Why doesn't every FP offer cosmetic derm procedures?

[bronx43]

I seriously cannot understand why more FPs don't offer cosmetics in their practice. It adds little to no overhead to your practice, brings in good chunks of cash from out of pocket payers, and requires little training and no additional certification.
All the "wealthier" FPs I know offer botox, lip injections, hair removal, etc

So, my question is... why not squeeze into that market?

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[DOwnage]

If everyone offered it, its likely that the wealthy physicians you refer to wouldn't be taking home as much

 

[bronx43]

If everyone offered it, its likely that the wealthy physicians you refer to wouldn't be taking home as much

That would be entirely true, but it doesn't explain why everyone doesn't offer it.

 

[deleted87716]

It's boring, and the patients are a pain. That's enough for me.

 

[bronx43]

It's boring, and the patients are a pain. That's enough for me.

Yeah, but let's say you do 2-3 botox injections a week, and 2-3 hair removals. Botox takes you 10-15 minutes tops, and hair removal maybe half an hour. One botox injection brings in a couple hundred bucks, and slightly more for hair removal (depending on size of area). Over the course of a year, you're looking at around $40-50k. I don't know, but $40-50k for 10-20 minutes a day is sublime, even if my patient load consisted of third world dictators.

 

[deleted87716]

We've had people in the group try it, and it doesn't work. There is overhead associated with these sort of things, and the volume is never what you think it'll be, nor is the revenue.

 

[Shinken]

Yeah, but let's say you do 2-3 botox injections a week. One botox injection brings in a couple hundred bucks. Over the course of a year, you're looking at around $40-50k.

You've got your numbers wrong. You can charge much more for Botox. The trick is to have enough people to justify the cost (one vial of Botox is several hundred dollars and has a very short shelf life once reconstituted).

The numbers look great on paper, but unless you live in an area where you can find a lot of patients that want Botox, the cost of training for the injections and buying the vials won't be worth it. As you suggest, you can eliminate the cost of training if you learn during residency, but you still have to make a profit after buying vials.

Also, like Blue said, the patients are....different. Here's a short blurb that gives you an idea of the patients you'll have to deal with:

http://www.acofp.org/membership/practice_management/ancillary/0307.html

This article from Medical Economics gives you an idea of the numbers involved:

http://medicaleconomics.modernmedic...ections/ArticleStandard/Article/detail/301442

I thought about Botox when I was a 4th year med student mainly because a fellow student told me about an FP that was making a killing doing it. However, I decided against it mainly because of the patient population I'd be dealing with (older, vain women...can't stand them) and also because my plans for practice are in small to medium-sized towns. Not too many people in small towns are looking to pay hundreds for Botox.

 

[bronx43]

Thanks for the responses.

So, what exactly separates the income of a FP and a non-cosmetic dermatologist? It seems like they have comparable overheads, and similar patient loads. Do derm visits reimburse that much more? I've seen sources say that the average derm visit is $50-75, which is what I would think the average FP visit would pull. So, where is this discrepancy?

 

[deleted87716]

Thanks for the responses.

So, what exactly separates the income of a FP and a non-cosmetic dermatologist? It seems like they have comparable overheads, and similar patient loads. Do derm visits reimburse that much more? I've seen sources say that the average derm visit is $50-75, which is what I would think the average FP visit would pull. So, where is this discrepancy?

We've had threads on this before. If you can practice like a dermatologist (e.g., see 50 patients/day, do a ton of procedures, read your own pathology slides, etc.) then you can probably make as much as a dermatologist. Good luck with that.

 

[Shinken]

So, where is this discrepancy?

Our local dermatologist accepts medical students/residents for rotations. One of the 4th year med students told me he sees an average of 90 patients in a day (yes, ninety patients).

Most dermatologists I know pull that off by running from room to room while a nurse pretty much takes the history before the doc enters the room and the same nurse writes the progress note afterwards. Crazy stuff.

 

[MossPoh]

Just from a business standpoint it seems impossible to be all profit with that. You can't just up and say "I'm going to do botox!" and expect people to walk into your door for it. You have to advertise. Advertising is expensive. If you are trying to mold your practice into something NOT in that domain it also seems like a risky proposition. I may be clueless, but seems like hidden costs lurk everywhere with it.

