Why doesn't every FP offer cosmetic derm procedures?

[bronx43]

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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...

Regards....

That was a joke.

Good job for not responding to the thesis of my arguments, and instead create a strawman from a lighthearted inter-disciplinary jab.

 

[JackADeli]

...Good job for not responding to the thesis of my arguments, and instead create a strawman from a lighthearted inter-disciplinary jab.

I am not looking to debate your "thesis"... I will no more prove to you with logic and/or formulas the economics of the matter then you will convince me with science that God/Yahweh/etc.... does not exist. Your position appears to be based on personal belief and/or opinion and/or "faith" about the value of the work and efforts others perform. You have stated as much.... that their work is not worth what they are paid.

As for "strawman", again, I will leave it to the readers to discern the tone and theme of your posts throughout this discussion. I am not sure what "med 2" means, but "interdisciplinary jabs" as you would describe them are probably not advantageous.

Finally, as a trained surgeon, with numerous FP friends and family in the FP field, I find your over-all approach to not be helpful. I have never heard my FP colleagues/friends/family say, "gosh, I don't think that surgeon is doing his/her job by answering their pager in under 10 minutes or coming in in the middle of the night or perform procedures late at night at my request....". I again find your approach and/or "thesis" to be counterproductive to the arguments for increased compensation. As stated, and I will continue to quote:

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

 

[bronx43]

I am not looking to debate your "thesis"... I will no more prove to you with logic and/or formulas the economics of the matter then you will convince me with science that God/Yahweh/etc.... does not exist. Your position appears to be based on personal belief and/or opinion and/or "faith" about the value of the work and efforts others perform. You have stated as much.... that their work is not worth what they are paid.

Um, no. Actually, my position isn't based on personal belief. Yours, however, are. You simply assumed, without providing a reasoning for why a specialist should be paid what he/she is. You stated over and over again that a specialist's pay goes beyond the extra few years of training, yet you never stated what those differences are, and how they applied to the reimbursement on an economic level. For instance, yes I realize that a cardiologist will be reimbursed X for Y service. But, why? How do you come up with that number? And why is that number important?
I did explain my reasoning, and it's based on economics. You? Not so much.

As for "strawman", again, I will leave it to the readers to discern the tone and theme of your posts throughout this discussion. I am not sure what "med 2" means, but "interdisciplinary jabs" as you would describe them are probably not advantageous.

This makes no sense. Non-sequitur, much? "Med 2" means I was a med 2 when I changed my profile, and how does "advantageous" have to do with "interdisciplinary jabs?" Do you even understand what I meant?

Finally, as a trained surgeon, with numerous FP friends and family in the FP field, I find your over-all approach to not be helpful. I have never heard my FP colleagues/friends/family say, "gosh, I don't think that surgeon is doing his/her job by answering their pager in under 10 minutes or coming in in the middle of the night or perform procedures late at night at my request....". I again find your approach and/or "thesis" to be counterproductive to the arguments for increased compensation. As stated, and I will continue to quote:



Regards

Again, how is this relevant? When did I ever say that a surgeon wasn't doing his/her job? You're pulling phantom arguments out of your ass.
How about you back up your argument of why my thesis is counterproductive? Are you going back to your little "ohhhh, but specialists are gonna work less and less, if they get paid less... boo hoo."As I stated in my earlier post, that thinking is pathetically naive.

 

[JackADeli]

..."Med 2" means I was a med 2 when I changed my profile...

Again, what does "med 2" mean? Either way (not sure I have used that in a manner you find acceptable).... good luck.

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.

 

[bronx43]

Again, what does "med 2" mean? Either way (not sure I have used that in a manner you find acceptable).... good luck.

Med 2 means second year medical student, but I'm sure you knew that.

 

[JackADeli]

Med 2 means second year medical student, but I'm sure you knew that.

yeh, sure.... it's a universal shorthand.... actually, everywhere I trained and/or practiced it was "MS2 or MS3, etc....". Colleagues accross the pond have different abbreviations/shorthands. I have seen some interesting abbreviations/shorthands used by EMTs & midlevels. But, I defer again to what you are sure of.....

 

[bronx43]

yeh, sure.... it's a universal shorthand.... actually, everywhere I trained and/or practiced it was "MS2 or MS3, etc....". Colleagues accross the pond have different abbreviations/shorthands. I have seen some interesting abbreviations/shorthands used by EMTs & midlevels. But, I defer again to what you are sure of.....

What I'm sure of? Heh, are you pulling seniority on this? Like, somehow, logic and economics change somewhere between intern year and whenever you feel like a great enlightenment happens?

 

[lowbudget]

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.

How are your SM guys listed/credentialed under each insurance plan? As primary care or specialist?

