Panel Urges Higher Primary Care Pay

[deleted87716]

FYI...

http://www.medpagetoday.com/PublicHealthPolicy/WorkForce/24474

Panel Urges Higher Primary Care Pay

By Joyce Frieden, News Editor, MedPage Today
Published: January 22, 2011

ROCKVILLE, Md. -- A government panel has recommended raising primary care physicians' income to at least 70% of the median of other physician specialties.

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[Khaos05]

What are the chances this would actually happen?

I've been contemplating medical school for about 3 years. It's something that I've always thought of doing and when I got serious about it about 3 years ago and starting doing research, I was startled. I had no idea how bad everything was.

Now i've decided that I'm going to take my chances because being a physician is the career I want. I am going back to school to get the necessary prerequisites and plan on applying Fall 2012.

The three areas I'm looking into are FM, EM, and Anesthesia. I think I've always wanted to do FM but the reimbursement issues scare me. According to salary.com, FMP's salary in my area (AR) range from $160k (50th percentile) to $208k (90th percentile). After taxes, malpractice, etc, etc. even at the 75th percentile I will be bringing home a salary comparable to an NP or PA once I pay my loan payment. This is what keeps me from wanting to do FM, but if these changes were made, I would look at it more strongly.

As far as anesthesia, that field just fascinates me. I, like others, thought "how boring" at first, but I've shadowed a few MDAs and that changed my outlook. Focusing on one patient at a time, having the majority of their care in your hands, and the amount of brain power that is required constantly fits me. Looking at salary.com, I would have no problem paying my loan payments (or even double) and still bringing home more than FMP (and actually more $ than I would even know what to do with).

All I can say is thank goodness I've got a few years to decide what specialty I want to choose and hopefully someone will figure out a way to pull primary care out of the ditch.

 

[bronx43]

What are the chances this would actually happen?

Not very high. Though as reimbursement erodes for specialists, you would begin to see more and more interest in primary care.

 

[GoodmanBrown]

Not very high. Though as reimbursement erodes for specialists, you would begin to see more and more interest in primary care.

I can't quite tell if you're saying it's very likely that PCPs will see their pay increase to that level or if you're saying it's not likely.

All I know is that according a health policy professor at my school, there are several specific pay increases for PCPs in the healthcare reform bill while there's nothing for specialists.

He said this year PCPs saw a 10% raise while most specialties saw either flat pay or a drop.

I don't know how the future will come out, but I get the sense that primary care will gradually see their pay increase while most others will see it stay the same. Just my humble opinion.

 

[bronx43]

I can't quite tell if you're saying it's very likely that PCPs will see their pay increase to that level or if you're saying it's not likely.

All I know is that according a health policy professor at my school, there are several specific pay increases for PCPs in the healthcare reform bill while there's nothing for specialists.

He said this year PCPs saw a 10% raise while most specialties saw either flat pay or a drop.

I don't know how the future will come out, but I get the sense that primary care will gradually see their pay increase while most others will see it stay the same. Just my humble opinion.

I'm saying it's unlikely that PCPs will get increased reimbursement for their services. And given the financial state that the nation is in, I also don't foresee specialists retaining their status quo. And going by your prediction, if PCPs' incomes go up, and specialists remain static, then it would mean increased total health care spending, which is almost absurd in my opinion.
I haven't seen any figures for a 10% increase in PCP take-home this year, nor do I know of any part of the reform bill which dictates increased pay for primary care. Do you have any links to a source?

 

[bronx43]

What are the chances this would actually happen?

I've been contemplating medical school for about 3 years. It's something that I've always thought of doing and when I got serious about it about 3 years ago and starting doing research, I was startled. I had no idea how bad everything was.

Now i've decided that I'm going to take my chances because being a physician is the career I want. I am going back to school to get the necessary prerequisites and plan on applying Fall 2012.

The three areas I'm looking into are FM, EM, and Anesthesia. I think I've always wanted to do FM but the reimbursement issues scare me. According to salary.com, FMP's salary in my area (AR) range from $160k (50th percentile) to $208k (90th percentile). After taxes, malpractice, etc, etc. even at the 75th percentile I will be bringing home a salary comparable to an NP or PA once I pay my loan payment. This is what keeps me from wanting to do FM, but if these changes were made, I would look at it more strongly.