 

[bronx43]

Our local dermatologist accepts medical students/residents for rotations. One of the 4th year med students told me he sees an average of 90 patients in a day (yes, ninety patients).

Most dermatologists I know pull that off by running from room to room while a nurse pretty much takes the history before the doc enters the room and the same nurse writes the progress note afterwards. Crazy stuff.

Yeah, that's pretty insane. I think that bit of info just made me not want to do derm (not that I necessarily could). I think I'd burn out faster seeing 90 patients (the majority of which you'd prescribe some kind of steroid for) a day than doing shifts in the ER.

 

[bronx43]

Just from a business standpoint it seems impossible to be all profit with that. You can't just up and say "I'm going to do botox!" and expect people to walk into your door for it. You have to advertise. Advertising is expensive. If you are trying to mold your practice into something NOT in that domain it also seems like a risky proposition. I may be clueless, but seems like hidden costs lurk everywhere with it.

Certain modes of advertisement does cost money, but you can simply start by telling "that" demographic (vain, older women) that your office now offers botox injections. So, instead of waiting for weeks for an appointment with the local derm, she can come to you on a shorter notice and get the very same service. Like the Shinken's article said, doing 300 injections a year pulls $150-200k. So, even if you shun the expensive forms of advertisement and get 1/3rd of that traffic, you're still doing really good.

 

[sivaprasadjasti]

I think it would be really great if they offered a 2yr or 3yr fellowship in dermatology(similar in duration of Derm residency) after FM. Many fellowships are available after FM like sleep,ID,sports medicine,OB and so on. why not add derm fellowship? If Derm board has a problem with that than may be we can name it skin fellowship. I feel Derm should not be a residency in the first place.

 

[bronx43]

I think it would be really great if they offered a 2yr or 3yr fellowship in dermatology(similar in duration of Derm residency) after FM. Many fellowships are available after FM like sleep,ID,sports medicine,OB and so on. why not add derm fellowship? If Derm board has a problem with that than may be we can name it skin fellowship. I feel Derm should not be a residency in the first place.

This is exactly my sentiment. FP should really start their own fellowship and take the basic dermatological cases, while leaving the "real" derms the complex ones. They should call it a Primary Dermatological Care Fellowship.

If derms don't like it, all 200 of them can march up to Congressional Hall, and try to explain why they are the only ones able to diagnose and treat life threatening skin conditions such as acne vulgaris and tinea versicolor. The FPs, who outnumber derms 50:1, will then proceed to explain why only one group of the two are doctors.

 

[sivaprasadjasti]

If derms don't like it, all 200 of them can march up to Congressional Hall, and try to explain why they are the only ones able to diagnose and treat life threatening skin conditions such as acne vulgaris and tinea versicolor.

That was funny, but on a serious note The American board of family medicine should really look into it. It is good for the patients it will save them from hassle of getting Derm appointment which will take months sometimes, for treatment of life threatening and I might add fatal skin acne . Derm is so protective of their field we must start acting now and protect our interests.

 

[sivaprasadjasti]

the "real" derms the complex ones

I cannot really think of any, I will try to read tonight

 

[deleted87716]

I think it would be really great if they offered a 2yr or 3yr fellowship in dermatology(similar in duration of Derm residency) after FM. Many fellowships are available after FM like sleep,ID,sports medicine,OB and so on. why not add derm fellowship? If Derm board has a problem with that than may be we can name it skin fellowship. I feel Derm should not be a residency in the first place.

Then you don't know very much about dermatology.

Family medicine is a specialty of breadth. Treatment of common skin disorders is already within the scope of family medicine, and advanced training in cosmetic procedures is readily available for the minority of family physicians who are actually interested in messing with that stuff. There is no need for a fellowship.

That being said, there will always be a need for specialists in dermatology, as in every other field. Nobody can possibly know it all, and those who think they do are dangerous. Present company excepted, I hope.

 

[sivaprasadjasti]

Then you don't know very much about dermatology.

Family medicine is a specialty of breadth. Treatment of common skin disorders is already within the scope of family medicine, and advanced training in cosmetic procedures is readily available for the minority of family physicians who are actually interested in messing with that stuff. There is no need for a fellowship.

