Redistribution of Physician Salaries

[Anicetus]

You actually believe your dean of your medical school when he says your school doesn't rank you?

So half the deans out there are just lying about not ranking the students?

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[DermViser]

So half the deans out there are just lying about not ranking the students?

If you think your medical school doesn't tell where you fall in the class to residency programs in some way, then you are in for a big surprise. They may not be lying by the pure definition, but they are not telling you the truth.

While yes technically they may not say, Anicetus is #5 in a class of 150 students in terms of ordinal ranking, they WILL say what which segment of the class you fall in or will have certain "code words" which are defined at the end of your Dean's letter (now called the MSPE) which are defined at the end and tell where you fall in the class.

 

[DoctwoB]

So half the deans out there are just lying about not ranking the students?

They may not write that you were student # 38 / 142, but they can (and do) say that you were "exceptional" e.g. top 10%, "very good" e.g. 2nd quartile, or "solid" e.g. dumb as a rock. PDs can and do pick up on that kind of language.

edit: dermviser beat me to it.

 

[Meh.meh]

We all know how little PCP's make compared to Specialists.

For those of us learning healthcare in MS1 for the first time are being exposed to some of the cost problems of healthcare. It seems that Physicians being overpaid is definitely one of them.

Personally, I consider myself as fairly fiscally conservative and generally opposed to socialism, but in light of PCP salaries vs Specialty salaries, I think there is problem here.

Can someone justify why some specialists make so much more than PCP's?

I don't buy the "Because it's longer training and worse hours", because if we look outside of the medical field there are so many problems with that argument and if most of America is down to redistribute the wealth, why would the medical field be opposed to redistributing physician salaries?

^ This is a really weird way to begin a thread. It makes me think you're a troll.

Some things to consider, just in case you're not a troll.

1.) Why are we dismissing length of training? Maybe you are one of the fortunate few who will have no loans, but for those of us who do, we have interest accruing as long as we train. We should be compensated for that at the very least.

Additionally, there is opportunity cost. A neurosurgeon who trains for 7 years should be paid no more than a family doc who trains for three? How do you cover the four years of missing salary? That's close to a million dollars in pre-tax pay, even ignoring any investments they might make. It also ignores interest payments that the neurosurg. resident might not make.

2.) Worse hours shouldn't increase pay? Once again, why the hell would anyone go into neurosurgery, or cardiology, or even EM?

Among skilled professionals, hours should correlate to pay. The fact that it doesn't happen universally is a sad reality, but it is not an argument to apply the model to medicine. Deep sea crab fishermen make the majority of their income during the fishing season. Should everyone be paid for a few months a year because this exception exists? No, because that's ****ing ridiculous.

3.) Where the hell is the supposition "most of America is down to redistribute wealth" coming from?

4.) Specialists are called specialists for a reason. They spend years developing incredible skill. They should be compensated for that skill. Not doing so is an insult to the effort and training those individuals underwent.

Extrapolating from your logic, there appears to be little reason why physicians should be paid well at all. If we are going to ignore length of training, hours worked, and skill, then what fundamental structures determine pay? Because you've dismissed all of them.

I love what I am doing, and I think I will love what I do one day. I would probably have chosen this pathway even if it paid far less. But there are limits to this sentiment, and I have a $150,000 in debt to consider. If I can't even ensure my children have a secure financial future, why should I sacrifice so many years of pay, so much time, and so much effort?

 

[DermViser]

They may not write that you were student # 38 / 142, but they can (and do) say that you were "exceptional" e.g. top 10%, "very good" e.g. 2nd quartile, or "solid" e.g. dumb as a rock. PDs can and do pick up on that kind of language.

edit: dermviser beat me to it.

Heck they specifically look for it. They flip all the way to the end of the MSPE and write it down and what it means-- along with your board scores, which school you go to etc. So they'll have written down already on a card or sheet of paper while they're interviewing you.

DoctwoB
Emory School of Medicine - (Maybe where that school is ranked)
Step 1: 250
Step 2 CK: 260
MSPE code word - Exceptional - top 10%
AOA (Yes or No): Yes

Along with other questions written for that person to evaluate - how good your English is, etc.

 

[Meh.meh]

I generally don't believe in redistributing the wealth in the ways that liberals want to.

I just think that when it comes to physicians, it is a very specific and particular crowd in society.