Anyone with a FP with a CAQ can be considered a specialist in the eyes of the insurance company. Most CAQ are mult-board recognized anyways (adolescent, sports, geri, sleep, hospice) so it's not FM-specific. For example, an IM with sleep CAQ can be considered a sleep specialist if they want to be called that...

And that's the key: it depends on how you list yourself. If a fellowship-CAQ FP lists themselves as a specialist, they can negotiate specialist rates and command specialist copay. If you still do primary care, however, insurance company may not pay you for doing primary care (wellness visits, etc) if you list yourself as a specialist. Plus, patients get confused on when they should pay a lower copay or a higher copay. Lastly, some insurances (particular HMO plans) require that specialists must have a referral from primary care to see them. So, if you're an FP or IM & you credential & bill as a geri or SM specialist with insurance, you may have a higher rate but lower volume (which would be fine in some intances, but not good if you have no patients or referrals). So sometimes, many fellowship trained FP's will list themselves as primary care so they bypass the referral process.

Some insurance plans will allow "dual credential" so that you can list yourself as primary care & a specialist. But Medicare has done away with consultation codes (which pay higher) on 1/1/2010 so this issue has become less important.

It's a business decision. Do you want high rate, maybe low volume with restricted access? Or do you want lower rate, high volume, easy access?

 

[deleted87716]

How are your SM guys listed/credentialed under each insurance plan? As primary care or specialist?

They're listed as specialists, and patients pay specialist co-pays to see them, where appropriate. They don't do any primary care.

I should add that they make more money than most of us doing outpatient primary care. It's a combination of referrals (only Medicare has stopped paying for consult codes at this point, and most young athletes have commercial insurance), procedures (they do a lot of 'em), and volume (they see 40-50 patients/day). They also have in-house XR and PT, which kicks in some ancillary revenue. On top of that, they get stipends from some local schools for being the team docs. Not a bad gig.

 

[Dillatar]

[/QUOTE]Explain to me on a economic level why a 10 minute visit for acne should be reimbursed $75, instead of $55.[/QUOTE]

Because it is what the market will bear.

 

[galactus]

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.

There is ONE derm fellowship for FM's. It's in UTHSC-San Antonio. I interviewed here for FM a few months back and they were telling me they just started this thing this past year.

http://www.aafp.org/fellowships/10000.html

 

[JackADeli]

...Because it is what the market will bear.

I recommend you leave it. The explanations have been given all around on both sides. It's not worth trying to explain.... will just lead to more dragging on of a sparring match, etc.....

 

[bronx43]

Explain to me on a economic level why a 10 minute visit for acne should be reimbursed $75, instead of $55.[/QUOTE]

Because it is what the market will bear.[/QUOTE]

Wrong. Try again.
Medical reimbursement isn't exactly a free market. This is why reimbursement rates were able to be cut steadily for the past decade or so. The only aspect of medicine that acts somewhat like a free market is the supply of future physicians. However, I don't think a 20-something% drop in income will dry that well up anytime soon. Even in the face of continued pressure on physician compensation, the number of MS applicants are staying steady, if not increasing.

 

[bronx43]

I recommend you leave it. The explanations have been given all around on both sides. It's not worth trying to explain.... will just lead to more dragging on of a sparring match, etc.....

Wait, you think you gave an explanation? You did no such thing. The only thing you've provided is a series of unsupported assumptions. I figure it's because you think you've worked hard, and are "entitled" to your current reimbursement rates.
Well, I hate to break it to you, old boy, but you're not entitled to anything. Like I said many times, society doesn't care how hard you've worked or how long your training was, the only thing society cares about is how little they can pay you without drying up the future supply of service providers.

 

[JackADeli]

...$40-50k for 10-20 minutes a day is sublime, even if my patient load consisted of third world dictators.

...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...

...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's pretty insane...that bit of info just made me not want to do derm (not that I necessarily could)....

...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...

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

...If derms don't like it, all 200 of them ...The FPs, who outnumber derms 50:1, will then proceed to explain why only one group of the two are doctors.

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

I understand, yes, you have little respect for specialists or at least dermatologists who are apparently not doctors in your view...

...my position isn't based on personal belief. Yours, however, are. You simply assumed, without providing a reasoning for why a specialist should be paid what he/she is...

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

...You stated over and over again that a specialist's pay goes beyond the extra few years of training, yet you never stated what those differences are...But, why?...How do you come up with that number?...

...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 (yes, ninety patients)...

...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...

...I did explain my reasoning, and it's based on economics. You? Not so much...

...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...

... I'm sure you knew that.

...But, I defer again to what you are sure of.....

What I'm sure of? Heh, are you pulling seniority on this?...

...I figure it's because you think you've worked hard, and are "entitled" to your current reimbursement rates...

Again, I defer to you. You are right. rejoice in your victory. You have proven your thesis.....etc./etc... I could keep splicing things together... but not worth it, I recognize your correctness. You are right......

