Why salaries are for suckers...

[deleted87716]

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Jack, you're starting to sound like one of those Holocaust deniers. If you're wondering why most of us are having trouble following you, it's because you're not making any sense.

Grass is green, the sky is blue, and primary care physicians are undercompensated...no matter what you think. It's not by choice, and it's not a "marketing" issue. 🙄

 

[JackADeli]

...Grass is green, the sky is blue, and primary care physicians are undercompensated...no matter what you think...

Maybe, but I haven't seen an explanation demonstration of how that determination is arrived at other then comparing end of year or end of career income without taking into account what was put into obtaining said income.

...Probably half the discussion has been about what exactly is the money....

...it's not a "marketing" issue...

The marketing issue I referred to was in reference to effective med-school grads/resident recruitment. Not if you are compensated a certain way.

...you're starting to sound like one of those Holocaust deniers...

Not sure why you like to go there🙁

 

[deleted87716]

Maybe, but I haven't seen an explanation demonstration of how that determination is arrived at other then comparing end of year or end of career income without taking into account what was put into obtaining said income.

It's not complicated.

The marketing issue I referred to was in reference to effective med-school grads/resident recruitment.

If you pay them, they will come. It's that simple.

Not sure why you like to go there🙁

If the shoe fits...

 

[JackADeli]

...I haven't seen an explanation demonstration of how that determination is arrived at other then comparing end of year or end of career income without taking into account what was put into obtaining said income...

It's not complicated...

Maybe not... but nobody seems to demonstrate it if it is so simple. The closest somebody comes to say, ~"I am FP therefore I deserve...".

...If you pay them, they will come. It's that simple...

Maybe. However, no data to show that I have seen. Maybe there are some straddling the fence.. again, I don't know that to be the case. What we do know is:
1. current attendings are arguing it is lack of income discouraging applicants
2. hundreds (?thousands, don't know the number), choose to enter FP/FM at current reimbursement expectation (or previous expectations).
3. current medical students say they enter FP/FM because of the lifestyle/income ratio with type of practice....
4. current medical students saying they choose other specialties because it is actually the scope of the FP/FM job (i.e. they don't like it).
5. current medical students enterring other specialties state they don't like FP/FM and are enterring more "brutal" and longer training programs with more post training work obligations.

It's nice for attendings and senior FP/FM residents to declare most of these students to be liars and really they are choosing careers primarily over the money. The attendings currently are all just exceptions with virtuous monk like callings. The hundreds (?thousands, don't know the number) of current enterring FP/FM residents are also just exceptions with virtuous monk like callings. But, the hundreds choosing something other then FP/FM/PC are mercenaries and liers if they tell you otherwise. Current FP/FM physicians choose for something other then money but if you choose other then FP/FM/PC its for money....

Jack, you're starting to sound like one of those Holocaust deniers...

...If the shoe fits...

Have to love that tactic. You seem too... someone questions if FP/FM amount/type/level of work is deserving of an increas income from what 200k to 350k? So, it is an appropriate comparison... to someone that denies the attrocities of the holocaust? Maybe the income difference of 200K vs 350k is such an attrocity on the same level.... I just don't see it appropriate now, just as I didn't see this sort of thing appropriate in other thread/s. Even at a joking level, I find it innappropriate.

 

[MJB]

I think I'd have to agree that if FP paid what Anesthesia, Urology, etc...paid...with the same hours currently worked...it would be a very popular residency.

 

[JackADeli]

...if FP paid what Anesthesia, Urology, etc...paid...with the same hours currently worked...

Are you talking same hours of anesthesia/Uro/etc... or are you talking same hours of FP/FM? Granted, I have no idea what the hours are of urology...

...Many people view it as boring and feel like they will be relinquished to hypertension and diabetes all day everyday for the rest of their life. I'm not saying that is true...

This is probably my biggest hang up...along with the fact that you don't get to do anything in the OR. I literally thought I was going to die while on my IM rotation...and during my FP rotation when I spent time with the guy that functioned more as an "internist"
I wanted to hurt myself...

The increase in income will not change the basics of what your career/job is composed of... of course you can have increased re-imbursement, work less/part time for current level income and live your working career as sort of a suffering purgatory...

 

[MJB]

Are you talking same hours of anesthesia/Uro/etc... or are you talking same hours of FP/FM? Granted, I have no idea what the hours are of urology...The increase in income will not change the basics of what your career/job is composed of... of course you can have increased re-imbursement, work less/part time for current level income and live your working career as sort of a suffering purgatory...

Basically, if all three paid the same for 50-60 hours a week with little call/weekend/holiday...I think you would see FP become more popular.

It's a 3 year residency. (HUGE plus in my book)
It's broad so you can shape your practice.
You can have autonomy if you want (unlike Gas, for the most part)


I just hear a lot of people say "I like FP, but..."
And a lot of times it has to do with money, and student loan payments.

Having the right to "fire" patients that are non-compliant would be very important to me. I have pretty much zero tolerance for that. I know physicians are technically capable of this, but from what I understand, it's pretty difficult.


I really believe there needs to be more information out there as to what FP in REAL LIFE is composed of...I know I'd listen.

Internal Medicine (real life practice), I've seen..and I liked the office based practice I saw. I just don't know if I could handle a residency of rounding all day with intermittent mental masturbation. That would be, to me, the definition of purgatory.

 

[tony montana]

(Hint: control=happiness.)

Amen!

 

[JackADeli]

Basically, if all three paid the same for 50-60 hours a week with little call/weekend/holiday...I think you would see FP become more popular...