Why.

 

[DermViser]

^ This is a really weird way to begin a thread. It makes me think you're a troll.

Some things to consider, just in case you're not a troll.

1.) Why are we dismissing length of training? Maybe you are one of the fortunate few who will have no loans, but for those of us who do, we have interest accruing as long as we train. We should be compensated for that at the very least.

Additionally, there is opportunity cost. A neurosurgeon who trains for 7 years should be paid no more than a family doc who trains for three? How do you cover the four years of missing salary? That's close to a million dollars in pre-tax pay, even ignoring any investments they might make. It also ignores interest payments that the neurosurg. resident might not make.

2.) Worse hours shouldn't increase pay? Once again, why the hell would anyone go into neurosurgery, or cardiology, or even EM?

Among skilled professionals, hours should correlate to pay. The fact that it doesn't happen universally is a sad reality, but it is not an argument to apply the model to medicine. Deep sea crab fishermen make the majority of their income during the fishing season. Should everyone be paid for a few months a year because this exception exists? No, because that's ******* ridiculous.

3.) Where the hell is the supposition "most of America is down to redistribute wealth" coming from?

4.) Specialists are called specialists for a reason. They spend years developing incredible skill. They should be compensated for that skill. Not doing so is an insult to the effort and training those individuals underwent.

Extrapolating from your logic, there appears to be little reason why physicians should be paid well at all. If we are going to ignore length of training, hours worked, and skill, then what fundamental structures determine pay? Because you've dismissed all of them.

I love what I am doing, and I think I will love what I do one day. I would probably have chosen this pathway even if it paid far less. But there are limits to this sentiment, and I have a $150,000 in debt to consider. If I can't even ensure my children have a secure financial future, why should I sacrifice so many years of pay, so much time, and so much effort?

Excellent points. I know where she got the idea that most of America is ok with redistributing wealth. They seem to not really believe it so much when it affects them.
It's any wonder PA and NP tracks are gaining popularity esp. if those years of sacrifice will go unacknowledged.

 

[BrooklynBulls]

I'm surprised that nobody mentioned that specialists are simply more valuable than PCPs. Period. There are fewer of them, their skills are...wait for it...specialized, sometimes subspecialized, they often do things that are inherently expensive or time-consuming, and they can only (with the exception of anesthesia, because the world's gone mad) do it if they go through medical school.

It's fairly simple economic principle here, of supply, demand, and resource rarity. A cancer patient can always get another PCP. But there are a limited number of surgical oncologists in the area, and only one of those two physicians can offer that patient a cure.

 

[W19]

If you think your medical school doesn't tell where you fall in the class to residency programs in some way, then you are in for a big surprise. They may not be lying by the pure definition, but they are not telling you the truth.

While yes technically they may not say, Anicetus is #5 in a class of 150 students in terms of ordinal ranking, they WILL say what which segment of the class you fall in or will have certain "code words" which are defined at the end of your Dean's letter (now called the MSPE) which are defined at the end and tell where you fall in the class.

How ranking can affect the prospect of someone getting in a good residency? For instance, let says you score 230 for step 1, which is average for GS residency. If you rank in the 4th quartile in your class, will that rank affects that much your prospect of getting into GS assuming you got EC/good LORs/Research etc...? This ranking stuff is driving me crazy!

 

[DermViser]

I'm surprised that nobody mentioned that specialists are simply more valuable than PCPs. Period. There are fewer of them, their skills are...wait for it...specialized, sometimes subspecialized, they often do things that are inherently expensive or time-consuming, and they can only (with the exception of anesthesia, because the world's gone mad) do it if they go through medical school.

It's fairly simple economic principle here, of supply, demand, and resource rarity. A cancer patient can always get another PCP. But there are a limited number of surgical oncologists in the area, and only one of those two physicians can offer that patient a cure.

I was just going to say. PCPs have to demonstrate greater value. As of right now they really don't whether you use healthcare outcomes or costs, neither of which they want to be evaluated by. If anything if P4P comes into play, it will hurt primary care much more than it will hurt specialists.

 

[DermViser]

How ranking can affect the prospect of someone getting in a good residency? For instance, let says you score 230 for step 1, which is average for GS residency. If you rank in the 4th quartile in your class, will that rank affects that much your prospect of getting into GS assuming you got EC/good LORs/Research etc...? This ranking stuff is driving me crazy!