Well I do know about Derm and it was meant to be a joke and it is not my unique joke every non Derm guy says the same thing. I am aware many FM doctors treat skin conditions so does many IM doctors but my my point is a fellowship would legitimize our work, I dont see nothing wrong with a fellowship, IM has plenty of fellowships of varying duration so does FM. It would be nice to say Blue Dog MD FPDC(Fellow primary derm care) rather than Blue dog MD ,we do treat some skin conditions with few cosmetic procedures. I am sure with a 2 yr or 3 yr fellowship it is very possible to learn most of the out patient DERM if not all. And if this creates turf wars name a specialty that doesnt have one. IR always complaints of CARDS taking interventional procedures and vascular does of IR.

 

[sivaprasadjasti]

and those who think they do are dangerous

My Reason for proposing a fellowship so that we are confident of what we are doing, I remember a friend who went to FM to for a boil on his neck and FM sent him to DERM.

 

[deleted87716]

it was meant to be a joke

We have smilies for that.

my point is a fellowship would legitimize our work

So, you're suggesting that family physicians shouldn't legitimately be treating common skin conditions under the current training and certification guidelines...?

I dont see nothing wrong with a fellowship

I hope you see something wrong with your grammar.

I remember a friend who went to FM to for a boil on his neck and FM sent him to DERM.

I doubt that was because the FP didn't know what to do. He probably just didn't want to deal with it, for whatever reason.

 

[sivaprasadjasti]

So, you're suggesting that family physicians shouldn't legitimately be treating common skin conditions under the current training and certification guidelines...?

I am not talking about common or simple skin conditions, Even medical students can treat mild to moderate acne( though they cannot prescribe they do know the treatment), and you dont need fellowship for that. IM doctors can treat many cardiology,GI,ID issues, so why do the need a fellowship, fellowship is for expertise to treat common/simple as well as complex cases. I hope you got the point.

I hope you see something wrong with your grammar.

I dont see anything rong with a fellowship, If that makes you happy. Sorry I misspelled Wrong(deliberate)

It doubt that was because the FP didn't know what to do. He probably just didn't want to deal with it, for whatever reason.

You can speculate his actions in any way and I am not mind reader and I am not good at knowing probabilities, The end result was he did not treat the patient

 

[sivaprasadjasti]

It doubt that was because the FP didn't know what to do. He probably just didn't want to deal with it, for whatever reason.

where did It come from?

 

[sivaprasadjasti]

Blue dog we can keep arguing all day, but we are missing the point, and the point is how to increase the scope of our practice if you have good suggestions for that bring it on, or you can keep arguing about my grammer

 

[deleted87716]

I am not talking about common or simple skin conditions

Well, you mentioned a boil...that's pretty simple.

fellowship is for expertise to treat common/simple as well as complex cases. I hope you got the point...the point is how to increase the scope of our practice

What would a fellowship in derm enable us do that we can't do already?

where did It come from?

Typo. I'm using my iPad. The on-screen keyboard is a little touchy.

we are missing the point

Well, one of us is.

 

[bronx43]

We have smilies for that.



So, you're suggesting that family physicians shouldn't legitimately be treating common skin conditions under the current training and certification guidelines...?



I hope you see something wrong with your grammar.



I doubt that was because the FP didn't know what to do. He probably just didn't want to deal with it, for whatever reason.

Hey BlueDog, is the reimbursement the same for if you treat a mild skin condition yourself versus sending the patient to a derm?

 

[deleted87716]

Hey BlueDog, is the reimbursement the same for if you treat a mild skin condition yourself versus sending the patient to a derm?

For Medicare, yes.

For commercial payers, it depends on the payer, but many payers reimburse specialists at a higher rate (or, more accurately, reimburse primary care physicians at a lower rate) for the same codes.

 

[sivaprasadjasti]

What would a fellowship in derm enable us do that we can't do already?

For commercial payers, it depends on the payer, but many payers reimburse specialists at a higher rate (or, more accurately, reimburse primary care physicians at a lower rate) for the same codes.

 

[deleted87716]

What would a fellowship in derm enable us do that we can't do already?

For commercial payers, it depends on the payer, but many payers reimburse specialists at a higher rate (or, more accurately, reimburse primary care physicians at a lower rate) for the same codes.

If you're suggesting that fellowship training would enable us to be reimbursed more by commercial payers, you're mistaken.

A fellowship trained FP (in anything) is still an FP.