Maybe, but, I haven't seen any evidence for that conclusion. Further, in most cases if you brought the sub-specialists lifestyles or life/work balance up to FP/FM levels in terms of actual practice, they (subspecialists) would not earn the income so envied by the FP/FM folks. More often then not, what I hear/read is maintain FP/FM/PC at ~50-60 hours (or less) a week with little call/weekend/holiday... but increase annual income to that of specilists that work ~60-80+ hours a week, take lots of call/weekend/holiday.

...It's a 3 year residency. (HUGE plus in my book)...

Right. It's another trade off. Many of the subspecialists put in not only a significant number of additional years of training but also the intensity and workload of training is significantly higher. It is the balance in lifestyle and training and lower intensity that numerous students also report attracks them to FP/FM/PC. In fact, I have often heard some say, "if surgery training was made easier and more like FP/FM/PC and the lifestyle of a surgeon was more like FP/FM/PC I would have done surgery".

Surgery: brutal hours and stress in residency, long hours and lots of call, especially in rural areas, malpractice claims...

OB: babies don't know the difference between night and day, malpractice claims...

So, I suspect that it is not just a money thing. I do believe the actual practice has a great deal to do with what we choose.

....I just hear a lot of people say "I like FP, but..."
And a lot of times it has to do with money, and student loan payments...

I hear the same about surgery, "I like surgery (or surgery is fascinating, etc), but...." And a lot of times it has to do with the length & intensity of training, the workload and lifestyle. As for money, I hear that as one dimensional from some. Some want to work as little as possible but make large sums. I think that is normal human/American profit motive. When you look at some of these folks in FP/FM that want the money, they hustle and make the money (i.e. >$200+). Do they make it sitting around, enjoying a 40 hour week? Probably not unless they are concierge. As to student loans, with a income somewhere in the range of $200k (plenty of folks start >$175 and quite a few >$200), you can make payments on a $200+ loan and still enjoy your life.

...No matter what you choose, don't feel too weighed down by your debt. You can pay down that burden in FM...

...Internal Medicine (real life practice), I've seen..and I liked the office based practice I saw. I just don't know if I could handle a residency of rounding all day with intermittent mental masturbation. That would be, to me, the definition of purgatory.

Then you need to be careful when thinking about FP/FM/PC. You need to look at what your residency will be and if FP/FM does not have too much rounding and mental mast. for you. Only you can answer what is too much. Again, plenty of folks choose one specialty over the other based on what they can not tolerate during training be it 3 or 5 years. I think it is a mistake to choose a career based primarily on the intensity of training or components of training you do not like. Most specialties can be tailored after training.

I really believe there needs to be more information out there as to what FP in REAL LIFE is composed of...I know I'd listen...

Which goes back to my earlier comments about poor marketing. The students I know that choose FP/FM do so because they like the field and the life balance. They are not self-sacrificing monks that believe they and their families will be living from check to check and drowned under their student loans. They also know what work level is put forth by the sub specialists to earn the incomes they earn. Some go on to work in FP/FM at the ~same levels and earn incomes very comparable if not greater then many general surgeons and still have a better lifestyle, life balance then the surgeons. You look on this forum and plenty of folks will discuss what their contracts are and the income they are signing for and the production expectations in a few years based on clinic track record(not based on expected political or insurance changes). However, you might also find those painting FP/FM/PC as being in such a suffering, overworked and underpaid profession. Again, back to my earlier comments about conflicting discussion that can be confusing to medical students. I suspect based on what I read here, the FP/FM/PCPs I know are apparently unique or exceptions because they hustle and they make bank for it.

Also, take a look at the following website just to get a taste of some of the opportunities and practices out there. It is by no means exhaustive:

http://www.aafp.org/careerads/

 

[deleted87716]

Jack, your arguments appear to be based on the belief that all fields reward physicians similarly for a given amount of work, which is clearly not the case in our procedure-focused reimbursement environment.

The idea that a general surgeon and a primary care physician can earn comparable incomes if they work comparable hours is, frankly, laughable.

Likewise, "lifestyle fields" are called that for a reason...more money, less work.

It's not about the hours. It's about the reimbursement.

 

[JackADeli]

...It's nice for attendings and senior FP/FM residents to declare most of these students to be liars and really they are choosing careers primarily over the money. ...Current FP/FM physicians choose for something other then money but if you choose other then FP/FM/PC its for money...

...Likewise, "lifestyle fields" are called that for a reason...more money, less work.

It's not about the hours. It's about the reimbursement.

Maybe, but, nobody has really given an argument as to why a PCP should receive $250-350/year with less amount of formal training, work at a 4-5 day/wk (45-50hrs/wk), limited to no call, limited to no weekends, limited to no hollidays, no OB as compared to a surgeon working 6+ days/wk(65-80+hrs/wk), Q2-3 call, 3 weekends/month, significant number of hollidays and makes $250-350/yr. The medical students I speak with choose a lesser income per year via PC in exchange for lesser training intensity, Lesser training duration, lesser work obligation, etc... All of which goes to a lifestyle choice.

The arguments I hear are ones of "I'm PC therefore I deserve" or "we are the foundation therefore we deserve", etc.... I have not argued PCPs should not necessarily receive more compensation. My argument is that trying to benchmark against other specialties without consideration of:
1. training requirements
2. actual labor/work requirements
Is fairly artificial. It also sets up a divide between other specialties and does not help recruit allies by implying in some manner that the general surgeon is overpaid at their workload and PCPs are underpaid at their workload.