As far as anesthesia, that field just fascinates me. I, like others, thought "how boring" at first, but I've shadowed a few MDAs and that changed my outlook. Focusing on one patient at a time, having the majority of their care in your hands, and the amount of brain power that is required constantly fits me. Looking at salary.com, I would have no problem paying my loan payments (or even double) and still bringing home more than FMP (and actually more $ than I would even know what to do with).

All I can say is thank goodness I've got a few years to decide what specialty I want to choose and hopefully someone will figure out a way to pull primary care out of the ditch.

Eh... anesthesia is a field that is well compensated now, but has some serious dark clouds looming in the not-so-distant future. The fact that the cheaper CRNA can do 95% of what a MDA can do only spells trouble as the market share for physicians in the field plummets in the setting of a contractionary economy.

 

[deleted87716]

I haven't seen any figures for a 10% increase in PCP take-home this year, nor do I know of any part of the reform bill which dictates increased pay for primary care. Do you have any links to a source?

http://www.aafp.org/online/en/home/policy/federal/hcrleg2010/fps.html

There's are also bonuses for PQRI and electronic prescribing, which aren't mentioned. They're not specifically tied to the reform legislation.

 

[bronx43]

http://www.aafp.org/online/en/home/policy/federal/hcrleg2010/fps.html

There's are also bonuses for PQRI and electronic prescribing, which aren't mentioned. They're not specifically tied to the reform legislation.

Thanks, BD. So, for the 10% increase in "primary care services," does that only cover a certain number of billable services that are deemed "primary care services?" Or is it any care provided by a primary care physician?

This is a good first step to fixing primary care in this country. Let's see if it actually does anything.

 

[deleted87716]

Thanks, BD. So, for the 10% increase in "primary care services," does that only cover a certain number of billable services that are deemed "primary care services?" Or is it any care provided by a primary care physician?

The bonus is 10% of your total Medicare charges if you're a qualified primary care physician.

http://www.aafp.org/online/en/home/.../government-medicine/20101103pcipchanges.html

 

[Khaos05]

Eh... anesthesia is a field that is well compensated now, but has some serious dark clouds looming in the not-so-distant future. The fact that the cheaper CRNA can do 95% of what a MDA can do only spells trouble as the market share for physicians in the field plummets in the setting of a contractionary economy.

I've thought about the CRNA/MD situation and I'm not too worried. Here are my thoughts (feel free to correct me if I'm wrong or overlooking something). CRNA's are pushing for independent practice rights and it's my opinion that if that happens CRNA's and MDA's will be billing the same (aka making same $). So if you have the choice between paying CRNA $250k or MDA $250k, who would you hire? I think MDA will win out every single time. Also, other groups (namely surgery) who have contracts with the hospital can hold out contracts until hospital gets MDA contract (if they choose). To sum up, I think the worst the CRNA/MDA situation will get is that CRNA's become independent and then salaries average between the 2 or MDA's drop to CRNA salary (paid the same) and then it's just a matter of who is more qualified.

Sorry to hijack thread - still interested in FM, just not for a nickel a day Hope it gets fixed soon...

 

[GoodmanBrown]

I've thought about the CRNA/MD situation and I'm not too worried. Here are my thoughts (feel free to correct me if I'm wrong or overlooking something). CRNA's are pushing for independent practice rights and it's my opinion that if that happens CRNA's and MDA's will be billing the same (aka making same $). So if you have the choice between paying CRNA $250k or MDA $250k, who would you hire? I think MDA will win out every single time.

I think your logic is pretty spot on, but I'll just give you the heads up that many anesthesiologists would bristle at this. Some of them are making north of $500K, and to see their salary drop to the $200K-$250K would be tantamount to theft to them.

The biggest threat is that more practices will go from MD-only to an MD supervision where the MD supervises 3-5 rooms with CRNAs actually staying in the OR while the MD goes to each room. In a situation like that, there may be a glut of MD anesthesiologists because you only need a ratio of 1 MD : 4 CRNAs.

