pay much better than general ortho for ex. If you disagree, throw in your predictions. No way to know for sure until 10 years from now after all.Written by someone that doesn't have a clue.
Interventional radiology and I expect a new field mixing quantum biology with medicine called quantum medicine that would be a very good speciality
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
Dude, you're crazy.I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
Hasn't ortho been at the top for a long time? I feel that this will be the case for a long time.
Surgeons barely have enough time to see their kids or remember what their faces look like. Think they have the time or will to lobby? They just sit around between OR cases complaining about the state of medicine just like every other doctor.
Fortunately, this just isn't true. Remember those gunners you knew in med school who went into surgery? Turns out they use that same intensity to protect their profession and are not the types to sit around and complain when something can be done about a problem. Some of the most politically active physicians I know are surgeons.
Sorry to derail from the payer/system debate above, just thought this jab needed to be addressed.
Ya, people keep saying the hammer is going to drop any day. But the fact still remains that total joints are a very quick, elective procedures with great outcomes and extremely satisfied patients. I don't think ortho is going anywhere.
Fortunately, this just isn't true. Remember those gunners you knew in med school who went into surgery? Turns out they use that same intensity to protect their profession and are not the types to sit around and complain when something can be done about a problem. Some of the most politically active physicians I know are surgeons.
Sorry to derail from the payer/system debate above, just thought this jab needed to be addressed.
I trained for more years than a PCP.I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
So tell me again why I'm "milking it" and should make less?
that makes absolutely no sense. the people who are gunners aren't politically active at all. people that are gunners are extremely tunnel minded and have zero to little hobbies or interests outside of medicine, hence the desire to solely define their self worth as a student to the point where they actively sabotage others.
and " most politically active physician" is like saying the skinniest fat chick you know. as a whole, physicians are very very very unorganized and poor at putting up organized fronts to represent their interests
I agree with PL198. The gunners I know all were looking out for #1 and had no sense of what was going on in the real world.
At my medical school's big academic surgery department, virtually all of the general surgeons were miserable and complained all day and did nothing about the issues they were complaining about. It sounded like a lot of it stemmed from working for "the man"...aka...the big evil hospital that was paying them less and hiring incompetent staff that they had to deal with.
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I trained for more years than a PCP.
I worked much longer hours during that training than a PCP.
I work longer hours now.I haven't had a single day off in the last 19 days and haven't been home before 8 pm this week. I'm on call this weekend as well so it won't be until next Saturday that I have a day off.
My malpractice is higher.
A well run FM practice can make in excess of $300k/year.
So tell me again why I'm "milking it" and should make less?
First one, then the other. Decreased facility payments will bankrupt small, independent and struggling community hospitals. Bankrupt businesses sell for pennies on the dollar.Besides, given the current political and structural realities of the country, federalization of payment is far more likely than total federalization of the health-care system.
Is this even a competitive surgical specialty?I foresee an explosion in colorectal surgery income in the near future, given the proliferation of butthurt since the advent of the internet.
Butt stuff is always competitive.Is this even a competitive surgical specialty?
First one, then the other. Decreased facility payments will bankrupt small, independent and struggling community hospitals. Bankrupt businesses sell for pennies on the dollar.
The rise of the mean, lean and profitable, future parallel private system is already happening.
Trump is unelectable, and Jeb! has so little charisma that he's losing to The Donald. Even with the !, he's still jeb who? 8 more years of a democratic agenda is moving up the time table. If you're looking for a long term career job, make sure you're with one of the big boys.
According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!Butt stuff is always competitive.
According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!
Yes.Is this even a competitive surgical specialty?
What is your issue with surgeons?According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!
Surgeons work extremely hard.According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!
What is your issue with surgeons?
Don't you think the increased liability and training requirements are worth something?
I know surgeons work hard, so are most physicians...Surgeons work extremely hard.
Not to mention, what does step 1 have to do with payment at all?
I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...We all knew the what reimbursements were going to be (more or less) when we chose our fields. Want to make more? Choose a field or location where that will happen.
well, there you go again pointing fingers at certain physician specialties.I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...
I have no issues with surgeons to be honest, I just want the system to be a little bit more fair... I am ok with surgeons making more money than PCP, but I am not sure it's fair for them to be making double and triple/quadruple in some cases... I was told that the panel who decides medicare reimbursement is full with surgeons. Don't you think there is some conflict of interest in that?