I will leave it at that before I am again accused of something along the lines of the holocaust.🙁

 

[cali-ob]

I actually made a switch from a higher paying field to FP during my intern year. When I was in medical school, I did not have very good exposure to FP and never planned on doing it. From my perspective, it seemed like long days taking care of sick old people with diabetes and hypertension. 😴
People tried to tell me I could still do OB as a FP and I was totally uninterested.
I liked peds, but didn't want to miss out on seeing adult women. When I realized that I totally hated the lifestyle of a surgical specialty, I realized FP was the only place for me to turn that left me with all of the things I liked in medicine (and a few I don't). I don't care what any other doctor makes. I can live just fine off of 170-200K. Would I take more? Absolutely. Do I want to have to work more? No. So I'm happy with what I will get, and I don't begrudge anyone else for what they get. I like my life the way it is now, and that to me, is priceless.

 

[JackADeli]

I actually made a switch from a higher paying field to FP during my intern year. When I was in medical school, I did not have very good exposure to FP and never planned on doing it. From my perspective, it seemed like long days taking care of sick old people with diabetes and hypertension...

Which goes to my earlier points on marketing. I know plenty of FPs/PCPs that went general surgery route and changed midstream to PC. The ones I speak with are thrilled with their decision and the compensation to work ratio.

...I can live just fine off of 170-200K. Would I take more? Absolutely. Do I want to have to work more? No. So I'm happy with what I will get, and I don't begrudge anyone else for what they get. I like my life the way it is now, and that to me, is priceless.

Exactly. A choice is made and the acceptable balance decided on a person by person basis. It just seems folks (as is American) want it all. ~I don't want to work more but I want more pay....

...It's not about hours of work. We work plenty.

 

[deleted87716]

Again, Jack, you seem to be in denial of the obvious.

As for your "marketing" argument, there is nothing incongruous about encouraging students to enter primary care while simultaneously advocating for payment reform. There's no reason for these to be mutually exclusive.

 

[JackADeli]

Again, Jack, you seem to be in denial of the obvious...

Ok, maybe.... it so obvious that no real argument has been made other then... "I'm PC, therefore...". So, I am missing the obvious. However, I think plenty have commented on the satisfaction of their PCP career choice.
Of course, a questioner asks about why folks comment negatively about the type of practice and lifestyle. Your response:

Because a lot of people don't know what they're talking about...

Seriously, though...the main reason that people avoid primary care is because of the money. However, they don't want to admit that, so they have to come up with other "excuses." Most of the time, these are B.S...

1. The people speaking to the type of lifestyle and/or practice in FM/FP do not know what they are talking about and
2. You then proceed to tell him/her its mostly about the money, the folks not wanting to go into PC medicine are lying about their reasoning, and their reasoning is mostly BS....
I think the approach/attitude of:

...attendings and senior FP/FM residents to declare...Current FP/FM physicians choose for something other then money but if you choose other then FP/FM/PC its for money...

Is fairly intellectually dishonest. again, my opinion, probably because I don't see the obvious.

...As for your "marketing" argument, there is nothing incongruous about encouraging students to enter primary care while simultaneously advocating for payment reform. There's no reason for these to be mutually exclusive.

I don't necessarily disagree. although, I am saying one can strive for reform accross professions without necessarily giving a bad image of the profession. You read through these forums and plenty of medical students and/or former alternate specialty drop-outs have repeatedly expressed a misunderstanding of what PC medicine was. Their understanding was one of practices composed of things they did not like. On top of that, it was things they didn't like at excessive amounts with miserable pay. The message they got was ~a career of self sacrifice, doing things you don't like and doing it for little income.

Why is it that I hear over and over again that family med has little control over their lifestyle? ...Part of what is attracting me to FM right now are these perceived options...

Because a lot of people don't know what they're talking about...

...That's a big problem in academic medical centers. Most academic primary care clinics suck. I wouldn't want to work there, either. You have to get out into the "real world" and work with some docs in private practice. That's the only way to see what's possible...

...Many people view it as boring and feel like they will be relinquished to hypertension and diabetes all day everyday for the rest of their life. I'm not saying that is true...

I really believe there needs to be more information out there as to what FP in REAL LIFE is composed of...I know I'd listen...

...When I was in medical school, I did not have very good exposure to FP and never planned on doing it. From my perspective, it seemed like long days taking care of sick old people with diabetes and hypertension...

That is poor marketing. There are plenty of medical students that do not understand the practice of PCPs. They are receiving mis-information. I believe PC medicine is loosing recruits to other specialties because they believe they will be required to practice aspects of medicine they don't like, at work levels they don't like for income to work levels they don't like. When some of these potential recruits have a better grasp of the lifestyle benefits, flexibility of practice in balance with the actual income for work, quite a few suddenly believe PC medicine might be the right career for them.

 

[deleted87716]

Ok, maybe.... it so obvious that no real argument has been made other then... "I'm PC, therefore...".

I have never heard anyone advocate for increased reimbursement for primary care "just because." I have, however, heard arguments based on recognizing and rewarding the cost-savings of good primary care, the need to pay for currently-uncompensated work, taking advantage of the efficiencies of technology ("virtual visits," for example), paying for disease management rather than just episodic care, rewarding quality, and so forth. Maybe you've been hanging around the wrong people.

You read through these forums and plenty of medical students and/or former alternate specialty drop-outs have repeatedly expressed a misunderstanding of what PC medicine was.

Correcting those misperceptions is the main reason I'm here.

 

[JackADeli]

...You read through these forums and plenty of medical students and/or former alternate specialty drop-outs have repeatedly expressed a misunderstanding of what PC medicine was. Their understanding was one of practices composed of things they did not like. ...The message they got was ~a career of self sacrifice, doing things you don't like and doing it for little income. That is poor marketing...

...Correcting those misperceptions is the main reason I'm here.

