Reimburstment to shift towards primary care?

[LebLlama]

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A GI doc who teaches at my school says he's been following "medical politics" for awhile and thinks that in 10 years primary care docs will make more and speciality doc will make less...

What do you all think? will there be a shift towards primary care in the near future?

 

[deleted500612]

I wouldn't be surprised. Simple supply and demand is a strong driving factor of salaries. Right now there is supersaturation of some specialties, but a high demand for most primary care. As long as that trend continues, I think we'll see reimbursements slowly shift toward primary care until the imbalance is corrected. Somebody posted a thread with the new upcoming reimbursement figures for each specialty not too long ago, and you could already see this trend starting. And to be quite honest, I think this shift is inevitable given that certain specialties pay basically double the salary of primary care specialties with the same length of PGY training. Of course people are not going to want to go into peds or general internal med as their first choice when the compensation is that heavily skewed. Funny how so many students seem to develop an inexplicable keen interest in skin disorders and botox treatments when it comes time to pick a residency.

 

[ksharp33]

I wouldn't be surprised. Simple supply and demand is a strong driving factor of salaries. Right now there is supersaturation of some specialties, but a high demand for most primary care. As long as that trend continues, I think we'll see reimbursements slowly shift toward primary care until the imbalance is corrected. Somebody posted a thread with the new upcoming reimbursement figures for each specialty not too long ago, and you could already see this trend starting. And to be quite honest, I think this shift is inevitable given that certain specialties pay basically double the salary of primary care specialties with the same length of PGY training. Of course people are not going to want to go into peds or general internal med as their first choice when the compensation is that heavily skewed. Funny how so many students seem to develop an inexplicable keen interest in skin disorders and botox treatments when it comes time to pick a residency.

Could you post a link to the new upcoming reimbursement figures for each specialty?

 

[username456789]

Funny how so many students seem to develop an inexplicable keen interest in skin disorders and botox treatments when it comes time to pick a residency.

You realize Dermatologists are nowhere near the top earners in medicine, right? Funny how med students always make this strange assumption and use Derm as the de facto example.

 

[WaylonS]

Even in Western European countries that have had national health care for over 50 years, specialists still make more than GPs. Yeah, the gap might narrow, but it seems unlikely that salaries between specialists and PCPs will be reversed

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

 

[Porfirio]

You realize Dermatologists are nowhere near the top earners in medicine, right? Funny how med students always make this strange assumption and use Derm as the de facto example.

I think it has more to do with lifestyle, length of residency, and high income (granted not the top earner on a per year basis).

 

[Arkangeloid]

You realize Dermatologists are nowhere near the top earners in medicine, right? Funny how med students always make this strange assumption and use Derm as the de facto example.

Actually, I'm pretty sure Derm does earn the most per-hour out of any specialty.


I mean, I'm not hating, and I don't think anyone is that petty. I fully realize that my chances of matching into Derm are worse than my chances of seducing Natalie Portman, but I still immensely respect students with the brains and motivation to get there.

But as my Gastro prof would say, "Let's call a spade a spade. Competitive specialties are competitive because of reimbursement and lifestyle, not because they're more interesting or fulfilling or whatever. Don't let anyone tell you different."

 

[TheWeeIceMan]

Even in Western European countries that have had national health care for over 50 years, specialists still make more than GPs. Yeah, the gap might narrow, but it seems unlikely that salaries between specialists and PCPs will be reversed

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

I took OPs statement to be that that primary care will make more than they do now and specialists will make less than they do now (not exactly a controversial statement). I may have misunderstood, but the wording could be interpreted either way.

in 10 years primary care docs will make more and speciality doc will make less...

 

[IamPsychiatrist]

A GI doc who teaches at my school says he's been following "medical politics" for awhile and thinks that in 10 years primary care docs will make more and speciality doc will make less...

What do you all think? will there be a shift towards primary care in the near future?

That's not a super risky prediction.

Let me make one.