Let's clarify who you mean when you say "surgeons".I have no issues with surgeons to be honest, I just want the system to be a little bit more fair... I am ok with surgeons making more money than PCP, but I am not sure it's fair for them to be making double and triple/quadruple in some cases... I was told that the panel who decides medicare reimbursement is full with surgeons. Don't you think there is some conflict of interest in that?
haha...at least you are honest...I do look askance at some of the specialties (and you know who you are) who don't work after 5 and don't work weekends, living in multi million dollar homes next to professional athletes but its jealousy.
I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...
Let's clarify who you mean when you say "surgeons".
You mean Orthopedic surgeons. Traditionally, they have been overrepresented on panels deciding reimbursement and it is true that Ortho and Neuro Spine can make significantly more than a PCP or other surgical specialties, for that matter. Do they deserve it? I think they do given the patient population, the skill required and the liability involved. I think a guy who could paralyze you (as one well known Neuro Spine guy in Texas did...more than once) should be well paid.
Physician reimbursement is based on RVUs. Its not a bunch of surgeons sitting around going, "we deserve more, so let's tell CMS to pay us moar!!!"
The Medicare Resource-Based Relative Value Scale (RBRVS) is the method by which Medicare sets reimbursement rates for each Current Procedural Terminology (CPT) code assigned to every physician encounter; thus physicians’ services are counted in RVU’s. For example, a level one office visit may be assigned an RVU of 1, a level three office visit might be assigned an RVU of 1.5, and a surgical procedure might be assigned an RVU of 20.
I make more on office visits than someone does who routinely bills a Level 3, because I bill more Level 4 and 5 visits - more complex visits, longer visits pay more. Seems fair to me.
RVUs are published in the Federal Register each November. Medicare bases RVUs on the following: (i) Physician work, which takes into account the physician’s expertise, the time and technical skill spent in performing the entire service including the mental effort and judgment expended by the physician prior to, during and after the patient encounter terminates, including documentation of the service; (ii) Practice expense, which accounts for the cost to operate a medical practice; and (iii) Professional liability insurance expense, which estimates the relative risk of services/cost to insure against the risk of loss in providing the service.
Each component of the relative value unit (work, practice expense and professional liability) assigned to each CPT Code, is then multiplied by the Geographic Practice Cost Index (GPCI) for each Medicare locality, which takes the cost of delivery of health care services based on locale into account, and which is further adjusted by a conversion factor that is set by the Centers for Medicare and Medicaid Services (“CMS”) on an annual basis. The Medicare Conversion Factor (CF) is a national value that converts the total RVUs into the dollar amounts paid by Medicare to physicians for the services they provide.
In New York City Suburbs/Long Island, New York the GPCI for the Work RVU, PE and Malpractice are 1.051, 1.289, and 1.235 respectively. The Physician practice conversion factor for calendar year 2010 was $36.0846. Thus, the formula for deriving the dollar amounts paid by Medicare for any service performed by a physician would be as follows:
[(Work RVU x 1.051) + (PE RVU x 1.289) + (MP RVU x 1.235)] x 36.0846.
In these days of physician hospital integration, hospitals are using RVU’s as a measure of physician productivity in order to calculate physician compensation. The advantage of using RVUs as a measure of productivity is that the RVU is independent of the physician’s charge schedules, patients’ insurance coverage, the reimbursement fee schedules assigned by any payor for any CPT code, or the practitioner’s ability to collect reimbursement revenue for any physician encounter. In addition, the RVU method of measuring productivity reflects the reality that every patient encounter is not equal.
To paraphrase an old joke, "when it came time to decide CMS reimbursement, a fight broke out amongst the specialists. The Orthopedic surgeons showed up to the fight with a gun, the radiologists showed up with a knife and the general surgeons didn't show up at all -- they were busy in the ED taking care of patients." The point? Not all surgeons are paid those ridiculous 7 figure salaries that pre-med students are so fond of quoting. The vast majority of surgeons, even Ortho and Neuro spine, are not making 3-4 times what a FM physician is making.
Is there a conflict of interest? Perhaps and there are steps to rectify the imbalance between the specialties. But rather than cry about surgeons, who take longer to train, have much high malpractice insurance (mine cost more than 100K per year in Pennsylvania), and more liability than the average PCP, making too much money why not advocate for every one to make more.
I don't decry my colleagues making $800K per year when they take a huge hit on malpractice and they work hard. I do look askance at some of the specialties (and you know who you are) who don't work after 5 and don't work weekends, living in multi million dollar homes next to professional athletes but its jealousy.
I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...
living [ ] next to professional athletes
Thanks Winged Scapula. This was like a partial refresher course of a course I took on Healthcare Economics.