Nurses Making More than FPs

[RamblinMan]

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Members do not see this ad.

Well, heres another depressing story about the current state of affairs in our field.
http://money.cnn.com/2010/03/11/news/economy/health_care_doctor_incomes/index.htm?hpt=T2

So it is projected that the demand for PCPs is increasing and will continue to increase in the coming years. Does this translate to potential increases in income? Increased demand = increased pay right?

 

[deleted87716]

Primary care incomes have nowhere to go but up.

Anesthesia incomes, OTOH...

 

[MedicineDoc]

I will not work for an organization that pays me less than a nurse with one hell of a lot less training. The average CRNA is obviously not any where near physician material from my experience with them. At the organization where I am completing my residency the CRNAs decided that they should have access to the physician lounge and Doctor lunch and started showing up in droves. The loud conversations centered around such things as the best brand of cigerettes and other blue coloresque type crap until they were kicked out. They are still taking up all the spots in the physician parking lot.

 

[Endolas]

At the organization where I am completing my residency the CRNAs decided that they should have access to the physician lounge and Doctor lunch and started showing up in droves....They are still taking up all the spots in the physician parking lot.

Class. They have it.

 

[jl lin]

While I support nurses, I must say that this is just wrong. I do not get how CRNAs, which mostly must be supervised by ologists, get to make close to $200,000 pretty much, straight time. (FP's may or may not have someone to fall back on in a pinch. This CRNA income also puts them close to many ED docs' salaries. I've got a huge problem with that too.) This is totally imbalanced. It's no wonder that the ologists make $300,000 and up.

I get that CRNAs work under their own licenses; still, the ologist is there to supervise and jump in. Interestingly, FP NPs or even critical care NPs make no where near what CRNAs make, and they are advanced practice. So it's just a device that hospitals and various outpt facilities use to try and save money.

 

[George85]

Several years ago I made comments on these forums regarding the direction of primary care, pay of CRNA's etc. Of course I received the usual abusive comments from the ill informed and naiive.

>>Primary care incomes have nowhere to go but up.
>>Anesthesia incomes, OTOH...
That's misleading. Just because primary care might get another 10% and specialists might loose 10% goes nowhere in addressing the overall imbalance. Certainly some specialists might loose more than others but the overall the pay gap will remain and overall I beleive it will increase.

As I said several years ago primary care in the US is doomed. Read the article on NP's on page 3A USA Today, March 12-14.

Anyone who goes to the effort and expense of going to med school in the US should continue into a specialty. It's a complete waste to go into primary care. This country doesn't actually want real doctors, it wants specialists who spend years perfecting one narrow area. In other words, technicians.

 

[deleted87716]

Anyone who goes to the effort and expense of going to med school in the US should continue into a specialty. It's a complete waste to go into primary care. This country doesn't actually want real doctors, it wants specialists who spend years perfecting one narrow area. In other words, technicians.

😴

 

[Shinken]

As I said several years ago primary care in the US is doomed.

People have been predicting the demise of Primary Care for -as you said it- several years now and I don't see Primary Care going away anytime soon. There was even a very notorious poster who posted nothing but "the sky is falling" predictions for Primary Care (I forget his screen name, it's been a while. I'm sure many people here remember him before he was banned).

I absolutely love Family Medicine and can't imagine doing anything else (I chose FM, I didn't do it because I had to). There are many people out there like me. Yes, we don't make as much money as other specialties. So what? You cannot pay me enough to do anesthesia (ugh!) or do the same cystoscopy or TURP every day of every week over, and over, and over, and over...

I'm perfectly content with making "only" a meager average of $160,000/year.

During my clinical years in medical school, in average, the most miserable and cranky preceptors I rotated with were in the higher-paying specialties. The worst were the urologists, anesthesiologists came in a close second. They were cranky most of the time. Money is nice, but I don't want to go through life in a bad mood because of my job.

I don't see Primary Care going away at all, but then again perhaps I'm naive and ill-informed...😉

 

[marlem66]

I couldn't agree more, its all in perspective. I don't give a hoot if the CRNAs are making more money than me because there is not enough money in the world to get me to do their job. I would be miserable standing and staring at the anesthesia machine, getting yelled at by cranky surgeons all day. Those guys earn their keep in my opinion. I'm very content to make my "meager" $150,000 and get to do the kind of work I enjoy.

 

[fab4fan]

😴

Isn't FP a specialty? 😕

 

[deleted87716]

Isn't FP a specialty? 😕

Indeed. Quite a challenging one, at that (assuming you're doing it right).