In 10 years the minimum wage will be higher, and the top 1% may have a little bit less % of the world's wealth.

See, it's not that hard - you try now.

 

[IamPsychiatrist]

Even in Western European countries that have had national health care for over 50 years, specialists still make more than GPs. Yeah, the gap might narrow, but it seems unlikely that salaries between specialists and PCPs will be reversed

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

I didn't read the statement like that. He said PC will earn more (well, that's probably true). Next he said, specialty medicine will earn less (well, that's also probably true). I've met very few doctor's who don't think we are near the peak of physician income/earnings.

I mean, look at how simple of a statement this is:

The docs earning 180k probably will have an increase in income while the docs earning 500k will probably have a decrease. According to everything we've seen in medicine / politics, I don't see many people who aren't thinking this will happen.

As far as asking, will PC earn more than specialists - haha! No one in the world is claiming this.

 

[Psai]

That's not a super risky prediction.

Let me make one.

In 10 years the minimum wage will be higher, and the top 1% may have a little bit less % of the world's wealth.

See, it's not that hard - you try now.

There was no increase in minimum wage between 1997 and 2007. The top 1% have been eating an increasingly larger slice of the pie for several years now.

 

[IamPsychiatrist]

There was no increase in minimum wage between 1997 and 2007. The top 1% have been eating an increasingly larger slice of the pie for several years now.

Lol. First of all, 13 states just raised their pay - so me saying something will happen in the next decade isn't a big prediction. Looking at a 30 year history:

Jan 1, 1980

$3.10 for all covered, nonexempt workers

Jan 1, 1981

$3.35 for all covered, nonexempt workers

Apr 1, 19904

$3.80 for all covered, nonexempt workers

Apr 1, 1991

$4.25 for all covered, nonexempt workers

Oct 1, 1996

$4.75 for all covered, nonexempt workers

Sep 1, 19975

$5.15 for all covered, nonexempt workers

Jul 24, 2007

$5.85 for all covered, nonexempt workers

Jul 24, 2008

$6.55 for all covered, nonexempt workers

Jul 24, 2009

$7.25 for all covered, nonexempt workers

It appears we've had minimum wage increases at least every decade! That's correct, if I made the prediction on September 1, 1997 - within the 10 years I still would have been right.🙂

Not to mention the nation is ripe for an increase right now, so again the prediction that something will happen by 2024 isn't that drastic. Nice try with selective bias - trying to find one small slice of history, even though it wasn't even a full decade.😉

 

[Silent Cool]

Actually, I'm pretty sure Derm does earn the most per-hour out of any specialty.


I mean, I'm not hating, and I don't think anyone is that petty. I fully realize that my chances of matching into Derm are worse than my chances of seducing Natalie Portman, but I still immensely respect students with the brains and motivation to get there.

But as my Gastro prof would say, "Let's call a spade a spade. Competitive specialties are competitive because of reimbursement and lifestyle, not because they're more interesting or fulfilling or whatever. Don't let anyone tell you different."

Your prof sounds like a straight shooter. I like that. He's 100% correct. It used to be that people in the bottom of the class went into Ortho, and now look at it.

 

[IamPsychiatrist]

Your prof sounds like a straight shooter. I like that. He's 100% correct. It used to be that people in the bottom of the class went into Ortho, and now look at it.

Well, I think the best way to look at it is to go to other countries. Ortho is in the middle of competitiveness in countries like England. General Surgery and IM are more popular there.

Money and status are obviously important to humans (*females also😉). I don't think that's a drastic assessment either.

 

[crimsonkid85]

I hate the fact that everyone makes it out to be a zero sum game. Why can't GP's make more AND specialists make more. The people who should be taking a pay cut is hospital administration and corporate insurance.

 

[Arkangeloid]

I hate the fact that everyone makes it out to be a zero sum game. Why can't GP's make more AND specialists make more. The people who should be taking a pay cut is hospital administration and corporate insurance.