Definately appreciate that... again, that is the big component of marketing. Hopefully, in addition to successful and/or respected community practitioners such as yourself advocating for the field, medical schools/academic centers will also advocate better (i.e. improve marketing/recruitment).

 

[deleted87716]

Hopefully, in addition to successful and/or respected community practitioners such as yourself advocating for the field, medical schools/academic centers will also advocate better (i.e. improve marketing/recruitment).

Well, it's not like we're not already doing it at the national level. There are lots of resources out there, including: http://fmignet.aafp.org/online/fmig/index.html

Recruiting and promotion at the state and local levels tends to require a more grassroots effort, sometimes helped or hindered by local issues, member involvement, and resource availability. It's a major focus in my state, FWIW.

 

[JackADeli]

...Recruiting and promotion at the state and local levels tends to require a more grassroots effort, sometimes helped or hindered by local issues, member involvement, and resource availability. It's a major focus in my state, FWIW.

I was actually in the FM/FP interest group at my medical school. We organized casting workshops and suture practice labs/seminars.... always with plenty of food and fun. Had local FPs, orthos and other surgeons come and help with instruction. We also had FP senior residents come and help and talk of their experiences and job offers. We routinely graduated large numbers of FP/FM bound.

 

[deleted87716]

I was actually in the FM/FP interest group at my medical school. We organized casting workshops and suture practice labs/seminars.... always with plenty of food and fun. Had local FPs, orthos and other surgeons come and help with instruction. We also had FP senior residents come and help and talk of their experiences and job offers. We routinely graduated large numbers of FP/FM bound.

It also helps to have pizza. 😉

At the state level, recruitment occurs at three points: the undifferentiated med student (encouraging them to consider FM), the FM-bound med student (convincing them to select a residency in your state), and the graduating FM resident (convincing them to join a practice in your state).

Successful recruiting requires ongoing commitment from med schools and residency programs throughout the state, who sometimes feel that they are competing with each other. Frequently, primary care recruitment efforts are at odds with med schools' financial incentives to develop lucrative specialty programs. All of this adds to the challenge.

The best results are achieved when support for primary care is present from day one. Sadly, this is not the case in most allopathic schools nowadays. It is in many osteopathic schools, however, and this is reflected in the relatively high percentage of DO grads who go into primary care. However, even DO schools aren't immune from the financial forces (high debt, low reimbursement) that are influencing career choices, and the percentages are dwindling in some cases.

 

[JackADeli]

It also helps to have pizza. 😉

At the state level, recruitment occurs at three points: the undifferentiated med student (encouraging them to consider FM), the FM-bound med student (convincing them to select a residency in your state), and the graduating FM resident (convincing them to join a practice in your state).

Successful recruiting requires ongoing commitment from med schools and residency programs throughout the state, who sometimes feel that they are competing with each other....

We did pizza or chinese food depending on which we did last.... just to add some variety.

Another important aspect of recruitment... other specialties. I have had some really good mentors. They have always spoken highly of the PC med side of healthcare and did not turn off or turn away students that were interested in PC medicine. Sadly, that is not always the norm. I have seen some of my colleagues in the surgical specialties with little knowledge of PC medicine talk doom and gloom to the med-students and/or treat the med students poorly if they chose PC medicine. The med students then hear some recruitment and some doom and gloom from PCPs.... it distracts them and discourages them from doing what they wanted to do... PC medicine.

I see medicine as a whole a team sport competing against disease and not each other. Unfortunately, too many try to pit specialties against each other.

 

[tony montana]

Great thread, kudos! 👍

 

[JackADeli]

For those interested.... I don't know anything about or have experience with:

http://www.aapp.org/

 

[JackADeli]

Reimbursement relative to other doctors.

The mere fact that you don't appear to read/understand/believe the data doesn't change reality.

Better still, look at the facts:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518004/

[URL]http://content.healthaffairs.org/cgi/content/abstract/29/5/933[/URL]

Through out this thread, folks have been refering to "the data". Though, as I repeatedly responded, no "data" was actually being provided in the responses. I will look back at the replies to see if these articles were actually provided in this thread earlier. I don't recall them being cited.

I have just started reviewing the articles above.... again, my initial impression are two:

1. A claim is made that gross income at the end of the year is significant reason why med-students avoid PC medicine (specificaly FP/FM). Though, so far, I have not seen specific data presented showing that. It would appear, folks make the statement that since FP/FM makes less money then X other specialty, that students are avoiding X other specialty. The presumption seems to be it is the money. Though, I have not seen data showing subspecialty choice is based on increased revenue. In fact, folks around here say they are sure it is and if someone says otherwise, they are probably lying. Again, that belief does not equate "data". That belief is not necessarily supported by what medical students have been saying (again, they must be lying?) and some of the posters here have said it was a lack of understanding or knowledge of what PC medicine was...

2. It appears folks take the approach that Dr. X earns $165K/yr and Dr. Y earns $300k/yr. Therefore there is a disparity/injustice/unfairness. I have not seen much in the data as to what amounts of work are going into this income or how much free time Dr. X may have vs Dr. Y.

I will look at these links further. Thank you for providing them BD.

 

[JackADeli]

[FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B]The Specialist...[FONT=AdvTT2032def7.B+20][FONT=AdvTT2032def7.B+20][FONT=AdvTT2032def7.B+20]–...[FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B]Generalist Income Gap: Can We Narrow It?.
..http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518004/

So my next take on this published interpretation catches my attention:

...evaluation and management (E&M) services (most commonly primary care office visits) and non-E&M services, including surgical, diagnostic (e.g., colonoscopy), and imaging (e.g., CT scans) procedures mostly billed by specialists.