I find it ironic that some people claim that what we do is so easy that even a caveman could do it, while third year med students consistently say that the FM shelf exam is the hardest one.

I suppose it's time to post this link again:

Ten Biggest Myths Regarding Primary Care in the Future
http://medicinesocialjustice.blogspot.com/2009/01/ten-biggest-myths-regarding-primary.html

 

[dantt]

During my clinical years in medical school, in average, the most miserable and cranky preceptors I rotated with were in the higher-paying specialties. The worst were the urologists, anesthesiologists came in a close second. They were cranky most of the time. Money is nice, but I don't want to go through life in a bad mood because of my job.

Many students see the exact opposite; cranky PCP preceptors and extremely happy ROAD preceptors.

Money is nice, you shouldn't go through life in a bad mood because of your job.

 

[tony montana]

Many students see the exact opposite; cranky PCP preceptors and extremely happy ROAD preceptors.

Money is nice, you shouldn't go through life in a bad mood because of your job.

This was not my experience at all, all my outpatient PCP prepcetors (with the exception of one) were content personable doctors, most of my ROAD were cranky.

I could not be paid enough to do general surgery, hospitalist, cardiologist, anesthesiologist, ER...

 

[George85]

Ten Biggest Myths - again, someone who is not only naiive but doesn't even read the available data. From the AAFP, Barbara Bein, 3/19/2009, "After a slight uptick in 2008, interest in family medicine among U.S. medical students has returned to its 10-year decline".

What would you say to someone who kept investing in a stock with a 10 year decline?

As for myth number 4 - if FP programs had a 91% fill rate, but only 1,083 US grads went into FP then who filled the other 1,246 positions?

>>I don't see Primary Care going away anytime soon
Of course it won't go away - it will simply change over time.

>>perhaps I'm naive and ill-informed
It's good that you enjoy what you do, but when it comes to primary care you are unfortunately in the minority - the numbers above speak for themselves.

 

[RamblinMan]

I don't think the poor recruitment rate for family medicine has much to do with people disliking the practice of primary care medicine. As usual, it comes down to dollars and cents.

Start paying FP doctors 300,000/year to take care of the underserved and underinsured and FP will become competitive and the shortage will disappear. Will this happen? Probably not.

Lets face it, alot of people make money the number one factor when choosing what to practice.

Also, there is alot of snobbery in medicine that equates money with status and prestige. This dissuades people from going into FP. Anybody ever hear this in medical school: 'Better do well on your boards or you might end up in family medicine'. Students get a complex, don't feel they will be respected as FPs and figure they will just shoot for a high paying specialty, even if they don't have a strong intrinsic interest in those fields.

FPs are underpaid. But don't make the assumption that choosing FP is a 'bad investment'. Investing in something you like doing day to day rather than allowing you the 'freedom' to have a boatload of material junk makes more sense.

 

[VA Hopeful Dr]

Ten Biggest Myths - again, someone who is not only naiive but doesn't even read the available data. From the AAFP, Barbara Bein, 3/19/2009, "After a slight uptick in 2008, interest in family medicine among U.S. medical students has returned to its 10-year decline".

What would you say to someone who kept investing in a stock with a 10 year decline?

As for myth number 4 - if FP programs had a 91% fill rate, but only 1,083 US grads went into FP then who filled the other 1,246 positions?

>>I don't see Primary Care going away anytime soon
Of course it won't go away - it will simply change over time.

>>perhaps I'm naive and ill-informed
It's good that you enjoy what you do, but when it comes to primary care you are unfortunately in the minority - the numbers above speak for themselves.

Didn't anesthesia programs have trouble filling about 15-20 years ago? I seem to recall some of the folks in that forum here saying that programs were going half-filled in those days. That rebounded. Who is to say primary care won't?

 

[deleted87716]

Ten Biggest Myths - again, someone who is not only naiive but doesn't even read the available data.

I don't even think you read the article.

Here's author Robert Bowman's CV. I think he's better informed than you are.

http://www.ruralmedicaleducation.org/facil/CV_RCB.htm

 

[deleted87716]

Speaking of CRNAs, if anesthesia incomes do decline, at least these guys have something to fall back on. 🙂

[YOUTUBE]WOrjcLJ2IE0[/YOUTUBE]

 

[leviathan]

I heard about a CNRA who didn't even know what a PFO was. They were probably making 200k to mismanage that case.

 

[JackADeli]

I am going to add my few cents...