Also, other groups (namely surgery) who have contracts with the hospital can hold out contracts until hospital gets MDA contract (if they choose).

Not sure this is quite true in hospitals. I could be wrong, but the impression I get from the anesthesiology forum is that surgeons mainly want folks who will keep the OR running quickly and smoothly with minimal cancelling. This isn't always the MD...

 

[GoodmanBrown]

Thanks, BD. So, for the 10% increase in "primary care services," does that only cover a certain number of billable services that are deemed "primary care services?" Or is it any care provided by a primary care physician?

This is a good first step to fixing primary care in this country. Let's see if it actually does anything.

One other thought I had was the ability of primary care MDs to step out of the system if it gets too bad. With almost all other medical specialties, that's just not an option because of the huge cost of medicine these days. I do have a relative who saved up and paid for needed surgery out of pocket, but that's got to be the exception.

Meanwhile, there are more and more practices springing up with a flat $50 office visit fee and very open, reasonable fees schedules for other stuff. If Medicare or insurance gets too bad, there could easily be a lot more. Just my thoughts on it.

 

[bronx43]

I've thought about the CRNA/MD situation and I'm not too worried. Here are my thoughts (feel free to correct me if I'm wrong or overlooking something). CRNA's are pushing for independent practice rights and it's my opinion that if that happens CRNA's and MDA's will be billing the same (aka making same $). So if you have the choice between paying CRNA $250k or MDA $250k, who would you hire? I think MDA will win out every single time. Also, other groups (namely surgery) who have contracts with the hospital can hold out contracts until hospital gets MDA contract (if they choose). To sum up, I think the worst the CRNA/MDA situation will get is that CRNA's become independent and then salaries average between the 2 or MDA's drop to CRNA salary (paid the same) and then it's just a matter of who is more qualified.

Sorry to hijack thread - still interested in FM, just not for a nickel a day Hope it gets fixed soon...

I agree that CRNA independence is naturally inflationary with respect to the cost of anesthesia services. But, in a situation where CRNAs can practice independently, there's no chance in hell they will receive the same reimbursement as the MDA. It simply won't happen. Their reimbursement will not be in the physician bracket, and their overall compensation will either remain static or drop, as third party payers decrease reimbursement for "nursing services."
In that situation, the "mean" that arises between MDAs and CRNAs won't be 250k, but likely 150k or lower. And since the CRNAs can provide 95% of the same services as their physician counterparts, the market share for MDAs will inevitably drop. The alternative, of course, is yielding to the lowest bidder and make CRNA money, which I don't think is all that palatable to you, or any other MD currently practicing in anesthesiology.
And I wouldn't expect the surgeons to come save the day for anesthesiology. There may be some cases where some surgeons would prefer a MD, but most don't care for the vast majority of their cases.

Remember this. Unlike primary care, which owns the inherent value of having direct influence on patients, anesthesiology is subject to the whims of institutions with a far more complex and ultimately profit driven motives.

 

[bronx43]

One other thought I had was the ability of primary care MDs to step out of the system if it gets too bad. With almost all other medical specialties, that's just not an option because of the huge cost of medicine these days. I do have a relative who saved up and paid for needed surgery out of pocket, but that's got to be the exception.

Meanwhile, there are more and more practices springing up with a flat $50 office visit fee and very open, reasonable fees schedules for other stuff. If Medicare or insurance gets too bad, there could easily be a lot more. Just my thoughts on it.

Yeah, boutique practices are certainly an option for a subset of primary care physicians. However, I don't think that a large scale exodus of PCPs into out-of-pocket businesses would prove more profitable than the current model. Essentially, I don't believe that the money saved from administrative costs and the uncertainty of adequate reimbursement from third party payers is enough to offset the effect of directly exposing consumers to the cost of care. Even $50 a pop, which isn't very high in price, would make a large proportion of the general populace squirm, especially for the services of a general practitioner managing relatively benign problems. Remember that the public would still have to buy health insurance to cover for the services of every other medical specialty, so any trip to the PCP would be "additional" costs. In that situation, primary care would expose itself to the large threat of independent mid-levels that would provide similar (albeit inferior) care, especially for services that are deemed by the public to be routine such as check ups and drug refills.