It's actually more of a negative sum game, come to think of it. The powers that be would like all physicians to make less than 100K and be replaced by nurses wherever possible.

 

[Psai]

Lol. First of all, 13 states just raised their pay - so me saying something will happen in the next decade isn't a big prediction. Looking at a 30 year history:


It appears we've had minimum wage increases at least every decade! That's correct, if I made the prediction on September 1, 1997 - within the 10 years I still would have been right.🙂

Not to mention the nation is ripe for an increase right now, so again the prediction that something will happen by 2024 isn't that drastic. Nice try with selective bias - trying to find one small slice of history, even though it wasn't even a full decade.😉

What about between the year 1020 BC and 1980. I bet there were plenty of 10 year periods without an increase in the minimum wage. This 3000 year history trumps your 30 year history.

 

[IamPsychiatrist]

I hate the fact that everyone makes it out to be a zero sum game. Why can't GP's make more AND specialists make more. The people who should be taking a pay cut is hospital administration and corporate insurance.

Oh, they have the most to gain here. Unless of course some way they pass universal health care, which seems unlikely in America.

 

[Arkangeloid]

Your prof sounds like a straight shooter. I like that. He's 100% correct. It used to be that people in the bottom of the class went into Ortho, and now look at it.

Yeah, he's a island of truth in a sea of bullcrap. I roll my eyes when I hear students talk about how fascinated they are with the eye or the brain, and that is why they want to do Ophtho or NeuSu. Yeah, let's see how fascinated they would be if those specialties made 200K rather than 500+. They're fascinated with money and swag and bishes, not "eyes" and "brains." Own up to it.


(Seriously though, I think at least 1/3 people in my MS1 class want to do Neurosurgery. What is in the water here?).

 

[username456789]

Yeah, he's a island of truth in a sea of bullcrap. I roll my eyes when I hear students talk about how fascinated they are with the eye or the brain, and that is why they want to do Ophtho or NeuSu. Yeah, let's see how fascinated they would be if those specialties made 200K rather than 500+. They're fascinated with money and swag and bishes, not "eyes" and "brains." Own up to it.

Wait, you actually think most ophthalmologists make $500k? No wonder you're so very very confused.

 

[Arkangeloid]

Wait, you actually think most ophthalmologists make $500k? No wonder you're so very very confused.

Nah, that was Neurosurgeons. I have no idea what Ophth dudes make, but I know that it's one of the most desirable specialties for a reason.

Also, they aren't my words, they are my GI Prof's. I don't know what to think, but I'll go with what he said. I mean, he's an attending in a competitive subspecialty, I would assume he knows more about this stuff than any of us do.

 

[mcloaf]

Yeah, he's a island of truth in a sea of bullcrap. I roll my eyes when I hear students talk about how fascinated they are with the eye or the brain, and that is why they want to do Ophtho or NeuSu. Yeah, let's see how fascinated they would be if those specialties made 200K rather than 500+. They're fascinated with money and swag and bishes, not "eyes" and "brains." Own up to it.


(Seriously though, I think at least 1/3 people in my MS1 class want to do Neurosurgery. What is in the water here?).

To be fair, 90% of those people are going to end up doing something else. Even though it's compensated so well I don't think many people are willing to put up with the neurosurgery lifestyle who aren't legitimately interested in the field. That being said, IMO if you're willing to go through neurosurgery training and treat those patients you deserve what you make.

 

[IamPsychiatrist]

Wait, you actually think most ophthalmologists make $500k? No wonder you're so very very confused.

I don't think anyone can dispute that earning potential affects interest level. Whether or not Nsurg earns 400k or 600k doesn't really change that fact.

 

[username456789]

I don't think anyone can dispute that earning potential affects interest level. Whether or not Nsurg earns 400k or 600k doesn't really change that fact.

I never said anything about neurosurgery.