Of course ranking in the 4th quartile of your class will have a huge affect on your prospect of matching, esp. General Surgery which is more competitive. It's your performance across the entire first 3 years of medical school. Chances are if you're ranked in the 4th quartile, you won't be getting good LORs from your clerkships bc your ranking includes your clinical grades. Are you an MS-4?

 

[sinombre]

How ranking can affect the prospect of someone getting in a good residency? For instance, let says you score 230 for step 1, which is average for GS residency. If you rank in the 4th quartile in your class, will that rank affects that much your prospect of getting into GS assuming you got EC/good LORs/Research etc...? This ranking stuff is driving me crazy!

Everything matters to some extent. The best objective answer you can get is to look at the NRMP Program Director Survey Report for the specialty you're interested in.

http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf

 

[W19]

Of course ranking in the 4th quartile of your class will have a huge affect on your prospect of matching, esp. General Surgery which is more competitive. It's your performance across the entire first 3 years of medical school. Chances are if you're ranked in the 4th quartile, you won't be getting good LORs from your clerkships bc your ranking includes your clinical grades. Are you an MS-4?

I am a MS1... I am trying to stay on at least at the bottom of 2nd quartile or the beginning of the 3rd quartile. But the problem is that even you get B average, you still can end up on the lower end of third quartile of your class... Everyone in med school is freaking smart and they are studying 8+ hrs/day.

Talking about the big league, med school is truly the big league!

 

[DermViser]

I am a MS1... I am trying to stay on at least at the bottom of 2nd quartile or the beginning of the 3rd quartile. But the problem is that even you get B average, you still can end up on the lower end of third quartile of your class... Everyone in med school is freaking smart and they are studying 8+ hrs/day.

Talking about the big league, med school is truly the big league!

Well it's a puzzle piece and each part contributes to the whole picture - class rank (preclinical grades if you go to a non P/F schoool, clinical grades), board scores, LORs, audition electives, etc. It's not an exact science, but yes, in general if you want to do well, you'll have to put in the hours, but it's no guarantee. Also depends what your specialty goals are.

 

[BrooklynBulls]

Of course ranking in the 4th quartile of your class will have a huge affect on your prospect of matching, esp. General Surgery which is more competitive. It's your performance across the entire first 3 years of medical school. Chances are if you're ranked in the 4th quartile, you won't be getting good LORs from your clerkships bc your ranking includes your clinical grades. Are you an MS-4?

I think "huge" would be a bit strong. Moderate is probably more accurate. Those in the 4th quartile certainly could have done well on clerkships, but not on shelf exams or some other components of the grade. If you're not a poophead, and all your other ducks are in a row, I don't think it's a massive bar to entry. But probably something you'd want to pre-emptively explain on your personal statement or on the interviews themselves.

Frankly my experience is that if you're in the 4th quartile, the rest of your application will reflect it. Although I suppose I haven't met many students from elite medical schools, where even the "deliquent" students are geniuses.

 

[DermViser]

I think "huge" would be a bit strong. Moderate is probably more accurate. Those in the 4th quartile certainly could have done well on clerkships, but not on shelf exams or some other components of the grade. If you're not a poophead, and all your other ducks are in a row, I don't think it's a massive bar to entry. But probably something you'd want to pre-emptively explain on your personal statement or on the interviews themselves.

Frankly my experience is that if you're in the 4th quartile, the rest of your application will reflect it. Although I suppose I haven't met many students from elite medical schools, where even the "deliquent" students are geniuses.

You have to pretty bad on the shelf to go from H/HP level evals to a P overall due to the shelf. The shelf is a standardizing measure, and you take in-training exams in residency.

 

[W19]

Well it's a puzzle piece and each part contributes to the whole picture - class rank (preclinical grades if you go to a non P/F schoool, clinical grades), board scores, LORs, audition electives, etc. It's not an exact science, but yes, in general if you want to do well, you'll have to put in the hours, but it's no guarantee. Also depends what your specialty goals are.

What if your interest is in IM or FM?

 

[BrooklynBulls]

You have to pretty bad on the shelf to go from H/HP level evals to a P overall due to the shelf. The shelf is a standardizing measure, and you take in-training exams in residency.