...So it is projected that the demand for PCPs is increasing and will continue to increase in the coming years. Does this translate to potential increases in income? Increased demand = increased pay right?

Primary care incomes have nowhere to go but up...

I will not work for an organization that pays me less than a nurse with one hell of a lot less training...

While I support nurses, I must say that this is just wrong...
...it's just a device that hospitals and various outpt facilities use to try and save money.

Again, physicians seem far too easily roped into the class warfare game. Our intrinsic sense of ...?nobility makes us not admit to any real monetary motivation in our career choices. Everyone out there seems to understand this and use it to manipulate physicians.... "we do it for the patients", "we just want to serve society", "you didn't go into medicine to be a bean counter", etc, etc.... But, if YOU want to buy all of that political sales, then do so... but do so for yourself and accept your decision to do so. If you feel YOUR efforts & investment are only worth 80k, 120k, 150k, 200k/yr etc return, great. However, do not try and compare yourself to the lawyer, engineer, nurse and mandate your value stick on other physicians. Hospitals, CEOs, & practice managers always play the card... "you could help the community oh, so much.... imagine the good you can do....". Then they offer you the privilege of accepting a 120k income to serve your community while they pocket the excess collections. You get your salary and the great spiritual uplifting satisfaction that you are serving the community greater good....

...I absolutely love Family Medicine and can't imagine doing anything else... ...You cannot pay me enough to do anesthesia (ugh!) or ...every day of every week over, and over, and over, and over...

I'm perfectly content with making "only" a meager average of $160,000/year...

Exactly! YOU have determined the monetary return on YOUR years of investment and future years of labor that is acceptable to you. But, to everyone else, if YOU accept a certain return on your investment... please do NOT try to mandate YOUR values and choices on folks making similar specialty training investments or worse mandating YOUR values and choices on those making completely different specialty choices, family and self investments and labor choices. Stop with the "fair" arguments. It's so "unfair".... "I earn 180K as an FP while the neurosurgeon/anesthesia/GSurgeon....(doing a job they "couldn't pay YOU enough to do") is earning over 300k for their training investments and current labor"

Ok, let's do a reality check....
...The class warfare theme is very easy if you simply take dollar figures out of the context of their reality. It is nice to complain about an 80k/yr engineer job over 17 yrs and explain that you prefer the route of the physician.... but, then, why didn't you?...

The grass is always greener on the otherside until you are actually the one responsible for the lawn maintenance. The "reality check" is that a 188k starting income does not arrive to the physician cause they sat on the couch eating bon-bons for seven more years. It was and continues to be hard work. It is that work and effort the we get paid for... those that start at 188k and don't continue hard work see a dramatic drop in income usually within a year or two...

...I encourage every physician to fight for maximum payment for the level of work/services they provide... We all need to acknowledge the sacrifices we have made by choosing the long path we chose and acknowledge that journey as having a true monetary value. It is/was an investment. We should be damn sure to collect a solid return on that investment and not leave it on the table cause someone else... made different choices.

So, do NOT begrudge the janitor, teacher, fireman, lawyer, or even the nurse the income they garner. Rather, stop the hypocrisy of being a "matyr" and demand the level of compensation each feels your investment, current labor efforts, and risks are worth... Otherwise, if this is about how charitable you are, then provide charity and shut up about those that want compensation for their work.

 

[deleted87716]

^ I assume you're responding to the OP. When you do those serial-quote things, it's difficult to know exactly who you're responding to, particularly when the quotes are unrelated to one another.

As far as the relative incomes are concerned, I do believe that primary care is undercompensated, and I think that's the real issue that the OP was getting at. The fact that CRNAs earn what they do is irrelevant, however.

 

[JackADeli]

I assume you're responding to the OP. When you do those serial-quote things, it's difficult to know exactly who you're responding to, particularly when the quotes are unrelated to one another...

Correct... it is not intended as toward any one individual poster but rather certain generalized ideas postulated... There seems to be a general trend to use specialties and professions against each other.

...As far as the relative incomes are concerned, I really don't care what CRNAs make. I continue to believe that primary care is undercompensated...The fact that CRNAs earn what they do is irrelevant...

I agree. I also believe young physicians with pie in the sky idealism drinking the koolaid propogate the underpayment. PCPs would do well to swallow the pride generated by a false sales pitch of nobility. While physicians believe the sales pitch of nobility from 1. academics that often work far less and think too much or 2. community business managers that have a vested interest in convincing you to accept spritual compensation over actual dollars, PCPs & others will continue to be underpaid.