 

[Silent Cool]

Yeah, he's a island of truth in a sea of bullcrap. I roll my eyes when I hear students talk about how fascinated they are with the eye or the brain, and that is why they want to do Ophtho or NeuSu. Yeah, let's see how fascinated they would be if those specialties made 200K rather than 500+. They're fascinated with money and swag and bishes, not "eyes" and "brains." Own up to it.


(Seriously though, I think at least 1/3 people in my MS1 class want to do Neurosurgery. What is in the water here?).

Yup.
Retina Ophtho can make 500K. Not gen'l, tho.
Most of those NSGY ppl will bail on it--trust me. Maybe one or two people in your class will end up going into it.

 

[DermViser]

I hate the fact that everyone makes it out to be a zero sum game. Why can't GP's make more AND specialists make more. The people who should be taking a pay cut is hospital administration and corporate insurance.

bc no one is EVER satisfied with how much they make, esp. the SDN crowd. It's one pie. It's how those slices are cut which is the issue. Without "corporate insurance", doctors wouldn't make the money they make now. Nowhere close.

 

[Silent Cool]

bc no one is EVER satisfied with how much they make, esp. the SDN crowd. It's one pie. It's how those slices are cut which is the issue. Without "corporate insurance", doctors wouldn't make the money they make now. Nowhere close.

Yup. It is human nature always to want more than what you have. If you made a million, you would be looking at the guy making 10 mil and thinking, "Man, this sucks."

 

[Arkangeloid]

I never said anything about neurosurgery.

But I mean, you're splitting hairs on a point where I was being metaphorical.

 

[username456789]

But I mean, you're splitting hairs on a point where I was being metaphorical.

I don't think you understand what a metaphor is . . .

And your statement was essentially accusing ophthalmologists, among others, of simply chasing a paycheck (specifically, a ~$500k+ paycheck). The truth of the matter is, most ophthalmologists (and dermatologists for that matter) make a lot closer to $200k than to $500k. Ultimately, their income is not all that different than a lot of medicine subspecialties.

So, yeah not really splitting hairs.

 

[IamPsychiatrist]

I don't think you understand what a metaphor is . . .

And your statement was essentially accusing ophthalmologists, among others, of simply chasing a paycheck (specifically, a ~$500k+ paycheck). The truth of the matter is, most ophthalmologists (and dermatologists for that matter) make a lot closer to $200k than to $500k. Ultimately, their income is not all that different than a lot of medicine subspecialties.

So, yeah not really splitting hairs.

True.

 

[Arkangeloid]

I don't think you understand what a metaphor is . . .

And your statement was essentially accusing ophthalmologists, among others, of simply chasing a paycheck (specifically, a ~$500k+ paycheck). The truth of the matter is, most ophthalmologists (and dermatologists for that matter) make a lot closer to $200k than to $500k. Ultimately, their income is not all that different than a lot of medicine subspecialties.

So, yeah not really splitting hairs.

Yes, but don't Derm and Ophtho have significantly superior lifestyles to IM and GS Subs, respectively?

Again, I'm not hating, I'm just really skeptical of anyone who says that "interest" in a field was their main reason for choosing it.

 

[deleted500612]

You realize Dermatologists are nowhere near the top earners in medicine, right? Funny how med students always make this strange assumption and use Derm as the de facto example.

I used derm because it is a perfect example of a specialty that has the same length of training as some of the primary care specialties but pays twice as much. Most of the few specialties that pay more than derm have longer residencies. And you do realize that derm is not the top earner because most dermatologists work standard office hours, while most of the specialties that make more than derm work 60+ hours per week plus call, right? Almost all the specialties that earn more than derm it's simply because they work a lot more hours, but actually earn less hourly ... so yes derm IS near the top earner in medicine. Like myself and an above poster stated, why do you think it is probably the most competitive residency out there right now? Do you really think all those students are just genuinely interested in skin conditions and botox? No, it's the high earnings to hours worked ratio, that's it.