...the volume of non-E&M services has grown far more rapidly

that the volume of E&M services, ...

It comes down to interpretation. Surgical specialties have seen a decline in income over recent years. However, according to this publication, the non-primary care volume (aka work) has increased more then the primary care work. Again, it comes down to interpretation. You can present this information with whatever slant you like and add colorful and stimulating verbage such as "enriching specialists" if you like. However, it does seem to again take the tactic of comparing final incomes while not accounting for the increased work they actually report on the part of "non-E&M" practitioners. This increased work is actually observed by medical students and they often state they do not want that workload and thus choose lesser intensity specialties.... as reported by some in this forum.

The primary care-specialty income gap: why it matters

http://www.ncbi.nlm.nih.gov/pubmed/17310054​

Here the author makes the statement:

This disparity is important because noncompetitive primary care incomes discourage medical school graduates from choosing primary care careers.

I have made the argument repeatedly that nobody has provided "data" to show a work related disparity actually exists. They have only shown differences in annual gross salary without taking into consideration what work is involved in said differences.

Further, the differences in annual gross salary have been attached to or used as the explanation why medical school grads have not chosen PC medicine. This is a presumption/belief and not data.​

In fact, folks have failed to demonstrate or show data that does attached these two things. I believe that would at the very least require large scale surveys of medical school graduates as to why they choose a certain specialty and more importantly why they did not choose PC medicine. Unfortunately, folks have a "belief" and thus presume medical school grads are lying if they don't fit with their beliefs... so, I don't see how a survey would help if PC medicine physicians are unwilling to believe the answer, "Yes, some grads choose other specialties because they do not like PC medicine."​

 

[deleted87716]

"Yes, some grads choose other specialties because they do not like PC medicine."

I'm sure some do. However, if you honestly believe that the income gap isn't driving people away from the field and that we as a society don't need to do anything to correct the problem, you're ignoring the facts.

I know you think surgeons work harder. You keep saying that. I suspect that'll go over better in the surgery forum than it does here.

 

[JackADeli]

...if you honestly believe that the income gap isn't driving people away from the field and that we as a society don't need to do anything to correct the problem, you're ignoring the facts...

Again, BD, you are marrying the word "fact" with belief. I have read here a repeated reference to "data", "facts", etc... but belief does not equate facts.

...I know you think surgeons work harder. You keep saying that...

Not what I am saying. The FACT is what I have asked is to show work levels. I do not have anymore data to show surgeons work harder then you apparently have data to show PC physicians work equally hard as surgeons. That is a simple fact not intended to offend. I am asking questions. Instead of a straightforward honest dialogue with "facts" and "data".... I am hearing attacks. I have been compared to "holocaust deniers". I have read that folks are lying if they say they chose another specialty then PC medicine for reason other then money.

Now back to the actual discussion. Folks refer to data and facts. These are the components of data and facts asked and/or required to make the claims:

1. What percentage of medical student grads chose claim they chose specialty other then PC because they didn't feel PC paid enough? It is a simple question. It is not intended to offend you or anyone else. An answer to this question could support the claims that money is the primary reason. Additionally, even if the answer is the minority (10-20%), and thus NOT the primary reason, it would support the argument that increased money would significantly increase the numbers choosing PC and/or filling training spots.

2. Yes, there is a difference in income between specialties. However to proclaim it a "disparity" requires facts/evidence/data/something. so, I have asked for some sort of facts/evidence/data to allow an honest assessment of work to income/benefits ratio. That is to say a difference does NOT equate a disparity. I have NOT said surgeons work harder. I have asked for something to allow comparison of incomes beyond just declaring the difference between end of year gross income equals "disparity". Without facts or data beyond the difference, it is just an opinion/belief. I am very willing to admit I have no definitive data to say a surgeon works more. Thus, I have asked when folks start comparing income, what level of work are we comparing i.e. hrs/wk, on-call, weekends, hollidays, etc? That is a reasonable question, again not intended as attack or insult just intended to establish some sort of basis for comparison.

.

 

[VA Hopeful Dr]

I think there's a middle ground you two either aren't seeing or aren't willing to admit exists.

Does money matter? Of course it does. If you're in $250k debt after med school, at some level you're going to be looking more at jobs that will let you pay that back without a huge sacrifice in net income. Money can also be a secondary thing. If a med student is torn equally between FM and anesthesia and would be perfectly happy in either field, is it unreasonable to think that income might tip him/her over to anesthesia?

Is money the only problem with FM interest? Not at all. Some medical students hate outpatient clinic. Why would they go into a field that is traditionally very outpatient heavy? Would increasing the salary convince some of these students to do FM instead? Very likely, but do we even want someone who's in FM purely for the money? What about students who hate long-term chronic disease management? That's something traditionally thought of when one thinks of family medicine. What about students who love clinic but hate working with children? Why wouldn't they go IM instead of family? What about the OB end of things? I know 3 people in my class who were all about family medicine until they rotated through our OB department. All 3 switched to IM because the thought of doing OB ever again was just that abhorrent.

You're both being too all-or-nothing and you won't get anywhere if you keep that up.

 

[JackADeli]

I think there's a middle ground...
...You're both being too all-or-nothing and you won't get anywhere if you keep that up.

I agree there is middle ground. I have stated as much throughout this long discussion. It would seem what I state is either ignored or mischaracterized.

...Yes there are some in any number of specialties that find most satisfaction in what they receive in money. But, I don't think everyone falls in that category. I also do not feel money would solve all of FP's problems...