There are very few other professions that require as much personal time and effort in training. I know of no other profession with any significant individual investment that then turns around and tries to undervalue that investment. You work hard, go up the ranks in business and you expect big dollars at the door.... In medicine, you work hard... then expect a "good" or "fair" amount to pay for a modest home and support your family for the "privilege to serve the community".....

Final point.... I think it is a grave mistake for any physician to use mid-levels as their yard stick of what their labors are worth.....

 

[smq123]

I know of no other profession with any significant individual investment that then turns around and tries to undervalue that investment. You work hard, go up the ranks in business and you expect big dollars at the door.... In medicine, you work hard... then expect a "good" or "fair" amount to pay for a modest home and support your family for the "privilege to serve the community".....

JAD -

I completely agree with what you're saying. It's kind of crazy that physicians are willing to undergo the hassles of training without demanding better reimbursement.

My question to you is, though - HOW do we go about demanding better reimbursement for our services? Look at what's happened in general surgery. Being a regular old general surgeon is a lot of headaches, a lot of time in the hospital, and decreasing reimbursements. So what do a lot of recent surg grads do? They go into fields like vascular or plastics that ARE well reimbursed. That hasn't led to an increase in average general surgeon salaries - just a flurry of articles in the mainstream media that there is a general surgeon shortage in the country.

Same thing in primary care. If a general internist doesn't make enough, IM grads will scurry into cards, GI, etc. If a general FP doesn't make enough, FP grads will fight for sports medicine fellowships. How do we stop this from happening? How do we make sure that even generalists are well compensated for their time and effort?

 

[JackADeli]

...I completely agree with what you're saying. It's kind of crazy that physicians are willing to undergo the hassles of training without demanding better reimbursement.

My question to you is, though - HOW do we go about demanding better reimbursement for our services?...

...How do we stop this from happening? How do we make sure that even generalists are well compensated for their time and effort?

I think the word "demand" is a big part of it. Physicians are too often demonized... even by their own colleagues for wanting compensation. Also, education. Medical school grads spend 4yrs in an unrealistic bubble and fed day in and day out about their privilege. They earn no money, their friends earn 30-80k/yr with a BS.... They are constantly told the money factor is somehow evil... it's greed... it shouldn't come into consideration. Somehow medicine is "a calling" akin to priesthood. Students need to be educated on the business realities.... Often, not just the students sacrifice. What about your spouse and/or children that go without for all those years? How about the debt? Then, what if all you make is 120k/yr.... you scrimp to pay your home bill, miss your kids first steps, maybe get a little in the bank... and every patient that walks into your doors is a potential multi-million dollar loss! You worked and you earned it. You shouldn't apologize for demanding compensation. We shouldn't be using lower levels of compensation to show we are better then the next physician.... "oh, DrX is is a great doctor, lives in a shack on the edge of town... DrY is an as% cause he drives a mercedes..." We teach these lessens to our med-students. We do them a disservice. Yes they need a focus on patients, compassion, and care.... but, they also need to be realistic of the real world. The world in which they might be on-call and chained to the hospital. The world in which they might get sued, might get attacked by a patient, might get infected by a patient (or bring MRSA or such home to their families), my get targeted by the DEA, etc, etc.... They need to understand exactly what they are settling for....

Consider this.... most students have never earned 40k/yr, most students never had a 150-250k mortgage, most students are paying nothing on student loans (just increasing them), most students have never worked over 50hrs per week. They don't get it. So, they look at a decrease in residency hours from 120/wk to 80wk with no point of reference and are sure life will be great. They look at 120k and think, "that's alot of money..." They have no point of reference... because we fail to burst their idealistic bubble. Consider the woman that wants kids.... she going to wait until she's 35, 40? Until student loans are paid, until practice established, until enough partners to cover, until enough house paid down????

There are true shortages around the country in numerous specialties... Yet, FPs & Surgeons etc... just give and give.... I saw something on the news about some FP that runs a clinic and almost lives on welfare because of the level of charity work.... well, it will never get better if we accept being undervalued. I much rather a little less nobility for a more reasonable compensation. I care about patients. But, I love my family more. There is a cost that patient and society are going to pay me/my family for time taken from family to spend with ~strangers....

 

[JackADeli]

Just to add.... I see no reason why a PCP shouldn't earn 250k and see less patients... and I see no reason why patients shouldn't pay for that level of service. Hell, Kate Gosselin just paid 5k for hair extensions!!!