Different schools prioritize the shelf differently. I do know of one school in particular where such a thing could occur, and you wouldn't have to do all that bad. Just be the kind of poor test-taker that most 4th quartile students tend to be. And other things do play into those grades sometimes. Written assignments and pap like that.

The point is, in isolation a 4th quartiler who's just an angel otherwise should match general surgery.

But I personally don't know anybody who fits such a profile, and doubt many do.

 

[sinombre]

What if your interest is in IM or FM?

http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf

 

[Anicetus]

Thank you for the responses. I am aware I am not really familiar with the healthcare system so I take my healthcare theme seriously in terms of trying to understand solutions etc.

I just think its horrible that med students bash PCP and I believe part of it has to do with the salaries and the lack of competition for some of those residencies.

So basically if you are in the bottom 1/4 of the class, you are pretty much stuck with primary care unless you get like a 250+ on the Step 1?

 

[Frazier]

Thank you for the responses. I am aware I am not really familiar with the healthcare system so I take my healthcare theme seriously in terms of trying to understand solutions etc...

So basically if you are in the bottom 1/4 of the class, you are pretty much stuck with primary care unless you get like a 250+ on the Step 1?

This is a new and exciting hyperbole.

 

[DermViser]

Thank you for the responses. I am aware I am not really familiar with the healthcare system so I take my healthcare theme seriously in terms of trying to understand solutions etc.

I just think its horrible that med students bash PCP and I believe part of it has to do with the salaries and the lack of competition for some of those residencies.

So basically if you are in the bottom 1/4 of the class, you are pretty much stuck with primary care unless you get like a 250+ on the Step 1?

I don't think that med students bash PCP solely bc of salaries and lack of competition. There are other reasons med students hate primary care, esp. with NPs and PAs ready to take it over while physicians assume a more administrative role in primary care as part of the PCMH.

I don't think even a 250+ is the magic out of the 4th quartile, but I also think it can vary a lot with the particular medical school in question.

 

[DermViser]

This is a new and exciting hyperbole.

SDN med students ALWAYS have to find exceptions.

 

[DermViser]

Because most of the country is advocating for closing the salary gaps DESPITE training, expertise, liability in other jobs.

The country is not.

 

[Meh.meh]

Thank you for the responses. I am aware I am not really familiar with the healthcare system so I take my healthcare theme seriously in terms of trying to understand solutions etc.

I just think its horrible that med students bash PCP and I believe part of it has to do with the salaries and the lack of competition for some of those residencies.

So basically if you are in the bottom 1/4 of the class, you are pretty much stuck with primary care unless you get like a 250+ on the Step 1?

Primary care doesn't deserve to be bashed. However, not everyone is a good fit for primary care. If you hear someone say "I would never be a family physician," that isn't really bashing. I feel like this is lost on some medical students.

I don't think I've ever heard a fellow medical student bash primary care. Only residents, attendings, and occasionally patients.

The bolded statement is a poor interpretation of reality. Short answer is no. Longer answer has multiple parts.

A person in the bottom quartile 1/4 is unlikely to get a 250+, at least compared to an upper 1/4 student.

A person in the bottom 1/4 of the class is not necessarily trapped in primary care. There are some less competitive specialties like PM&R and Neurology. There are also less competitive sub-specialties like endocrinology.

Even if you are in the bottom quartile in the first two years, you may do well in third year (less likely, for the same reasons as high step scores are unlikely). Third year grades are more important than pre-clinical grades.

Research is also important.

 

[PL198]

my head is spinning from this thread. no words.

in short- economics. prices aren't arbitrary

 

[PL198]

Also I'm sure this thread will end up being a goldmine
http://forums.studentdoctor.net/threads/reimbursement-rates-after-obamacare.1104223/#post-15804106

Premeds talking about how ACA affects reimbursement. Over under for first post to talk about ponies is 6

 

[Frazier]

Also I'm sure this thread will end up being a goldmine
http://forums.studentdoctor.net/threads/reimbursement-rates-after-obamacare.1104223/#post-15804106

Premeds talking about how ACA affects reimbursement. Over under for first post to talk about ponies is 6

I have no doubt "under".

 

[Silent Cool]

 

[pathstudent]

We all know how little PCP's make compared to Specialists.