 

[bronx43]

Again, I defer to you. You are right. rejoice in your victory. You have proven your thesis.....etc./etc... I could keep splicing things together... but not worth it, I recognize your correctness. You are right......

So... your entire point lies on the fact that a FP can make derm money if he/she can do the logistically improbable (or ethically irresponsible)... alright, buddy. Then, I assume you have no problems with surgical reimbursement rates being cut in half, because... well, since, you can just see twice as many patients to make the same amount of money. Otherwise, you don't deserve it, because... you know, YOU are the one who doesn't want to put in the extra effort, and YOU are the one who has the choice of working more. Thinking you deserve more would be like holding out your hand, saying "please sir, may I have some more?"

 

[JackADeli]

... alright, buddy...

We're not buddies.... but sure, again, I defer to you, you are right

...you know, YOU are the one who doesn't want to put in the extra effort, and YOU are the one who has the choice of working more. Thinking you deserve more would be like holding out your hand, saying "please sir, may I have some more?"

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

...How high their residents score on step 1, or how many of them are AOA is irrelevant outside of the medical community...

5+ yrs post Grad training, Q1-3 on-call, coming in, hospital emergencies, etc/etc.... vs 4 days/wk outpt, minimal call, weekends & hollidays regularly off, sure, you are right, I have chosen to not work and/or put forth the "extra effort".....😴

 

[bronx43]

We're not buddies.... but sure, again, I defer to you, you are right

5+ yrs post Grad training, Q1-3 on-call, coming in, hospital emergencies, etc/etc.... vs 4 days/wk, minimal call, weekends regularly off, sure, you are right, I have chosen to not work and/or put forth the "extra" effort.....😴

Buddy, glad to see you've once again missed the point, buddy ole' pal. I'm not saying surgeons work less than FPs, or that FPs should make the same amount as a surgeon. Obviously, a surgeon should make more. But, the only determinant of the respective reimbursement rates should be the only market force present in medicine - lowest cost vs steady stream of future surgeons. Whether or not that threshold has been reached is an entirely different debate. (And just for some perspective, I do believe that certain surgical specialties (GS) have reached this threshold as there are now a shortage of these providers)

The fact that you trained for so long, or work so hard is irrelevant outside of the perceptions of future surgeons. I've said it numerous times and I'll say it again. No one cares that you're Q2 and working 70 a week. They only care about the service you provide and the availability of said service at the lowest possible cost.
And for derm, there's room for more economic efficiency. For PC, there is room for increased reimbursement in order to cause increased supply of providers.
Hope you can understand that, buddy.

 

[JackADeli]

Buddy ...buddy ole' pal....Obviously...I do believe...buddy.

You are correct. I leave you now to be correct amongst those that are interested in continuing the "thesis" discussion. Now employing the ignore list function, Regards....

 

[bronx43]

You are correct. I leave you now to be correct amongst those that are interested in continuing the "thesis" discussion. Now employing the ignore list function, Regards....

Awww, no more epileptic episodes of splicing and dicing? You and your unsupported arguments will be greatly missed, old chap.

Friend.

 

[lowbudget]

Because it is what the market will bear.

Bad response, sorry.

The market does not bear that price point. The market's incredibly distorted. Consumer (patient) is not the payer (insurance company) who is not the price negotiator (Medicare-pegged rates and therefore bureaucratic arm of Congress i.e. CMS). The consumer has imperfect information (internet at best, TV commercials) and relies on a middle person (physician) who is both an agent (dispense acne meds) and a seller (provides consultative knowledge, convinces patient to do in-house procedures).

Pretty complicated f'ed up market totally incapable of pricing correctly if you ask me.

 

[bronx43]

Bad response, sorry.

The market does not bear that price point. The market's incredibly distorted. Consumer (patient) is not the payer (insurance company) who is not the price negotiator (Medicare-pegged rates and therefore bureaucratic arm of Congress i.e. CMS). The consumer has imperfect information (internet at best, TV commercials) and relies on a middle person (physician) who is both an agent (dispense acne meds) and a seller (provides consultative knowledge, convinces patient to do in-house procedures).

Pretty complicated f'ed up market totally incapable of pricing correctly if you ask me.

Bingo. It's actually shocking to me how many medical students are completely clueless about how the medical business functions.

 

[bluealiendoctor]

Shocking? Medical students not knowing medical business? Are ya kiddin' me? Hell, these kids get on this forum asking how to dress for interviews and you're shocked they don't understand the world of business medicine?

 

[deleted87716]

Shocking? Medical students not knowing medical business? Are ya kiddin' me? Hell, these kids get on this forum asking how to dress for interviews and you're shocked they don't understand the world of business medicine?

Most doctors don't understand it, either. 😉