You want a "MacbookPro" your not going to get it by demanding to pay less then you would for a "Dell inspirion". You want an iPad? You ain't getting one by demanding to pay less then the cost of the Kindle.... Medicine is a product/service. Patients have become too seperated from the costs of the service and come to expect someone else to pay for it or the physician to go unpaid. They enter the hospital and want therapy "x" over the cheaper therapy "y" and want to pay less then the cost of cheaper therapy "y".... There is no other business/industry that functions that way. We as physicians have and continue to enable this lopsided industry.

 

[deleted87716]

HOW do we go about demanding better reimbursement for our services?

Get involved politically. Contact your legislators about issues related to primary care reimbursement. The AAFP has made this easy:

http://www.aafp.org/online/en/home/policy/grassroots.html?navid=grassroots+advocacy

If you think you don't have the time, at least give money to those who do - support FamMedPAC and/or your state family medicine PAC:

http://www.aafp.org/online/en/home/policy/fammedpac.html?navid=fammedpac

 

[tony montana]

I think the word "demand" is a big part of it. Physicians are too often demonized... even by their own colleagues for wanting compensation. Also, education. Medical school grads spend 4yrs in an unrealistic bubble and fed day in and day out about their privilege. They earn no money, their friends earn 30-80k/yr with a BS.... They are constantly told the money factor is somehow evil... it's greed... it shouldn't come into consideration. Somehow medicine is "a calling" akin to priesthood. Students need to be educated on the business realities.... Often, not just the students sacrifice. What about your spouse and/or children that go without for all those years? How about the debt? Then, what if all you make is 120k/yr.... you scrimp to pay your home bill, miss your kids first steps, maybe get a little in the bank... and every patient that walks into your doors is a potential multi-million dollar loss! You worked and you earned it. You shouldn't apologize for demanding compensation. We shouldn't be using lower levels of compensation to show we are better then the next physician.... "oh, DrX is is a great doctor, lives in a shack on the edge of town... DrY is an as% cause he drives a mercedes..." We teach these lessens to our med-students. We do them a disservice. Yes they need a focus on patients, compassion, and care.... but, they also need to be realistic of the real world. The world in which they might be on-call and chained to the hospital. The world in which they might get sued, might get attacked by a patient, might get infected by a patient (or bring MRSA or such home to their families), my get targeted by the DEA, etc, etc.... They need to understand exactly what they are settling for....

Consider this.... most students have never earned 40k/yr, most students never had a 150-250k mortgage, most students are paying nothing on student loans (just increasing them), most students have never worked over 50hrs per week. They don't get it. So, they look at a decrease in residency hours from 120/wk to 80wk with no point of reference and are sure life will be great. They look at 120k and think, "that's alot of money..." They have no point of reference... because we fail to burst their idealistic bubble. Consider the woman that wants kids.... she going to wait until she's 35, 40? Until student loans are paid, until practice established, until enough partners to cover, until enough house paid down????

There are true shortages around the country in numerous specialties... Yet, FPs & Surgeons etc... just give and give.... I saw something on the news about some FP that runs a clinic and almost lives on welfare because of the level of charity work.... well, it will never get better if we accept being undervalued. I much rather a little less nobility for a more reasonable compensation. I care about patients. But, I love my family more. There is a cost that patient and society are going to pay me/my family for time taken from family to spend with ~strangers....

Preach it brother!! 👍👍👍

 

[JackADeli]

Get involved politically...

...If you think you don't have the time, at least give money to those who do...

I got to agree. It is amazing that physicians do NOT have the most well funded lobbying machine! I wouldn't be surprised if teacher unions have a better funded, better organized lobby machine. I think most of us in practice can contribute decent sums to any assorted lobbying group on our behalf... the lobbying groups could help both at the DC level and could be impacting at the med-school level. The AMA and such goes back and forth and has so many different agendas... thus that would not be the organization of my choice.... yet they grab almost every med-student way early!!!

If we accept/acknowledge we are part of an "industry" that provides a service/product, we should assure we stear the direction of the industry and fund a powerful spearhead lobby truely on our behalf....

IMHO, for whatever reason, physicians are just incapable of effectively mobilizing. During med-school and then residency we are indoctrinated to not "whine". We tell applicants for residency how great it is (because we have a vested interest in a new batch of interns matching into the program). We end up complaining amongst each other in the corner but when asked we feign a smile and speak to how great everything is.... etc, etc... Don't get me wrong. I am NOT saying we are victims. This isn't about "poor us". But, physicians are the epitomy of the saying, ~"people get the government they deserve...".