I'm not hating on derm at all, I'll be the first to say that it is just as important as other specialties, and far from an easy residency. All I'm stating is that derm is extremely well compensated compared to other specialties that require the same amount of work.

 

[anbuitachi]

I always thought the idea is that specialists will make much less in the future, and so will primary care physicians, just not as much less.

 

[deleted500612]

bc no one is EVER satisfied with how much they make, esp. the SDN crowd. It's one pie. It's how those slices are cut which is the issue. Without "corporate insurance", doctors wouldn't make the money they make now. Nowhere close.

Not sure about that. People assume that US docs still earn far more than their western counterparts, which is not the case anymore. Back in the 90s and early 2000s this was still certainly true, yes, but since then pay for most specialties in the US has stagnated or even decreased slightly, while public healthcare nations like Australia and Canada have continued to increase physician pay (although European doc pay is still substantially behind these countries for the most part). Pretty much in every specialty nowadays Canadian physicians are paid the same (once you factor in insane malpractice insurance rates in the US) or at the very most within 10-15% of their US counterparts., and there is no corporate insurance. No longer are the days when US docs are making 40-60% more than everywhere else.

 

[deleted500612]

Could you post a link to the new upcoming reimbursement figures for each specialty?

Did some digging, finally found the thread down on page 5

http://forums.studentdoctor.net/threads/new-final-2014-physician-fee-schedule-published.1045063/

edit: link at top of that original thread appears to be dead now, but found another for you. Use this:

http://www.ama-assn.org/resources/d...physician-fee-schedule-final-rule-summary.pdf

 

[evilbooyaa]

(Seriously though, I think at least 1/3 people in my MS1 class want to do Neurosurgery. What is in the water here?).

Wait until they actually do a rotation in it as a MS3. We had at least 5-10 people drop out of doing NSG once they saw the lifestyle that the residents and attendings (and even the medical students) had during the rotation. Everyone wants to be a brain surgeon b/c it sounds like the coolest thing in the world. Once you see what the lifestyle is like, a lot of people back away from doing it. That plus the 7 year residency.

GuyWhoDoesStuff - While you are technically right, I believe the $/hour that dermatologists are paid must make them at least one of the top 5 most compensated specialties. I'd be surprised if that is not true. Not having to do call and being all clinic means less hours than an average GS attending at least. Harder to say with IM with the 7 on, 7 off system of hospitalists.

As to the OP, I think specialist pay will drop and PCP pay will increase, but specialists (especially proceduralists) will still make more than PCPs. Just that the gap will be smaller.

 

[DermViser]

Actually, I'm pretty sure Derm does earn the most per-hour out of any specialty.

I mean, I'm not hating, and I don't think anyone is that petty. I fully realize that my chances of matching into Derm are worse than my chances of seducing Natalie Portman, but I still immensely respect students with the brains and motivation to get there.

But as my Gastro prof would say, "Let's call a spade a spade. Competitive specialties are competitive because of reimbursement and lifestyle, not because they're more interesting or fulfilling or whatever. Don't let anyone tell you different."

Just to be fair, even if Derm didn't reimburse well, I would still do it. Why? Bc Primary Care (esp. of adults) is boring as hell, bc you're not actually doing anything.

 

[Anastomoses]

I've accepted that the majority are singularly interested in money - that they find the most financially/lifestyle rewarding and pick the one they can get or dislike the least. I accept another large minority will find what they genuinely like best and pursue that even if it means giving up a few thousand. Anything else?

 

[ulikedaggers]

I've accepted that the majority are singularly interested in money - that they find the most financially/lifestyle rewarding and pick the one they can get or dislike the least. I accept another large minority will find what they genuinely like best and pursue that even if it means giving up a few thousand. Anything else?

Lifestyle and salary play roles in what some people "genuinely like best".

Every other profession is driven by $/hr and it always surprises me when people (especially med people) think medicine is any different.

I didn't come to med school for the perceived huge salary of physicians, but that doesn't mean I want to do primary care and make peanuts (relatively).