For those of us learning healthcare in MS1 for the first time are being exposed to some of the cost problems of healthcare. It seems that Physicians being overpaid is definitely one of them.

Personally, I consider myself as fairly fiscally conservative and generally opposed to socialism, but in light of PCP salaries vs Specialty salaries, I think there is problem here.

Can someone justify why some specialists make so much more than PCP's?

I don't buy the "Because it's longer training and worse hours", because if we look outside of the medical field there are so many problems with that argument and if most of America is down to redistribute the wealth, why would the medical field be opposed to redistributing physician salaries?

I know a woman who did a residency in peds, got boarded and worked for a short time before applying to anesthesiology and then getting boarded and working in that field.

As she said "if I could make the same as a pediatrician as an anesthesiologist, I would do it in a second as there is so much less pressure".

 

[Mad Jack]

We all know how little PCP's make compared to Specialists.

For those of us learning healthcare in MS1 for the first time are being exposed to some of the cost problems of healthcare. It seems that Physicians being overpaid is definitely one of them.

Personally, I consider myself as fairly fiscally conservative and generally opposed to socialism, but in light of PCP salaries vs Specialty salaries, I think there is problem here.

Can someone justify why some specialists make so much more than PCP's?

I don't buy the "Because it's longer training and worse hours", because if we look outside of the medical field there are so many problems with that argument and if most of America is down to redistribute the wealth, why would the medical field be opposed to redistributing physician salaries?

Really though, the big reason for physician salary disparities boils down to the fact that representation on the board that determines Medicare compensation is divided pretty evenly among the specialties, not by physician population. So while there are a lot more IM and FM physicians than, say derm or neurosurg, they all have equal say in how the pie is divided. Since there are a lot more specialists determining how that pie is divided, it's going to be procedure based, and it's going to benefit specialists more.

The best way to change things would probably be to have a voting board that is representative of the actual population of physicians, rather than just a couple per specialty.

 

[gettheleadout]

You actually believe your dean of your medical school when he says your school doesn't rank you in your Dean's Letter?

If she's referring specifically to preclinicals (where the fellow M1's are) then it's possible. There are P/F schools where it's explicitly stated in the policies that performance in the preclinical courses does not factor in to one's class rank as reported in the MSPE.


Sent from my neural implant using SDN Mobile

 

[DrBodacious]

O

Can someone justify why some specialists make so much more than PCP's?

Why do PCPs make more than PAs or NPs?

We all know you are qualified to do very little after you are done with medical school. Residency is where you gain your value. 5-9 yrs vs 3 yrs. The extra years are spent learning to do things that are valuable to patients. Things that PCPs are not qualified to do.

You admit you are naive. I agree. If you make it out in practice, you will know why your suggestions are ludicrous.

As far as what you you are suggesting, it aligns most with the movement away from FFS.

I am a strong proponent of continuing a FFS model. If you are having surgery, wouldn't it be comforting knowing that your surgeon gets paid for doing your surgery?

The propaganda regarding changing from FFS to capitated or strictly value based systems is supported by hospital systems with their own special interests.
FFS is really the only way that private practice is viable. Having doctors manage their own offices adds a tremendous amount of value to the patient, and is more efficient.

Plus, ripping 100,000+ medical practices (small businesses) out of the hands of their owners is probably the most socialist, unamerican thing I can think of.

If you look at the FFS model today from the standpoint of the costs that are required to provide the services, doctors are not getting over paid.

 

[DrBodacious]

Really though, the big reason for physician salary disparities boils down to the fact that representation on the board that determines Medicare compensation is divided pretty evenly among the specialties, not by physician population. So while there are a lot more IM and FM physicians than, say derm or neurosurg, they all have equal say in how the pie is divided. Since there are a lot more specialists determining how that pie is divided, it's going to be procedure based, and it's going to benefit specialists more.

The best way to change things would probably be to have a voting board that is representative of the actual population of physicians, rather than just a couple per specialty.

That might be a good way to change things, but it is completely unfair, which is why the system is the way it is.

 

[DermViser]

If she's referring specifically to preclinicals (where the fellow M1's are) then it's possible. There are P/F schools where it's explicitly stated in the policies that performance in the preclinical courses does not factor in to one's class rank as reported in the MSPE.


Sent from my neural implant using SDN Mobile

But that doesn't make any sense bc the MSPE lists your rank at the end of 3 years by the time it's sent out, not just preclinicals.