Physicians have and continue to get the troubles we create, propogate, etc... We continue with preaching the lack of importance of financial compensation. We espouse the values of voluntary service and the "privilege" to serve to our next generation. We demonize one specialty over the next because of their sizeable compensation. We have failed to educate and inform the politicians and public effectively... and we continue to fail ourselves.... Then, we complain about being underpaid in an atmosphere we created in which such complaints make us look less noble, more greedy, etc....

PS: you got to love the "House" episode in which the oncologist cared soooo much he donated one of his organs to his patient!!!

 

[deleted87716]

It is amazing that physicians do NOT have the most well funded lobbying machine!

Speaking for my own state, if every family physician who belonged to our state AFP chapter gave a mere $5 per year to our state's family medicine PAC, we would have the largest PAC in the state - bigger even than the trial lawyers.

The fact that we don't is unconscionable.

 

[JackADeli]

Speaking for my own state, if every family physician who belonged to our state AFP chapter gave a mere $5 per year to our state's family medicine PAC, we would have the largest PAC in the state - bigger even than the trial lawyers.

The fact that we don't is unconscionable.

Agree 100%.... physicians love to complain but often unwilling to do the very basics. Like I said we own a great deal of blame for our current problems... reimbursement, malpractice reform (lack of), etc....

Honestly with the size of payment cuts, it is becoming more and more like indentured servitude. Physicians could easily spend $5/yr, I dare say many could pony up $1k/yr and have a big impact. Our character or something just enables the current situation/s.... We like to sit back and take it.... sheep (lambs), fans of Mariah

I don't get it and as you say.... it "is unconscionable".

 

[RamblinMan]

Clearly, primary care docs need to fight harder to gain fair compensation. But outside of funneling money into PACs what leverage can we exert? Given the nature of what we do and that we are essentially the foundation of the health care system, physicians can't unionize. I mean, its not like we are making automobiles here.

This is complex. I understand that more and more docs are deciding to opt out of medicare/medicaid. This may be a necessity for some folks. I have to admit that I am uncomfortable with this though, the patients that rely on medicare/medicaid are the most vulnerable and need the greatest access to care.

If, for example, we all start dropping medicare/medicaid to protest decreasing payments, who suffers the most? This is not going to be fixed overnight. The question is, what is the most effective way to advocate for our own interests without denying care to people who need it?

 

[deleted87716]

Clearly, primary care docs need to fight harder to gain fair compensation. But outside of funneling money into PACs what leverage can we exert?

Vote with your feet. Just say "no."

Stop signing third-party payer contracts that suck. Don't accept Medicaid. Limit the size of your Medicare panels. Drop insurance and go cash-only. If you live somewhere where the reimbursement climate is particularly toxic, move.

Yes, these are tough choices. I understand that every doctor doesn't have equal flexibility to do these things, and some simply won't have the gumption for it. However, sitting back and complaining without doing anything to change your circumstances should not be an option.

 

[JackADeli]

Clearly, primary care docs need to fight harder to gain fair compensation. But outside of funneling money into PACs what leverage can we exert? Given the nature of what we do and that we are essentially the foundation of the health care system, ...I mean, its not like we are making automobiles here.

This is complex. ...I am uncomfortable with this though, the patients that rely on medicare/medicaid are the most vulnerable and need the greatest access to care...

Vote with your feet. Just say "no."

Stop signing third-party payer contracts that suck. Don't accept Medicaid. Limit the size of your Medicare panels. Drop insurance and go cash-only. If you live somewhere where the reimbursement climate is particularly toxic, move.

Yes, these are tough choices. ...sitting back and complaining without doing anything to change your circumstances should not be an option.

I have to agree with BD. We all need to wrap our heads around the fact that we have made sacrifices/investments, continue to make sacrifices and do so to provide specialized goods and service for which we, as long as we're in America, are entitled to compensation. If you are such a indipensable "foundation", then they should pay you and acknowledge your worth... Instead, practices and CEOs are very quick to dismiss you if their heart-string tactics fail. You can be dragged around by the sob story if you like. But, it is YOUR decision.