...I just don't think all the folks (or a majority of folks) that have chosen subspecialty practice with the associated lifestyle did so for the money. Most folks I speak with going into subspecialty see the writing on the wall with dropping incomes and still choose these long hour, worse life-style fields because it is what they want to do... The same for folks going into FP/FM. They usually tell me they choose the field because they like it AND the lifestyle/different intensity workload is what they want. Further, they cite that reason as to why they also do NOT plan to do OB.

...I have not said it is all about money. I have not said there is NO relation to money. I have not said money will solve all problems...

...The increase in income will not change the basics of what your career/job is composed of...

...So, I suspect that it is not just a money thing. I do believe the actual practice has a great deal to do with what we choose...

Also, plenty have claimed things "obviously" or the "facts" or the "data"... I have just asked for said factsdata/etc....

 

[deleted87716]

I think there's a middle ground you two either aren't seeing or aren't willing to admit exists....Does money matter? Of course it does...Is money the only problem with FM interest? Not at all. Some medical students hate outpatient clinic. Why would they go into a field that is traditionally very outpatient heavy?...You're both being too all-or-nothing and you won't get anywhere if you keep that up.

Neither I (nor anyone, as far as I can tell) has ever said that if only the money weren't an issue, that everyone would become a family physician. That's a straw man.

The bottom line is that the income gap is a significant factor in the decline of interest in family medicine, and if we don't work to change that, we can only expect things to continue to worsen. This is not merely my opinion. Anyone who doesn't agree with this is simply ignoring the facts. Period.

Jack, if you don't think you've got "all the facts," I invite you to Google to your heart's content. The information you seek is out there in abundance.

 

[JackADeli]

...The bottom line is that the income gap is a significant factor in the decline of interest in family medicine, and if we don't work to change that, we can only expect things to continue to worsen. This is not merely my opinion. Anyone who doesn't agree with this is simply ignoring the facts. Period...

Again, I have stated at more then one occassion on more then one of these threads.... I suspect FP/FM/PC and other specialties are underpaid and/or could benefit from increased income. I have also commented that income may be part of it.

However, plenty of folks around here and throughout this thread have referred to:

....the main reason that people avoid primary care is because of the money. However, they don't want to admit that, so they have to come up with other "excuses." Most of the time, these are B.S....

...FM residencies are not filling as well as some other specialties. Money is absolutely the reason why...

...you seem to be in denial of the obvious....

if you honestly believe that the income gap isn't driving people away from the field and that we as a society don't need to do anything to correct the problem, you're ignoring the facts...

Continued reference to the "main" reason or "absolute" reason, or "obvious" reason, "facts", data, etc.... But, nobody has provided the obvious facts or data. Nobody at all to this point. In fact, if it was the driving reason or absolute reason, you would suspect that was derived from a survey or something. But, that obviously can't be done because "they don't want to admit that..." and are just lying invalidating the surveys. kind of self serving.

Yet, even in this very thread, splenty of folks referring to numerous factors OTHER then money as the reasons they were turned off or less then thrilled in PC medicine.

...components of data and facts asked and/or required to make the claims:

1. What percentage of medical student grads chose claim they chose specialty other then PC because they didn't feel PC paid enough? It is a simple question. It is not intended to offend you or anyone else. An answer to this question could support the claims that money is the primary reason. Additionally, even if the answer is the minority (10-20%), and thus NOT the primary reason, it would support the argument that increased money would significantly increase the numbers choosing PC and/or filling training spots...

Folks are not looking to discuss the facts or data.... it is the approach as practiced by current administration of ~"never let a disaster go to waste". Plenty of hyperbole and clouding of the facts to push for increased income. As I said earlier, that approach that includes insults and/or attacks just divides physicians and prevents recruitment of allies to your goal.

 

[deleted87716]

Again, I have stated at more then one occassion on more then one of these threads.... I suspect FP/FM/PC and other specialties are underpaid and/or could benefit from increased income. I have also commented that income may be part of it.

Then what the heck are you going on about...?!? 😕

Try leaving out all of the unrelated nested quotes and put your argument in 2-3 concise sentences.

 

[JackADeli]

Then what the heck are you going on about...?!? 😕

Try leaving out all of the unrelated nested quotes and put your argument in 2-3 concise sentences.

Yeh, whatever....

.... I suspect FP/FM/PC and other specialties are underpaid and/or could benefit from increased income. I have also commented that income may be part of it...

Folks are not looking to discuss the facts or data...Plenty of hyperbole and clouding of the facts to push for increased income. As I said earlier, that approach that includes insults and/or attacks just divides physicians and prevents recruitment of allies to your goal.

 

[deleted87716]

Yeh, whatever....

I knew it was too much to ask.

Plenty of hyperbole and clouding of the facts to push for increased income. As I said earlier, that approach that includes insults and/or attacks just divides physicians and prevents recruitment of allies to your goal.

Neither I nor anyone in organized family medicine, to my knowledge, have ever insulted or attacked another specialty in our efforts towards payment reform. In fact, we're quite aware of the importance of not doing so, as we're all in it together.

Furthermore, none of the facts in the matter are the least bit "clouded," except perhaps to those who don't want to see.

I'll throw you a bone:

Graduate Medical Education: Trends in Training and Student Debt
GAO-09-438R May 4, 2009
http://www.gao.gov/products/GAO-09-438R

...more medical students have preferred surgical and procedural specialties over primary care specialties since 1999...the desire for a controllable lifestyle...and high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care.

Don't believe the income gap has gotten worse?

 

[JackADeli]

...Graduate Medical Education: Trends in Training and Student Debt
GAO-09-438R May 4, 2009
http://www.gao.gov/products/GAO-09-438R
....

I appreciate that.....