As an example, our sports medicine guys get paid the same thing for joint injections that I do...they just do a lot more of 'em.

 

[sivaprasadjasti]

As an example, our sports medicine guys get paid the same thing for joint injections that I do...they just do a lot more of 'em.

lot more of 'em, lot more easy dough I am up for that

 

[sivaprasadjasti]

A fellowship trained FP (in anything) is still an FP

When was cardiologist/GI/ID still an IM?

 

[deleted87716]

When was cardiologist/GI/ID still an IM?

Not the same at all.

Fellowships in IM lead to specialty (ABMS) certification. Fellowships in FM, at best, lead to a CAQ.

 

[sivaprasadjasti]

Hey Blue dog I just noticed you are a attending ,you know more than I do. My apologies.

 

[VA Hopeful Dr]

Blue dog we can keep arguing all day, but we are missing the point, and the point is how to increase the scope of our practice if you have good suggestions for that bring it on, or you can keep arguing about my grammer

What, exactly, do you want to be able to do that you can't already do? Sports medicine trained FPs don't do anything that a non-fellowship trained FP is forbidden from doing.

When was cardiologist/GI/ID still an IM?

IM isn't FP. Family fellowships don't make you anything different from an FP, just an FP who has had more training in a certain area.

I don't know why its different, just that it is.

 

[deleted87716]

Hey Blue dog I just noticed you are a attending ,you know more than I do. My apologies.

No need to apologize. I don't care if we have a difference of opinion. I just try to keep the discussions fact-based. There are a lot of misconceptions out there about FM. The main reason I even bother coming here is to inject a little dose of reality occasionally.

 

[sivaprasadjasti]

I don't know why its different, just that it is.

I really want to know why? I Love primary care and it saddens me when I hear specialist nurses make more than doctors

 

[deleted87716]

I really want to know why? I Love primary care and it saddens me when I hear specialist nurses make more than doctors

Now you're changing the subject. The fact that the highest-paid nurse might make more than the lowest-paid doctor shouldn't upset anybody. Who cares? It's apples and oranges.

The ABFM, AAFP, and pretty much everyone connected with FM leadership takes pride in the fact that FM is a specialty of breadth. They don't want family doctors to be specialists. We're generalists. If you don't want to be a generalist, you shouldn't go into FM. Period.

 

[sivaprasadjasti]

Thou speak the truth, But I feel we need to be better compensated for our breadth

 

[deleted87716]

The point is how to increase the scope of our practice

I should also add that fellowship/specialty training doesn't increase one's scope of practice. Typically, it limits it.

I feel we need to be better compensated for our breadth

You and me both.

 

[bronx43]

Thou speak the truth, But I feel we need to be better compensated for our breadth

Either that or pay specialists less. I don't see how anyone can make a coherent argument that a radiologist is worth 2-3 times more than a FP.

 

[VA Hopeful Dr]

Either that or pay specialists less. I don't see how anyone can make a coherent argument that a radiologist is worth 2-3 times more than a FP.

Just to play devil's advocate here...

Longer training, very busy and efficient (they can read films and dictate reports amazingly fast, and we all know that volume = money), increasing numbers of complex scans (they get paid better for MRI, CT than for plain films), plenty of procedures (if you're IR, and a fair number if you're not), malpractice (they may get sued less, but when they do it is often cut and dry ie. you missed this tumor and here's the annotated picture to prove it), and subspecialty training.

On the other hand, specialties like this are more likely to have their reimbursement rates first on the chopping block.

 

[bronx43]

Just to play devil's advocate here...

Longer training, very busy and efficient (they can read films and dictate reports amazingly fast, and we all know that volume = money), increasing numbers of complex scans (they get paid better for MRI, CT than for plain films), plenty of procedures (if you're IR, and a fair number if you're not), malpractice (they may get sued less, but when they do it is often cut and dry ie. you missed this tumor and here's the annotated picture to prove it), and subspecialty training.

On the other hand, specialties like this are more likely to have their reimbursement rates first on the chopping block.

I don't think 2 more years of training equates to a 2-3x difference in pay. Either way, the healthcare bill has a section where it plans to cut reimbursement for all types of diagnostic imaging. It's not looking good for radiologists.
Now, if they'll only do the same for derm...