You ever see those credit card commercials of "priceless moments" or the air-line commercial were daddy is viewing a web video of his kids first steps? Supposedly priceless.... yet, since I am a physician, invest/sacrificed much of my youth to education/training for a career that often mandates I miss first steps, birthdays, recitals, etc.... Some how my lost moments are not priceless? Somehow, I have to explain to my kids & spouse I gave up these moments for charity to folks that are not my family, friends, church congregation? Even if I wore the collar and monk frock with a belief of this perfect stranger charity, it gets old very fast for my spouse. If they don't have me at home, they damn sure better have the compensation for their losses. It is that simple.... if they want these sacrifices, stop trying to tell me how noble they[sacrifices] are and just compensate me. Folks pay their hairdressers, by the minute/hours to their lawyers, phone computer tech support, etc.... They want me to NOT have a beer with friends and family, be ready to come in and get exposed to their bodily fluids, risk their multi-million dollar expression of dissatisfaction.... pay me. Charity begins at home. At some point, both my family & I expect... correction, DEMAND compensation.

 

[tony montana]

If you live somewhere where the reimbursement climate is particularly toxic, move.

How do you know if an area has a toxic climate for reimbursement?? 😕

 

[VA Hopeful Dr]

How do you know if an area has a toxic climate for reimbursement?? 😕

Compare it with areas that have similar costs of living. Also, you can look at fee schedules to see what % of medicare they are and compare that around.

 

[deleted87716]

How do you know if an area has a toxic climate for reimbursement?? 😕

It's usually pretty obvious.

 

[tony montana]

Compare it with areas that have similar costs of living.

Compare what to areas that have similar costs of living?

Also, you can look at fee schedules to see what % of medicare they are and compare that around.

Where does one see the fee schedules and how does one compare around? Is this some website you're referring to? Thanx

It's usually pretty obvious.

How is it obvious? Excuse my ignorance but I'm really not following you.

 

[buffdoc]

Compare it with areas that have similar costs of living. Also, you can look at fee schedules to see what % of medicare they are and compare that around.

Not to be a tool, but where do you find this information? I did a google search for 'fee schedules' and browsed the AMA website but didn't find anything.

 

[VA Hopeful Dr]

Compare what to areas that have similar costs of living?

Where does one see the fee schedules and how does one compare around? Is this some website you're referring to? Thanx


How is it obvious? Excuse my ignorance but I'm really not following you.

Compare the fee schedules in the area you're looking at with fee schedules from places with similar costs of living, as many plans will adjust reimbursements to account for different costs of living from place to place.

You can get the Medicare fee schedule online, search for it using those exact 3 words and you should be able to find it. Medicaid you might have to search by state, but its usually up there as well.

 

[AbbyNormal]

I think you are comparing apples and oranges when comparing CRNA's salary to family practice MD/DO

You would do better to compare CRNA salary to anesthesiologist salary and family care nurse practitioner to family practice physician. Makes more sense to me.

 

[VA Hopeful Dr]

Not to be a tool, but where do you find this information? I did a google search for 'fee schedules' and browsed the AMA website but didn't find anything.

Here is one from the AAFP on Medicaid...

http://www.aafp.org/online/en/home/policy/state/issues/medicaid/medfeesched.html

Here is from CMS on Medicare...

http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp?intNumPerPage=all&submit=Go

Private insurance companies don't have to post their fee schedules to non-providers so those can be difficult to obtain, but the two above are a good start to my mind.

 

[VA Hopeful Dr]

I think you are comparing apples and oranges when comparing CRNA's salary to family practice MD/DO

You would do better to compare CRNA salary to anesthesiologist salary and family care nurse practitioner to family practice physician. Makes more sense to me.

Hence the general lack of outrage

 

[RamblinMan]

I suppose if your ok with a system that allows wealthy people to attain healthcare while leaving the poor to their own devices, then telling medicare and medicaid to f-off is a reasonable way to exert leverage and advocate for yourself.

I think we are all on the same page in that we agree we are undercompensated. The reason many of us have difficulty taking a hardened stance is not because we are pushovers but because there are some major social implications to self-advocacy that involves denying care to people who need it.

Call it a sob story from a bleeding heart if you like but what is the answer to this.... cash for service only and to hell with the rest? Government is going to need to be involved in some form and we will need to work with the government to attain higher salaries in the long run.

 

[deleted87716]

How is it obvious? Excuse my ignorance but I'm really not following you.

It's not complicated. One rule of thumb is to compare your fee schedules from third-party payers to Medicare. Nobody should pay less than Medicare, and most should pay considerably more.

For example, in Rhode Island, Medicare is the best payer. Not a great place to be.

 

[deleted87716]

The reason many of us have difficulty taking a hardened stance is not because we are pushovers but because there are some major social implications to self-advocacy that involves denying care to people who need it.

You're not denying care. You're just making them go somewhere else for it. If you prefer to be a sacrificial lamb, fine. Just don't complain about it, as it's your decision.

