Subspecialists Exempt?

[H_Caulfield]

I've noticed that threads addressing a very specific topic don't often get too far, but I figured I'd see if anyone wanted to discuss. There's a whole lot of talk in the surgery forum about insurance-executive slaughter of patients and mistreatment of doctors, nationalization of medicine, Orwellian-Randian nightmare, etc. I agree with all of it, and I'm a little disgusted that either the government or a private business-man, neither of whom know a thing about medicine, is ultimately going to dictate the way I practice and what I'm allowed to do.

However I've spoken to a number of practicing physicians lately who've told me that higher specialization plays on supply and demand and can give you a lot of power over the craptastic directions in which the whole field is headed. Example: A neurosurgeon told me he's one of a few in his whole area, so he basically just demands payment...and he gets it. A pediatric surgeon told me something very similar. There's no large pool of lesser-qualified people with the same title (let's not get into who I'm referring to here) ready and willing to accept the insulting offers/conditions of the payors (thereby lowering the payment standards, which all in the field must then accept if they want any patients).

A small, rare group of subspecialists can more easily adhere and take some of the power back. Anyone else see/hear much of the same?

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[Winged Scapula]

However I've spoken to a number of practicing physicians lately who've told me that higher specialization plays on supply and demand and can give you a lot of power over the craptastic directions in which the whole field is headed. Example: A neurosurgeon told me he's one of a few in his whole area, so he basically just demands payment...and he gets it. A pediatric surgeon told me something very similar. There's no large pool of lesser-qualified people with the same title (let's not get into who I'm referring to here) ready and willing to accept the insulting offers/conditions of the payors (thereby lowering the payment standards, which all in the field must then accept if they want any patients).

A small, rare group of subspecialists can more easily adhere and take some of the power back. Anyone else see/hear much of the same?

Definitely: the one who holds all the cards has all the power.

It is not uncommon for rural/suburban hospitals to not have a Neurosurgeon, especially after hours. After all, the surgeon can demand and get huge sums of money and benefits and have less demands on his time elsewhere...why would be take a job which entails more call, less money, etc.? Altruism sure...but that doesn't happen as often as we like it.

A specialist in demand is in much more control of these things than those who aren't...to a degree. If there is no one else in town who does what you do - you are in control; this is often the case in smaller areas. If you are salaried, you have more control but as more and more hospitals go to pay for performance for their staff physicians, these surgeons are then subject to the same craptastic reimbursement schedules as everyone else. They can perhaps negotiate better packages with more vacation, less call, more CME money, but not ncessarily pay.

Personally I'm finding the same thing...since it seems like everyone wants a fellowship trained surgeon now, I can refuse interviews with places that require things I have no interest in (like general surgery call). It can be a buyer's market if you have the skills that someone wants. Although, truth be told, the best salaries are in less urban areas in the mid-section of the country.

 

[jdm51]

Yeah but geography is the price subspecialists pay. You need about a million people to keep a pediatric surgeon busy.

 

[PediBoneDoc]

location is the key here more so than the subspecialty. if you are in a small town without a big city near by, the payor is forced to pay a higher price because there is less competition. in larger cities, there is a lot of competition and therefore the payor can can go elsewhere with their business. in many subspecialties, by their nature there are less of them and therefore, less in small towns.