 

[VA Hopeful Dr]

I don't think 2 more years of training equates to a 2-3x difference in pay. Either way, the healthcare bill has a section where it plans to cut reimbursement for all types of diagnostic imaging. It's not looking good for radiologists.
Now, if they'll only do the same for derm...

Neither do I, hence the other reasons I included.

Meh, I'd rather they not cut derm too much. Much of the non-cosmetic stuff that they do (ie. covered by medicare) is stuff we can do as well (excising lesions, freezing stuff off).

 

[JackADeli]

I don't think 2 more years of training equates to a 2-3x difference in pay....

Neither do I, hence the other reasons I included.
...I'd rather they not cut derm too much. Much of the non-cosmetic stuff that they do... is stuff we can do as well...

I think there in lays your flaw in logic. Everyone likes to purely focus on the length of training.... "oh, it's only one/two/three more years, etc". As noted by others, it isn't simply the training. It is also how and what you practice. If you want the practice of a dermatologist do the work to get there and do the subsequent work to maintain the income once you get there. I just don't get the ease at which people take the logic.... "well, I should be paid as a bus driver the same as the train engineer or airline pilot... etc/etc....". I think the comments below are pertinent. I think it is time to end the trophies for cleanest uniform, whitest socks at the end of the little league season.

We've had threads on this before. If you can practice like a dermatologist (e.g., see 50 patients/day, do a ton of procedures, read your own pathology slides, etc.) then you can probably make as much as a dermatologist...

Our local dermatologist ...sees an average of 90 patients in a day...

...that bit of info just made me not want to do derm (not that I necessarily could). I think I'd burn out faster seeing 90 patients (the majority of which you'd prescribe some kind of steroid for) a day than doing shifts in the ER.

You got it right.... maybe you couldn't even do derm... so why should you earn the same income for a different practice that you have said you wouldn't be able to do???? Because you finished training in less years? Because you see less patients per day? Because you see less patients and are looking for a 4 day/wk, no weekend call job? Please enlighten us.... oh, because you want to do primary care, and you are therefore most important... but we'd like to be able to be paid to do what the subspecialists do....

...I'd rather they not cut derm too much. Much of the non-cosmetic stuff that they do... is stuff we can do as well ...

Do the practice and the work as described by BD and others above and you will get paid accordingly.... That doesn't take a federal healthcare reform. It takes an individual work ethic reform (with some added training).

 

[bronx43]

I think there in lays your flaw in logic. Everyone likes to purely focus on the length of training.... "oh, it's only one/two/three more years, etc". As noted by others, it isn't simply the training. It is also how and what you practice. If you want the practice of a dermatologist do the work to get there and do the subsequent work to maintain the income once you get there. I just don't get the ease at which people take the logic.... "well, I should be paid as a bus driver the same as the train engineer or airline pilot... etc/etc....". I think the comments below are pertinent. I think it is time to end the trophies for cleanest uniform, whitest socks at the end of the little league season.You got it right.... maybe you couldn't even do derm... so why should you earn the same income for a different practice that you have said you wouldn't be able to do???? Because you finished training in less years? Because you see less patients per day? Because you see less patients and are looking for a 4 day/wk, no weekend call job? Please enlighten us.... oh, because you want to do primary care, and you are therefore most important... but we'd like to be able to be paid to do what the subspecialists do....Do the practice and the work as described by BD and others above and you will get paid accordingly.... That doesn't take a federal healthcare reform. It takes an individual work ethic reform (with some added training).

Whoa calm down, cowboy. The only point I was trying to make is that primary care is an under-compensated field. Everything is based on reimbursement rates, which is a largely arbitrary number. How do you determine exactly how much a dermatologist should receive for an acne diagnosis? Or a radiologist for reading a MRI? You can't, because there isn't a right answer. The only gauge you can possibly have is the supply for a service once the cost is determined. Cut the pay too much and you'll see a slow erosion of availability. Pay too much and you have inefficiency.
However, using the bottom of the barrel numbers from FP reimbursement rates, it seems erroneous economics to overspend on specialists, when the system can cut cost by reducing their reimbursement. Would you see dramatic decrease in radiology services should they receive less money for a service? Probably, but how much less, and how much more do you have to pay a radiologist for him to spend the extra two years in residency? My conclusion is that 2-3x is too much, as I can't see radiologists drying up if they made $250k average.