 

[Khaos05]

Hey Goodman and Bronx,

Thanks for the responses. At this point in my career, $250k is more than I could dream of, but I do understand how MDAs feel having to wonder if their pay will get cut by 50% or more at any time. It's easier for me going into it with that kind of pay rather than having a higher salary for most of my career then having the rug pulled out from under me. Like I said, while it's easier for me since I'm not practicing, I feel for those currently practicing.

I just hope someone, somewhere wakes up and smells the coffee. As long as I can get out of med school and find a job in anesthesia making enough to pay off loans and live a good lifestyle, I'll be ok.

My biggest fear is going through 10 more years of school, accruing $150k+ in debt only to graduate and be unemployed or make $100k. That would shatter my hopes, dreams, and my career.

 

[GoodmanBrown]

Yeah, boutique practices are certainly an option for a subset of primary care physicians. However, I don't think that a large scale exodus of PCPs into out-of-pocket businesses would prove more profitable than the current model. Essentially, I don't believe that the money saved from administrative costs and the uncertainty of adequate reimbursement from third party payers is enough to offset the effect of directly exposing consumers to the cost of care. Even $50 a pop, which isn't very high in price, would make a large proportion of the general populace squirm, especially for the services of a general practitioner managing relatively benign problems. Remember that the public would still have to buy health insurance to cover for the services of every other medical specialty, so any trip to the PCP would be "additional" costs. In that situation, primary care would expose itself to the large threat of independent mid-levels that would provide similar (albeit inferior) care, especially for services that are deemed by the public to be routine such as check ups and drug refills.

I agree that with the current system, and for the at least a ways in the future, this style of practice won't be feasible for everyone. But if regulation gets even more onerous than it currently is (which this same health policy prof said that it probably will), PCPs some day might realize they'd break even switching to it.

And if health insurance costs so much that most people switch to high deductible plans with HSAs, it would all be about upfront costs rather than insurance deductibles. So, you'd have the advantage there compared to a "standard" practice (even ones with NPs) that was charging $85 in hopes of getting an average of $50 back.

Anyway, this is idle speculation on my part. The healthcare debate will probably rage until 2012 when the presidental election occurs. If Obama wins, I think the reform will be entrenched enough by 2016 to basically make it permanent. If Obama loses, and Dems lose more seats in the Senate, who the hell knows what's gonna happen?

 

[GoodmanBrown]

Hey Goodman and Bronx,

Thanks for the responses. At this point in my career, $250k is more than I could dream of, but I do understand how MDAs feel having to wonder if their pay will get cut by 50% or more at any time. It's easier for me going into it with that kind of pay rather than having a higher salary for most of my career then having the rug pulled out from under me. Like I said, while it's easier for me since I'm not practicing, I feel for those currently practicing.

I just hope someone, somewhere wakes up and smells the coffee. As long as I can get out of med school and find a job in anesthesia making enough to pay off loans and live a good lifestyle, I'll be ok.

My biggest fear is going through 10 more years of school, accruing $150k+ in debt only to graduate and be unemployed or make $100k. That would shatter my hopes, dreams, and my career.

Just as a heads up, the federal government has lots of loan repayment programs that really make the loan burden a bit less "burdensome." The IBR is a good program that could keep your loan payments to a reasonable sum, no matter what your debt level and income.

 

[rachmoninov3]

Just as a heads up, the federal government has lots of loan repayment programs that really make the loan burden a bit less "burdensome." The IBR is a good program that could keep your loan payments to a reasonable sum, no matter what your debt level and income.

Between the fact that you have an RN-believe it or not, you can work 12-24 hours per week in medical school (at least the first two years) and loan repayment options, you should be able to make it through medical school with minimal amount of debt. This is especially true if you go to a state school where total cost is $50K-60K (8 grand and change/semester).

If you like gas, do gas. If you need continuity and more variety, and want your patients to remember you past the first dose of versed, do family med. Do what makes you happy.