...the percentage of physicians pursuing subspecialty training grew from 2002 to 2007, according to national data. This trend was observed in fields such as orthopedic surgery (a surgical subspecialty), anesthesiology (a procedural specialty), and family medicine (a primary care specialty)...

...While there is no consensus on the most influential factors affecting specialty choice, students consider various factors either individually or in concert when selecting a specialty, according to multiple sources, including published literature, a 2008 AAMC survey, and experts we interviewed. For example, students may consider their intellectual interest in the specialty, their exposure to the specialty, or the prestige of the specialty when making their specialty choice...

Thus, it is NOT obvious, it is NOT a fact, it is NOT absolutely the reason why....

...high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care...

Again, the key words here are "may lead". Not an absolute or obvious "data" based fact by any long stretch. Keep that thought of a maybe reason in context with the other statement made, "...While there is no consensus on the most influential factors affecting specialty choice...". We could go round and round. I have said income/money "may" be part of the decision or may relate to the decision. The reference you provide does not surprise me nor say anything different then what I think I have said in many respects. It surely does not say (from what I have read so far) an income "disparity" exists or that lower income is the reason or lower income is the driving force or etc.... Yes, a difference in gross income exists. A difference does not equate a "disparity" (i.e. ~unfair)...

...Don't believe the income gap has gotten worse?...

I have NOT denied a difference in gross total earnings at any point in this discussion. What I have said is that nobody has provided data or evidence to support the claim that this differences in income represents a "disparity". On the contrary, one of the links you provided found the amount of work performed by non-PC medicine physicians has increased at a greater rate then that of PC physicians.... your reference, not mine.

[FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B]The Specialist...[FONT=AdvTT2032def7.B+20][FONT=AdvTT2032def7.B+20][FONT=AdvTT2032def7.B+20]–...[FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B][FONT=AdvTT2032def7.B]Generalist Income Gap: Can We Narrow It?.
..http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518004/

...evaluation and management (E&M) services (most commonly primarycare office visits) and non-E&M services, including surgical, diagnostic (e.g., colonoscopy), and imaging (e.g., CT scans) procedures mostly billed by specialists. ...But the volume of non-E&M services has grown far more rapidly that the volume of E&M services...

 

[deleted87716]

A difference does not equate a "disparity" (i.e. ~unfair)...

So, you just think that primary care physicians deserve to earn less. That's pretty much it.

 

[JackADeli]

So, you think that primary care physicians deserve to earn less. A lot less. Brilliant. Nothing self-serving about that. 🙄

BD, you can try to be snide and mischaracterize what I have written if you like. However, you and I both know that is not what I have written or said at any point.... PERIOD.

 

[deleted87716]

BD, you can try to be snide and mischaracterize what I have written if you like. However, you and I both know that is not what I have written or said at any point.... PERIOD.

Mmmkay. So, why don't you just say what you mean?

Trying to hold a discussion with you is like talking to Bill Clinton...it depends on what the meaning of the word "is" is.

the volume of non-E&M services has grown far more rapidly that the volume of E&M services...

You seem to feel that "doing more work" equates with "doing more procedures." Well, that's really the point, isn't it? Our current reimbursement system favors procedural work at the expense of cognitive work. That's the problem. That's what needs to change.

 

[JackADeli]

So, you just think that primary care physicians deserve to earn less. That's pretty much it.

Mmmkay. So, why don't you just say what you mean?...

Again, you seem to like the snide...

...Yes, there is a difference in income between specialties. However to proclaim it a "disparity" (i.e.~unfair) requires facts/evidence/data/something. so, I have asked for some sort of facts/evidence/data to allow an honest assessment of work to income/benefits ratio. That is to say a difference does NOT equate a disparity. I have NOT said surgeons work harder. I have asked for something to allow comparison of incomes beyond just declaring the difference between end of year gross income equals "disparity" . Without facts or data beyond the difference, it is just an opinion/belief. I am very willing to admit I have no definitive data to say a surgeon works more. Thus, I have asked when folks start comparing income, what level of work are we comparing i.e. hrs/wk, on-call, weekends, hollidays, etc? That is a reasonable question, again not intended as attack or insult just intended to establish some sort of basis for comparison...

And so, we go back and forth to rehash it because...? you don't like a question? you don't have an answer beyond just your opinion or belief? I don't know. I do know what I have typed and I do know you routinely try to mischaracterize it.

Regards

 

[deleted87716]

Again, you seem to like the snide

I prefer "snark." Snark is my superpower. What's yours? 😉

I think we're just going to have to agree to disagree, Jack. You don't get it, and I don't care.

 

[JackADeli]

....I think we're just going to have to agree to disagree, Jack. You don't get it, and I don't care.

I agree we will have to agree to disagree. You mischaracterize my remarks and/or ignore what has been said/typed.... Thus, I suspect you don't get it and/or don't care.

 

[deleted87716]

You mischaracterize my remarks and/or ignore what has been said/typed...

If I've misunderstood anything that you've written, it wasn't intentional. If I've ignored something, it's because I couldn't figure out what you were trying to say.

I've suggested on prior occasions that you try to post more concisely and to avoid quoting out of context. If ever you choose to follow that advice, I think you'll find yourself less misunderstood.

 

[EdibleEgg]

Jack...

Of course, choosing a residency is not just about money. However, FM and IM residencies fill at a lower rate than other specialties. If primary care starts making more money, then fill rates will go up. If pay goes down, then rates will go down. It is a complicated decision, and money is definitely not the sole factor involved, but it is a very large part. No one is saying that everyone would be FP's if the average income was 500K a year. If surgeons worked 40 hours a week, everyone wouldn't choose a GS residency, but I'm pretty sure landing a residency spot would become more competitive.