 

[drdev]

Hi Guys, I am new to this forum. I am currently working as a Hospitalist for almost 2 years now. Now planning to go to either Primary care- traditional versus Pulmonary and Critical Care. I am really confused between the two. Hospitalist is great but there is no room for growth after a point. Can someone help me decide between Primary care and PCCM. I know specialist codes have been gone but I believe that if I DONT do it now I will never bbe able to do it. I would appreciate any input from any attendings, fellows or Pulmonologits. Thank you.

Dev

 

[JackADeli]

...I don't know, but $40-50k for 10-20 minutes a day is sublime, even if my patient load consisted of third world dictators.

...made me not want to do derm (not that I necessarily could). I think I'd burn out faster seeing 90 patients...

...The FPs, who outnumber derms 50:1, will then proceed to explain why only one group of the two are doctors.

Either that or pay specialists less. I don't see how anyone can make a coherent argument that a radiologist is worth 2-3 times more than a FP.

...The only point I was trying to make is that primary care is an under-compensated field.

That's really not the only point you were making even if that may have been your intent... guess we will take your word for it.

...Everything is based on reimbursement rates, which is a largely arbitrary number. How do you determine exactly how much a dermatologist should receive for an acne diagnosis?...My conclusion is that 2-3x is too much...

Again, I suspect you will receive the compensation for your work. If a Derm is seeing 90 patients a day and you 25... 2-3x is too much?

I actually agree that PCPs are undercompensated. That being said, it is time to stop arbitrarily declaring that based on minimal portions of the formula. It is very convenient to "class warfare" the matter. Pump one's self up as the foundation, declare it unfair that "only" a "couple more years" of training get too great a compensation difference. But, the formula of compensation is far more then simply a few extra yrs of training.

I find it disengenuous to be making points about "2-3x" more income in a thread about FP performing cosmetic, primarily cash only procedures to squeeze into a market, in which folks want the reimbursement cuts to be limited cause they want to do the procedures but not actually do the training, not actually be "the specialist", not actually do the work (i.e. 50-90 patients per day, read your own slides, etc...). It smaks of hypocrisy.

It also hurts all physicians and definately hurts any true efforts to gain support for increased compensation for the PCPs. Yes, let's join the hoards speaking to the greedy specialists, over paid, etc.... Let's move to a different system.... I suspect, instead of seeing a dramatic increase in PCPs' income, you will first see drops in specialists' income, followed by drops in specialists work motivation (read as availability). Ultimately, we can drag the system down so we all suffer "fairly" and that will simply diminish patient care. Yes, there are plenty of models/examples of other systems out there that have diminished/decreased value of specialists, and yes they have ALL demonstrated marked decrease in access to specialists.... Why do you think the Canadian politician came to the USA for his heart care? Or the Canadian lady that came to the USA for her brain MRI followed by her brain cancer treatment?

"a coherent argument".... you have failed to make such an argument to justify support of increased reimbursements. You do not want to put forth the effort to enter derm residency, you do not want to do the extra length of training, you do not want to see 50-90 patients a day, etc.... In short, you don't want to do the work, you want more money and you want it taken from those that have done the work/continue to do the work... your hands out, "can I have some more please".... Your right, sounds "sublime".

...If you can practice like a dermatologist (e.g., see 50 patients/day, do a ton of procedures, read your own pathology slides, etc.) then you can probably make as much as a dermatologist...

 

[bronx43]

That's really not the only point you were making even if that may have been your intent... guess we will take your word for it.

Again, I suspect you will receive the compensation for your work. If a Derm is seeing 90 patients a day and you 25... 2-3x is too much?

What exactly are you trying to get at, here? That it's purely a capitalist system where the more patients you see the more you receive? If so, then my original point stands. In a capitalist system, the system always cuts cost until a balance is reached between efficiency and functionality. I don't think anyone can believe that should their reimbursement rates be cut so that the average derm who sees 50-75 patients in a day makes $200-250k, there would be a shortage in dermatological services. In fact, I would venture to say that you can cut it all the way to FP numbers without any derm shortage.

If on the other hand, your point is that the FP seeing 25 patients a day is somehow working less diligently than a derm with 90 patients, then I think you better rethink your argument. There's a reason why FPs can only see 25-30 patients, and derms can see many more. Arguing that one deserves more because of greater effort is asinine.