 

[Khaos05]

Hey guys, thanks for the replies.

rachmoninov I had to read yours a few times because at first glance I thought "he doesn't think I'm intelligent enough to get my bsn?!?".

I do plan on going to a state school. I'm in AR and plan on attending UAMS. That is where I want to go and it's my best chance of admission. However, I have a friend who is an ms4 and she had to sign a contract stating that she would not work and if found otherwise, would be expelled. So I will not be able to work during med school (I think I'll have to focus on studying anyway) so I will have to take out ~$25k-30k per year based on numbers from their website and what my friend has had to do.

I guess I have no problem with IBR - I just really wanted to make enough so I could make more than I do now AND make massive payments in order pay pay off loans ASAP. I wouldn't like loans looming over my head until I retire.

 

[GoodmanBrown]

Hey guys, thanks for the replies.

rachmoninov I had to read yours a few times because at first glance I thought "he doesn't think I'm intelligent enough to get my bsn?!?".

I do plan on going to a state school. I'm in AR and plan on attending UAMS. That is where I want to go and it's my best chance of admission. However, I have a friend who is an ms4 and she had to sign a contract stating that she would not work and if found otherwise, would be expelled. So I will not be able to work during med school (I think I'll have to focus on studying anyway) so I will have to take out ~$25k-30k per year based on numbers from their website and what my friend has had to do.

I guess I have no problem with IBR - I just really wanted to make enough so I could make more than I do now AND make massive payments in order pay pay off loans ASAP. I wouldn't like loans looming over my head until I retire.

The nice thing about the IBR is that if you work at a qualifying location, your loans are forgiven after 10 years. So, you could actually end up paying significantly less than you may imagine.

 

[Khaos05]

The nice thing about the IBR is that if you work at a qualifying location, your loans are forgiven after 10 years. So, you could actually end up paying significantly less than you may imagine.

That would be nice too.

I did some calculations and they don't look bad (unless I'm way off the map). If I come out of school with $150k in loans and I'm able to find an FM position where I bring home $120k (50th percentile or central AR) then I would qualify for IBR. With those numbers and interest at 6% the standard repayment plan (10yrs) comes out to ~$1700/mo but IBR comes to ~$1100/mo. That's very doable. And what's keeping me from making double or triple payments if I have the money? (i.e. anesthesia)

I guess I was just thinking absolute worst case scenario (that I would graduate with $200k in loans than charge insane interest, required payments of $4k/mo, and then finding an FM job paying $60k or be unemployed).

 

[GoodmanBrown]

That would be nice too.

I did some calculations and they don't look bad (unless I'm way off the map). If I come out of school with $150k in loans and I'm able to find an FM position where I bring home $120k (50th percentile or central AR) then I would qualify for IBR. With those numbers and interest at 6% the standard repayment plan (10yrs) comes out to ~$1700/mo but IBR comes to ~$1100/mo. That's very doable. And what's keeping me from making double or triple payments if I have the money? (i.e. anesthesia)

I guess I was just thinking absolute worst case scenario (that I would graduate with $200k in loans than charge insane interest, required payments of $4k/mo, and then finding an FM job paying $60k or be unemployed).

I think a lot of stuff has to go incredibly bad for your worst case scenario to play out. FM's the #1 recruited job right now and probably will be for many years. Unemployment shouldn't be a real worry.

Don't know how much physicians will be paid in the future, but you can opt out of large practice more easily than others can and thereby retain more control over your salary.

 

[Khaos05]

I think a lot of stuff has to go incredibly bad for your worst case scenario to play out. FM's the #1 recruited job right now and probably will be for many years. Unemployment shouldn't be a real worry.

Don't know how much physicians will be paid in the future, but you can opt out of large practice more easily than others can and thereby retain more control over your salary.

Leaning toward anesthesia - strongly. Right now I work at a FM clinic and while it seems slightly different than some (naturally) some days I feel like I'm going to pull my hair out. Between patients coming in for what I consider ******ed complaints, patients wanting refills ad nauseam for abx, pain meds, psych meds, on and on, plus coming in for problems not taking medical advice then returning multiple times with same complaint. Not to mention the massive amounts of paperwork to fill out and papers to sign. It seems like every patient wants medication, but can't come for an appointment - ironic.