 

[TooMuchResearch]

I'm fiscally conservative when it comes to 90% of the economics in our country, but when it comes to Physician salaries, I am not yet convinced that we shouldn't just redistribute to help with the PCP shortage.

Is there really a PCP shortage, or is there just a shortage of PCPs where they're needed?

 

[TooMuchResearch]

^ I don't believe in raising taxes on the rich to solve the economy's problems.



So then what of the people who purely become family practitioners and general pediatricians? Are they just doing it out of the goodness of their hearts?

Honestly, some that intend to subspecialize don't because they weren't good enough as residents or got too burned out in residency to continue.

 

[TooMuchResearch]

So half the deans out there are just lying about not ranking the students?

Yes.

 

[DermViser]

Honestly, some that intend to subspecialize don't because they weren't good enough as residents or got too burned out in residency to continue.

 

[theseeker4]

Because most of the country is advocating for closing the salary gaps DESPITE training, expertise, liability in other jobs.

So because "most" of the country, many of whom can't tell a nurse from a doctor in the hospital, let alone describe the difference in training, wants yo do something, it must be a good idea?

 

[TooMuchResearch]

Haha, you know it's true. I've known a bunch of IM residents who intended to do fellowship, then had a "screw it, I'll be a hospitalist and work 26 weeks per year" moment.

Also, some decide against fellowship because they don't want to uproot their family.

 

[DermViser]

Haha, you know it's true. I've known a bunch of IM residents who intended to do fellowship, then had a "screw it, I'll be a hospitalist and work 26 weeks per year" moment.

Also, some decide against fellowship because they don't want to uproot their family.

It was more the other reason for the . But yes there are many categorical residents who at the end of 3 years of IM are so exhausted are like F' it. Quite sad really. I don't know if it's the specific program or IM in general.

 

[histidine]

Really though, the big reason for physician salary disparities boils down to the fact that representation on the board that determines Medicare compensation is divided pretty evenly among the specialties, not by physician population. So while there are a lot more IM and FM physicians than, say derm or neurosurg, they all have equal say in how the pie is divided. Since there are a lot more specialists determining how that pie is divided, it's going to be procedure based, and it's going to benefit specialists more.

The best way to change things would probably be to have a voting board that is representative of the actual population of physicians, rather than just a couple per specialty.

Idk, wouldn't we want to compensate specialists higher than primary care, due to the extra training and difficulty? Perhaps FM makes a bit too little these days, while some other specialties seem to make too much, but I can definitely see the logic in paying a neurosurgeon or a plastic reconstruction surgeon significantly more than a pediatrician.

As for procedure based billing, I think it's necessary in our current healthcare system. How else would you do it? It's already difficult for physicians to get reimbursed by insurance companies for concrete procedures. Imagine how hard it would be for physicians to convince insurance companies to get paid for abstract measures.

 

[BestDoctorEver]

I generally don't believe in redistributing the wealth in the ways that liberals want to.

I just think that when it comes to physicians, it is a very specific and particular crowd in society.

Lol.. Obama has been one of the greatest wealth 'redistributionist', but his distribution has gone to the top 5%--not the poor or the middle class... Have you heard of 'quantitative easing'? Look at the number yourself! Almost 90% of the economic gains in the last 5 years has gone to the top 5%+. Obama talks good game, but he is not doing anything for the middle class.

 

[SouthernSurgeon]

Heck they specifically look for it. They flip all the way to the end of the MSPE and write it down and what it means-- along with your board scores, which school you go to etc. So they'll have written down already on a card or sheet of paper while they're interviewing you.

We don't even have to look for it. The PC makes a one page summary for us as the cover sheet for each applicant - they have to go through all the MSPEs and sort through the code words. The cover sheet looks very similar to this actually:

DoctwoB
Emory School of Medicine - (Maybe where that school is ranked)
Step 1: 250
Step 2 CK: 260
MSPE code word - Exceptional - top 10%
AOA (Yes or No): Yes

Except it also has a line for their surgery clerkship grade, # of clinical honors overall, and research (# pubs/presentations)

Frankly my experience is that if you're in the 4th quartile, the rest of your application will reflect it. Although I suppose I haven't met many students from elite medical schools, where even the "deliquent" students are geniuses.