Don't get me wrong, I'm not a heartless bastard. However, I'm no sacrificial lamb, either.

Government is going to need to be involved in some form and we will need to work with the government to attain higher salaries in the long run.

We're already "working with the government." Have you been paying attention to how that's going so far...?

 

[tony montana]

Here is one from the AAFP on Medicaid...

http://www.aafp.org/online/en/home/policy/state/issues/medicaid/medfeesched.html

Here is from CMS on Medicare...

http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp?intNumPerPage=all&submit=Go

Private insurance companies don't have to post their fee schedules to non-providers so those can be difficult to obtain, but the two above are a good start to my mind.

I think I got it, thanks

Let me go play with this new toy

 

[tony montana]

It's not complicated. One rule of thumb is to compare your fee schedules from third-party payers to Medicare. Nobody should pay less than Medicare, and most should pay considerably more.

For example, in Rhode Island, Medicare is the best payer. Not a great place to be.

I thought third party payers didn't publicly show their schedule of fees, do you know of any online? I just googled a few w/o any luck. Txs.

 

[JackADeli]

I suppose if your ok with a system that allows wealthy people to attain healthcare while leaving the poor to their own devices, then telling medicare and medicaid to f-off is a reasonable way to exert leverage and advocate for yourself.

I think we are all on the same page in that we agree we are undercompensated. The reason many of us have difficulty taking a hardened stance is not because we are pushovers but because there are some major social implications to self-advocacy that involves denying care to people who need it...

You're not denying care. You're just making them go somewhere else for it. If you prefer to be a sacrificial lamb, fine. Just don't complain about it, as it's your decision.

...I'm not a heartless bastard. However, I'm no sacrificial lamb...

We're already "working with the government." Have you been paying attention to how that's going so far...?

I got to agree with BD. Again, consider the reality and not the tear jerk political adds... Nobody is talking about profit scalping on someone with an acute life threatening/catastrophic medical illness/event.... We don't wallet biopsy a trauma patient or rupured AAA or etc... What we are talking about is all those "poor" souls, often non-compliant, often suffering disease with a relationship if not direct cause from lifestyle choices (obesity/sedentary/tobacco/alchol/etc...). I again say, I will choose to who, when, and where I provide charity.

I am not going to be convinced by the political speach of the poor woman that died of breast cancer and wants a casket B.O. t-shirt... supposedly a poster child of no healthcare. Accept, when you look beyond the rhetoric and adds you find a different reality.... like she ignored her breast mass, ignored care, declined early care, etc., etc.... Too many folks out there proclaiming "death from lack of healthcare"... I don't buy it.

You have high blood pressure but don't exercise. You have elevated cholesterol but don't exercise or adjust your diet. You have diabetes (you choose the flavor) and don't adjust you diet, exercise, etc... and run an A1C over 10. You smoke or chew or dip. Now, I am suppose to miss my kids first steps, my daughters recital, my niece's birthday, my brothers anniversary, etc.... to "service" these needy folks for free because I have "a calling". Somehow I am to turn to my family and tell them all my absenteism was for a greater good, and they should maybe thank me for assuring they made sacrifices to society by not having me around?

The "priceless" moments sacrificed in every other service industry is compensated (hell the plumber gets over $100 to just get out of bed and drive over... doesn't include the work). But, the physician, well we are better then that. Our lives, our families, those "pricelss" moments really are priceless.... that is they are worthless?, because we should do for peanuts if not free.

I don't see any of these folks going without care as long as folks like you have "a calling" and desire to serve and sacrifice.... That is your choice. It is not mine.

 

[deleted87716]

I thought third party payers didn't publicly show their schedule of fees, do you know of any online? I just googled a few w/o any luck. Txs.

No, they don't. Physicians only know how much they're getting paid, not how much other people are getting paid. It's actually illegal for doctors to share information about their fee schedules from third-party payers ("collusion"), and the insurance companies certainly aren't going to tell anyone.

 

[deleted87716]

What we are talking about is all those "poor" souls, often non-compliant, often suffering disease with a relationship if not direct cause from lifestyle choices (obesity/sedentary/tobacco/alchol/etc...). I again say, I will choose to who, when, and where I provide charity.

I agree with you about the last part. That's what we're really talking about here.

The stuff about non-compliance and lifestyle-related disease, however, is a different subject altogether. I really don't care what diseases a person has, as long as they keep their appointments and pay their bills. As for non-compliance, I'll tolerate it up to a point. However, if it's putting them at significant risk and they refuse to come around, I have no difficulty making them somebody else's problem.