I know every clinic isn't like this and I think I may have a jaded view because I'm on a different side of the coin than the MD. Sometimes I feel like he writes yay or nay on a note and I'm left calling in rx, arguing with patient, or with insurance meanwhile he's in his office watching tv.

Insight for FM?

 

[deleted87716]

I know every clinic isn't like this

It certainly doesn't have to be like that.

It's entirely up to you.

 

[FutureDoctor317]

I think I've always wanted to do FM but the reimbursement issues scare me. According to salary.com, FMP's salary in my area (AR) range from $160k (50th percentile) to $208k (90th percentile). After taxes, malpractice, etc, etc. even at the 75th percentile I will be bringing home a salary comparable to an NP or PA once I pay my loan payment. This is what keeps me from wanting to do FM, but if these changes were made, I would look at it more strongly.
.

From what I've heard (I'm only a med student so I may be wrong) is that it is not that difficult to earn around $180K after malpractice in FM. So I don't think you have to worry about being out earned by a PA or NP. Correct me if I am wrong.

 

[Khaos05]

From what I've heard (I'm only a med student so I may be wrong) is that it is not that difficult to earn around $180K after malpractice in FM. So I don't th

ink you have to worry about being out earned by a PA or NP. Correct me if I am wrong.

Yeah - when everyone throws these quotes out about salary I never know exactly what that means. Is that the base? Are benefits included in that figure? I like to know what's going to be on the bottom line aka what's going to be on my check and in my account (after taxes, malpractice/insurance, etc)

Here is the table I made with numbers pulled from salary.com using my zip code and assuming you bring home 75% of quoted salary:

Family Medicine:
10% - $125,499 (75% home - $94,124) - $7,844/mo
25% - $142,241 (75% home - $106,680) - $8,890/mo
50% - $160,631 (75% home - $120,473) - $10,039/mo
75% - $185,070 (75% home - $138,802) - $11,567/mo
90% - $207,320 (75% home - $155,490) - $12,958/mo

Anesthesia:
10% - $225,927 (75% home - $169,445) - $14,120/mo
25% - $265,592 (75% home - $199,194) - $16,600/mo
50% - $309,158 (75% home - $231,869) - $19,322/mo
75% - $351,725 (75% home - $263,793) - $21,983/mo
90% - $390,480 (75% home - $292,860) - $24,405/mo

 

[Khaos05]

It certainly doesn't have to be like that.

It's entirely up to you.

Also very good to hear (even though I guessed it was that way). The two doctors in this practice are polar opposites. My doctor is on paper charts, old school, deals with the junk and it's just me and him. The other doctor has EMR/E-Rx, 2 nurses, and a PA, and is very strict on needy/annoying patients.

 

[bronx43]

Yeah - when everyone throws these quotes out about salary I never know exactly what that means. Is that the base? Are benefits included in that figure? I like to know what's going to be on the bottom line aka what's going to be on my check and in my account (after taxes, malpractice/insurance, etc)

Here is the table I made with numbers pulled from salary.com using my zip code and assuming you bring home 75% of quoted salary:

Family Medicine:
10% - $125,499 (75% home - $94,124) - $7,844/mo
25% - $142,241 (75% home - $106,680) - $8,890/mo
50% - $160,631 (75% home - $120,473) - $10,039/mo
75% - $185,070 (75% home - $138,802) - $11,567/mo
90% - $207,320 (75% home - $155,490) - $12,958/mo

Anesthesia:
10% - $225,927 (75% home - $169,445) - $14,120/mo
25% - $265,592 (75% home - $199,194) - $16,600/mo
50% - $309,158 (75% home - $231,869) - $19,322/mo
75% - $351,725 (75% home - $263,793) - $21,983/mo
90% - $390,480 (75% home - $292,860) - $24,405/mo

Have you read anything that has been written so far? Yes, anesthesia makes more money now. Yes, family medicine reimbursement is in the crapper right now. Yes, it is laughably shortsighted to go into a field purely based on current compensation numbers. And no, you won't be out-earned in the long run by physician extenders even with loan repayments.
The bottom line: if you absolutely love anesthesia (which you can't possibly do right now, because you know little to nothing about it), then go into it. But, do so with the awareness that compensations will certainly change by the time you are done with training, and anesthesia is subject to far greater threats to its viability than primary care specialties like FM, peds, IM.

