I talked to the deans of Western and DMU recently and they said that they biggest thing that the profession has is the challenge of fairness/respect for equivalent pay.
What do you think they are talking about when they say things like that?
I assume what they are saying is - do we get paid the same for a bunion that an orthopedist gets paid? I suppose on some broad level that impacts the profession; however, for you personally, when you sign an associate 75K/30% deal - it won't matter to you whether the orthopedist gets paid $200 more for a bunion since you won't be making any money off of anything you do.
Its been asked before - do orthopedists get paid more per procedure than we do. I won't offer any sort of definitive yes or no because I can't say. These are things I've seen:
-When you are in private practice my big thing is - are your insurance contracts well negotiated. We have another thread on this elsewhere. I have a Medicare advantage contract that pays 65%/75% of the Medicare fee schedule for E&M/Procedures. A friend in town is part of a group that negotiated 100%. So for any procedure he receives 33% more than we do. He's not an orthopedist. He's part of a group that fights and I'm part of a group that complains nothing pays anymore. I tried to fight. I lost. Was offered actually a pay cut by the insurance company.
-That said - I recently went to a dermatologist. He billed me a 99203. My practice's fee schedule for this service is $130. His fee schedule for this was $230. My insurance allowed $128 which I think is what we get paid from this insurance for that service. Presumably his fee structure is setup this way to capture higher billing on cash pay patients and out of network.
-Hospital employed? Well, hospital people tend to be on RVUs. This is an oversimplification, but the procedure is associated with a relative value unit (RVU) which essentially can be assigned to any procedure or service to describe the level of effort, complexity, risk etc. So let's say you do something and its worth 7 RVUs. The RVU will have a dollar value also - the value could be fixed or there could be tiers where the RVUs are worth more as your RVU accumulation increases. If the orthopedist outcollects you in total RVUs and his RVUs scored at a higher tier than you could argue that he was paid more for the procedure, but the real issue is just the total value for the orthopedist was greater for the organization. The simple truth is those RVUs were at their heart based on the ultimate reimbursement that was received by the organization from different payors, medicare, and anything could fluctuate in time.
This is a silly question, but all these things that makes one want to leave, if the same effort was placed in their own shop/solo PP, would that be worth it and compensated properly? I'm sure it can lead to burnout and it's grueling but all those aside, would one see the fruits of their labor if one says screw this I'm opening my own clinic and eat what I kill?
Forget even for a second its a podiatry shop. Its a business. Can you get it started, borrow, find, setup, do the regulatory game, buy, hire, do payroll, get equipment, inventory, bring in customers, do good service, get on insurance panels, submit, get paid, run it efficiently controlling costs, etc.