I actually agree that PCPs are undercompensated. That being said, it is time to stop arbitrarily declaring that based on minimal portions of the formula. It is very convenient to "class warfare" the matter. Pump one's self up as the foundation, declare it unfair that "only" a "couple more years" of training get too great a compensation difference. But, the formula of compensation is far more then simply a few extra yrs of training.

I find it disengenuous to be making points about "2-3x" more income in a thread about FP performing cosmetic, primarily cash only procedures to squeeze into a market, in which folks want the reimbursement cuts to be limited cause they want to do the procedures but not actually do the training, not actually be "the specialist", not actually do the work (i.e. 50-90 patients per day, read your own slides, etc...). It smaks of hypocrisy.

How is it disIngenuous? Btw, it's "therein lies."
Since when did I or any of the posters here say that we want the money without seeing the patients? Just so you don't bring up my post about burning out, I was referring to the monotony of derm cases. If FPs can logistically see 90 patients a day without compromising quality of care, I would do it.

It also hurts all physicians and definately hurts any true efforts to gain support for increased compensation for the PCPs. Yes, let's join the hoards speaking to the greedy specialists, over paid, etc.... Let's move to a different system.... I suspect, instead of seeing a dramatic increase in PCPs' income, you will first see drops in specialists' income, followed by drops in specialists work motivation (read as availability).

Right... so over the years as the reimbursement rates dropped precipitously, did we see specialists just throw down their white coats, scrubs, and pagers? No. It's a modern medical fairy tale that physicians will work less in the face of decreased reimbursement. The opposite is closer to reality. Every attending I've talked to admitted of working far more hours to maintain their income, in comparison to the old glory days. Because, to be honest, what else are they going to do? Default on their mortgage? Stop saving for retirement?
Just show me one statistic that shows physician work hours decrease in relation to reimbursement rates. Just one.

Ultimately, we can drag the system down so we all suffer "fairly" and that will simply diminish patient care. Yes, there are plenty of models/examples of other systems out there that have diminished/decreased value of specialists, and yes they have ALL demonstrated marked decrease in access to specialists.... Why do you think the Canadian politician came to the USA for his heart care? Or the Canadian lady that came to the USA for her brain MRI followed by her brain cancer treatment?

Jesus Christ... this "why did blah blah come to the US for blah blah" argument. Until you can offer evidence that the US actually has superior care, then please refrain from this argument. And by evidence, I don't mean bringing up confounding factors which show an ambiguity of a conclusion. Where are actual studies that demonstrate superior overall American health care on a macro scale? Saying Americans are less healthy as a population doesn't prove your point; it merely sheds doubt on the opposing argument.

"a coherent argument".... you have failed to make such an argument to justify support of increased reimbursements. You do not want to put forth the effort to enter derm residency, you do not want to do the extra length of training, you do not want to see 50-90 patients a day, etc.... In short, you don't want to do the work, you want more money and you want it taken from those that have done the work/continue to do the work... your hands out, "can I have some more please".... Your right, sounds "sublime".

You've failed to make a coherent argument of why a dermatologist SHOULD receive their current reimbursement numbers. How high their residents score on step 1, or how many of them are AOA is irrelevant outside of the medical community. The only thing that matters is what is the lowest we can pay you without there being a shortage in future dermatologists?
Explain to me on a economic level why a 10 minute visit for acne should be reimbursed $75, instead of $55.

 

[bronx43]

Oh, and before you make an entire post about it, my reasoning for why I think PC reimbursements should be increased is to make up for the shortage of PCPs around the country.
So, going back to the cost and supply model, PC is one field where costs were cut too drastically, leading to decreased availability over time. Keep in mind that this longterm decrease in availability isn't the same as your idea that doctors will all of a sudden stop working.

 

[JackADeli]

.....

Oh, and .....

I understand, yes, you have little respect for specialists or at least dermatologists who are apparently not doctors in your view. I think I have pretty much stated my points... even if the grammar/spelling/etc... is not perfect. I think you have tried to make your points and positions.

Still, in the end, I think it was said best...

We've had threads on this before. If you can practice like a dermatologist (e.g., see 50 patients/day, do a ton of procedures, read your own pathology slides, etc.) then you can probably make as much as a dermatologist. Good luck with that.

Regards....