 

[MJB]

Have you read anything that has been written so far? Yes, anesthesia makes more money now. Yes, family medicine reimbursement is in the crapper right now. Yes, it is laughably shortsighted to go into a field purely based on current compensation numbers. And no, you won't be out-earned in the long run by physician extenders even with loan repayments.
The bottom line: if you absolutely love anesthesia (which you can't possibly do right now, because you know little to nothing about it), then go into it. But, do so with the awareness that compensations will certainly change by the time you are done with training, and anesthesia is subject to far greater threats to its viability than primary care specialties like FM, peds, IM.

Interestingly, an FM trained physician I was working with in the ER (who, btw, got a 73K RVU bonus last QUARTER) the other day was simply blown away when i told him how competitive Anesthesia is now (not ridiculous, but fairly tight). He said when he went through (in the mid 90's or so), programs couldn't recruit to anesthesia hardly at all. I knew this, but he had no idea. I found it funny.

Funny how things change....

And, how much money you can make (if you care to) with the versatility of FM. Granted, I have no desire to work in the ER...AT ALL, but it was interesting to me knowing the kind of change he's bringing home.

Even if the base is 150K...with a 73K quarterly RVU bonus...well, you can do the math.


My hope is that the government wakes up and PRIMARY CARE (whose job, imo, is to keep people OUT of the ED) will be compensated much much better than they currently are. I have no problem with Gas docs making money...what I have a problem with is them making money off of CRNA's doing the work (and CRNA's making 150+).

 

[lowbudget]

He said when he went through (in the mid 90's or so), programs couldn't recruit to anesthesia hardly at all. I knew this, but he had no idea. I found it funny.

If you go back in time, it all happened when primary care was at a point in crisis, so the pendulum swung. Anesthesia then hit rock bottom, and came to a crisis point. So the pendulum swung back.

Now, primary care is in crisis. Maybe primary care was always in crisis. Maybe the pendulum swings.

If you play your cards right, you get in when a specialty is at its lowest, and you leave when the specialty is at its highest.

I can't tell you where anesthesia will be 4+4 years of training +20 to 30 years of practice from now.

But, now is the time to be a primary care doctor.

One thing is true and time-tested: there will always be a need for doctors, no matter what your specialty is. Are midlevel providers here to stay? Or, are they just a fad in the face of a primary care crisis? I don't know the answer, but I do know that now is the time to be a primary care doctor.

 

[Khaos05]

Have you read anything that has been written so far? Yes, anesthesia makes more money now. Yes, family medicine reimbursement is in the crapper right now. Yes, it is laughably shortsighted to go into a field purely based on current compensation numbers. And no, you won't be out-earned in the long run by physician extenders even with loan repayments.
The bottom line: if you absolutely love anesthesia (which you can't possibly do right now, because you know little to nothing about it), then go into it. But, do so with the awareness that compensations will certainly change by the time you are done with training, and anesthesia is subject to far greater threats to its viability than primary care specialties like FM, peds, IM.

Yes - i've read everything. I wasn't posting the numbers to prove a point. Just showing what I found in my area. I know going into a field based on compensation is not a good idea - it spells nightmare. If I was going purely for the time:money ratio i'd obviously pick derm, but I wouldn't do derm if it allowed you to work 1 day a week and make $800k. I am interested in FM, EM, and Anesthesia right now.

Do I know everything there is to know about the field of anesthesia? Or know what being one is like? Of course not. But I have been researching these 3 fields for over three years (reading massive amounts on this forum shadowing FM,EM,CRNA,MDA, and researching schools, residencies, etc) so I've got a pretty good idea.

Just not sure which one i'm going to pick - good thing i've got time to decide and some rotations to help