One of your problems is you are trying to compare the lowest paid surgeons with the highest paid primary care docs. The senior FP in one of the groups I interviewed with made over 400K. One of the surgeons here makes less than 200K. I assure you both of these are outliers. Just because you know a couple of guys who tell you they make >200K working 9-5 doesn't mean every FP does. It doesn't really matter though. I think GS are generally undercompensated anyway, it's apples and oranges.

 

[JackADeli]

If I've misunderstood anything that you've written, it wasn't intentional. If I've ignored something, it's because I couldn't figure out what you were trying to say.

I've suggested on prior occasions that you try to post more concisely and to avoid quoting out of context. If ever you choose to follow that advice, I think you'll find yourself less misunderstood.

Sure.... thus I have reposted numerous time where I did not say what you were characterizing as my comments.

 

[JackADeli]

...FM residencies are not filling as well as some other specialties. Money is absolutely the reason why...

...Of course, choosing a residency is not just about money. However, FM and IM residencies fill at a lower rate than other specialties. If primary care starts making more money, then fill rates will go up. If pay goes down, then rates will go down. It is a complicated decision, and money is definitely not the sole factor involved, but it is a very large part

Graduate Medical Education: Trends in Training and Student Debt
GAO-09-438R May 4, 2009
http://www.gao.gov/products/GAO-09-438R
the percentage of physicians pursuing subspecialty training grew from 2002 to 2007, according to national data. This trend was observed in ...family medicine (a primary care specialty)...

...While there is no consensus on the most influential factors affecting specialty choice... according to multiple sources, including published literature, a 2008 AAMC survey, and experts we interviewed....

...there is no consensus on the most influential factors affecting specialty choice....

I appreciate the opinion that increased income may increase recruitment. I have said that on several occasions throughout this thread. However, it is just an opinion until some sort of facts/data are presented. The problem is that some have said the data/facts are impossible because folks will lie if asked. As for money being a "very large part", again, an opinion. The presumption is that without facts or data that this is just a truth. Nobody has demonstrated that to be a fact. I refer you to the link above (provided previously by BD) and associated quotes/excerpts.

...One of your problems is you are trying to compare the lowest paid surgeons with the highest paid primary care docs. The senior FP in one of the groups I interviewed with made over 400K. One of the surgeons here makes less than 200K...

Again, I will be the first to say I can use gross generalizations. However, throughout this discussion/conversation, I have repeatedly asked for and looked for a means of comparison. I have not stated FP/FM/PC physicians should make "x" or surgeons should make "y". I have asked for a basis of declaring a "disparity" (i.e. unfair) beyond just comparing the difference in annual gross salary. I have asked that early on and still asked it. It seems folks presume that to ask the question is making a statement of worthiness... thus ccan not ask the question. This leaves the conversation in the realm of belief and dogma. It is not based on "fact" or "data". Again, I don't know the answer. I have asked the question and no grounds or basis of comparison and or determination has really been set forth beyond highlighting the difference in gross annual income.

 

[Slack3r]

Well, if FMs are underpaid, at what point do they become adequately compensated? At what point will the wage disparity become fair?

 

[JackADeli]

Well, if FMs are underpaid, at what point do they become adequately compensated? At what point will the wage disparity become fair?

I am going to let this one fade away.... I think this thread has debated and hashed and rehashed from serveral perspectives much of this point and encourage those with interest to read from the start and formulate their own opinions. I would also encourage folks to really discuss with their mentors what their interest and hope for practice & lifestyle balance. Then make an informed decision. Look beyond what the residency encompasses as you practice in surgical or PC medical specialties can be refined to your interests after residency. Consider all factors and do not get distracted by any factor taken out of context.🙂

 

[deleted87716]

Well, if FMs are underpaid, at what point do they become adequately compensated? At what point will the wage disparity become fair?

Anyone who feels satisfied with their income is probably overpaid. 😉

 

[MedicineDoc]

250,000 to 300,000 in today's money for me without killing myself trying to achieve it. I've got about 200,000 in loans and would like to be able to pay them off and start saving for retirement, a home and potential college for kids after all these years of schooling and training.

 

[JackADeli]

250,000 to 300,000 in today's money for me without killing myself trying to achieve it. I've got about 200,000 in loans and would like to be able to pay them off and start saving for retirement, a home and potential college for kids after all these years of schooling and training.

While not getting back into what each specialty earns or does not earns, I did want to comment in general.

Yes, it is easier to pay back loans of any type with higher income. However, the size of one's debt in most instances of professional career are irrelevant to answering the question of what a job should pay*. It is relevant as to what YOU WANT a job to pay. The same is true about your dreams and aspirations. Would you be less deserving of said income if you have no student loans (maybe scholarships), rent small apartment, have no children, do not plan to have kids in college? All of those factors may be components of what YOU WANT to do with your earnings. But, they are irrelevant to answering the question of what a job should pay.

Also, folks should keep some perspective. Plenty of folks with masters and PhDs and upwards of 100-150k debt and they are not earning much beyond 60-80K. You can pay off student loans with incomes in the range of 100-200K (and less). Plenty of folks out there with 250K home mortgages and incomes under 150K. Plenty of these folks have sizeable loans, children, and dreams of their children attending college.



*so yes, there is something to be said about a return on an investment and so some amount of compensation for the debt you incur and time you invest. I just don't know the math on what that return should be. Should that amount be equal or greater then your financial investment every year for life of your career (i.e. debt = 200K therefore income should be 250+K/yr for life of career?)? Should a job pay enough for you to pay off a twenty year note in 1-2 years? I don't know. But, it doesn't seem like that is the reality/expectation in other specialties/professions outside of medicine.