See this is the thing I keep trying to say. I know there is this SDN fable of the student who struggles in the pre-clinical years but then turns into a clinical superstar. But I've reviewed a lot of residency applications - I can't ever recall seeing a student who had honors in many/most clerkships who wasn't at least ranked in the top half of their class, if not higher.

 

[DermViser]

See this is the thing I keep trying to say. I know there is this SDN fable of the student who struggles in the pre-clinical years but then turns into a clinical superstar. But I've reviewed a lot of residency applications - I can't ever recall seeing a student who had honors in many/most clerkships who wasn't at least ranked in the top half of their class, if not higher.

What about the scenario of the student who aces every single preclinical course in the first 2 years, and falls completely flat in the clinical year?

 

[Mad Jack]

Idk, wouldn't we want to compensate specialists higher than primary care, due to the extra training and difficulty? Perhaps FM makes a bit too little these days, while some other specialties seem to make too much, but I can definitely see the logic in paying a neurosurgeon or a plastic reconstruction surgeon significantly more than a pediatrician.

As for procedure based billing, I think it's necessary in our current healthcare system. How else would you do it? It's already difficult for physicians to get reimbursed by insurance companies for concrete procedures. Imagine how hard it would be for physicians to convince insurance companies to get paid for abstract measures.

I'm not saying PCPs should be compensated the same as specialists, just that we should have a compensation board that actually reflects the physician population and let things be decided from there.

 

[Slack3r]

Really though, the big reason for physician salary disparities boils down to the fact that representation on the board that determines Medicare compensation is divided pretty evenly among the specialties, not by physician population. So while there are a lot more IM and FM physicians than, say derm or neurosurg, they all have equal say in how the pie is divided. Since there are a lot more specialists determining how that pie is divided, it's going to be procedure based, and it's going to benefit specialists more.

The best way to change things would probably be to have a voting board that is representative of the actual population of physicians, rather than just a couple per specialty.

But really, all political correctness aside, do we really believe titrating HTN and DM meds (that the patient probably won't take anyway) should pay more than surgery? Seriously?

We've already given half of primary care away to mid levels and physician extenders as it is. Can we really sit here and say, with a straight face, that primary care should be paid an equivalent amount as a specialist?

And frankly, I do believe PCPs should make more, just like i believe all physicians should make more because we provide highly specialized, downright essential skills, NOT because of some misguided attempt at "fairness".

 

[SouthernSurgeon]

What about the scenario of the student who aces every single preclinical course in the first 2 years, and falls completely flat in the clinical year?

I probably don't ever see their applications lol.

Anecdotally, I'm sure it happens, but I think it happens a lot less than the SDN wishers would hope. The flip side of the fable that people who struggle in the pre-clinical years will magically demonstrate their brilliance in the clinical years, is that the gunners will get their comeuppance as an M3 when their "book smarts" won't help.

Turns out the things that make one successful as an M1-M2 (work ethic, intelligence, organization, etc) actually carry over pretty well to the clinical realm. There are certainly exceptions, but I don't think they are that common.

 

[DermViser]

I probably don't ever see their applications lol.

Anecdotally, I'm sure it happens, but I think it happens a lot less than the SDN wishers would hope. The flip side of the fable that people who struggle in the pre-clinical years will magically demonstrate their brilliance in the clinical years, is that the gunners will get their comeuppance as an M3 when their "book smarts" won't help.

Turns out the things that make one successful as an M1-M2 (work ethic, intelligence, organization, etc) actually carry over pretty well to the clinical realm. There are certainly exceptions, but I don't think they are that common.

Maybe it's just me but I feel like M1-M2 vs. M3 just capitalize on different capabilities and abilities. It's just that M3 the skills required to be successful can be more nuanced or "soft" such as being able to read that your intern/resident is tired and doesn't have time to hold your hand on everything. A lot of M3 is being a chameleon as well as brief snapshots (i.e. clinical presentations, your confidence while presenting, and answer pimp questions to test that you understand what's going on) which are used to evaluate you, although the difference btw HP vs. H is usually the shelf exam.

Not like M1-M2 where pounding the information in your head and repetition, repetition, repetition does the trick (assuming your school is efficient to give you course syllabi, watch recorded/streamed lectures, etc.) and your entire evaluation is a multiple choice exam.