Why should pediatricians get paid less

[Whodathunkit]

than say a Dermatologist. I know, I know...it's because of reimbursements and the like. But is that really fair?

I mean, "I believe the children are our future...teach them well and let them lead the way. Show them all the beauty they possess inside..."* Without them, who would realize that little Mikey isn't reaching his developmental milestones and should be tested for lead poisoning? Without them, who would make sure that Little Caleb got his immunizations so that a Whooping Cough outbreak didn't happen at a local school killing 3 kids? Without them, were would we be today?

I don't think our society would take a serious hit if Dermatologists were fewer in number. Not to take anything away from those guys of course. Someone's gotta diagnose that Stevens-Johnson syndrome.

Do you think that Pediatrics would be super popular, with people having to scramble for the match if those guys started at salaries comparable to Derm, Optho, and Rads?

Just wondering...and wondering if anyone else thought the same?

*edited to make more sappy* 🙂

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[ckent]

Pediatricians get paid less because even though every kid needs to see a pediatrician, there are very few sick kids out there. When a pediatrician encounters a sick kid, they are usually sent to a specialist right away. A lot of adult IM physicians do this too, so I'm not criticizing, I'm just saying that if you look at a pediatrician's day, most of their day is spent reassuring parents and "screening" for 1 in 1,000 diseases. Also, because people view health care for kids as essential, people aren't willing to tolerate having to pay a lot for it. Even though a dermatologist could save your life too, people aren't going to get upset if they hear about a patient who doesn't get appropriate dermatologic care because he or she couldn't afford to see a dermatologist. Peds on the other hand will always make a good popular media story.

 

[....]

"I mean, the prospects of our future rest in the hands of these guys(and gals)."

I hate this sort of sappy stuff. sorry.....

Anyway, i feel what your saying but your looking at it too simplisticly. The amount of value somthing has to society or a single person is not SIMPLY its cost and vice versa. Water is ridiculously important but its cheap. Antibiotics save more lives than Chemotherapy does but their prices dont reflect that.

Im sure you can think of dozens of factors that result in lower salaries.

 

[doc_strange2001]

how much do you expect to be able to bill somone for diagnosing and treating an ear infection or giving imunizations?? Not much dough in that

 

[doc05]

Originally posted by Whodathunkit
Do you think that Pediatrics would be super popular, with people having to scramble for the match if those guys started at salaries comparable to Derm, Optho, and Rads?

this will NEVER happen....

(1) there are thousands of peds spots, so we would have to see about a zillion-fold increase in applications for this to occur.
(2) dealing with parents absolutely sucks.
(3) who wants a practice that is 100% kids? it's not for everyone.

 

[PedsEndo]

I have even been told that FP docs or IM docs can bill more for the exact same office visit than a Ped doc can, just because it is an adult and not a child. That seems absurd. I understand that most adults walk in with HTN, Diabetes, CAD, or some other problems but strep throat is strep throat, period. Why is it fair that insurance companies reimburse more for adults than kids?

 

[neutropeniaboy]

Originally posted by doc_strange2001
how much do you expect to be able to bill somone for diagnosing and treating an ear infection or giving imunizations?? Not much dough in that

That's an interesting statement. Where I am now, we can bring in about $200 for a first time visit that ends up being an ear infection, and more if we do an endoscopic evaluation of the throat to rule out a pharyngeal source for the chief complaint of "ear pain."

Most physicians, and I include otolaryngologists as well, just don't know how to bill properly. They don't keep track of how much time they spend with patients (including time thought about patients); they don't bill all the diagnoses that are possible; they don't know when to bill a separate complaint as a new complaint.

This isn't fraud or deception. It's smart business. Like it or not, medicine is now a business.

 

[tofurious]

You're probably right in saying that pediatricians do good work and don't get paid/reimbursed for it. For most pediatricians I know, they went into it because they like childrenj/pediatric diseases rather than because it is the best reimbursed or hottest specialty of its time (Derm). Plus people are not having as many kids as they used to, slowly decreasing the demand of pediatricians.

As for there being very few sick kids, I don't think that's true at all. There are sick kids everywhere, but only a small percentage of them ABSOLUTELY NEED to see a pediatrician for more than reassurance. It's the same thing for the rare diseases: they are difficult to diagnose and probably more difficult to treat, but because how rare it is (low demand) there just isn't the market force driving people into the super subspecialty fields. Along the same line of supply vs. demand, pediatrics has such a high supply of physicians that salaries will always be kept low.

 

[edinOH]

It is because billing is now based on weight. Most kids don't weigh very much so they just bring in less revenue.

On the other hand, I treated this really fat woman the other day in the ED. I swear she was on the sunny side of 600#. I'm sure that lady was worth some bank! Why do you think the gyn-onc surgeons get paid so well?

 

[Idiopathic]

If you are a pediatricin, you need to set up some creative ways to make more $$$. If you just hang out your shingle, you will not rake it in. You have to do some procedures (tough on kids) or really squeeze in a lot of patients (one doc I know tries to see 1 patient every 4 minutes). I am not in favor of that, which is probably why i wouldnt be a good pediatrician, because i would only want to see 2 patients an hour.

 

[Chimera]

how does one explain pediatric specialists making less than their respective IM couterparts?

 

[Idiopathic]

The kids dont control the money.

 

[Thewonderer]

A lot of care given to kids is also seen as "charity work" by the hospitals. sometimes, parents simply cannot afford the care and yet hospitals still have to treat their sick children. In the end, the pediatricians don't get paid when money does not flow into the system.

 

[Sessamoid]

I'm not getting in the argument of whether pediatricians should get paid less than other physicians. But as to why they get paid less than other physicians, one word sums it up: "Medicaid."

 

[edmadison]

You want the real answer? I hope you can handle the truth. The truth is that our society does not value children. Pediatricians get paid less. Crimes against children are not punished as severely. Kill your 2 year old, get 5 years in jail. Kill your husband, get life. Look at the state of our public schools. Citizens want low taxes, teachers want high salary without any proof of competence, administrators want their chronism -- what about the kids? No one cares.

Aside from my rant, one of the reasons peditricians get paid so little is because they do virtually no procedures. Let's face it the technical sometimes brainless parts of medicine are what get reembursed at high levels.

Ed

 

[seattledoc]

I agree with part of edmadison's reasoning. It's all about the procedures. Procedures are the money maker for all specialties. Name a highly paid specialty that isn't procedure based. I'm not saying it's right but the reimbursment is slanted towards procedures rather than diagnosing and Rx.

That's why peds/FP, and IM don't make as much as rads, optho, derm. It's not that they don't have to think as someone implied above, it's that the vast majority of their bills are E&M (eval and mgmt) based and not procedure based. Sucks but true.

e.g. in my office I get paid the equivalent of 5 office visits if I Dx/cast a simple radius buckle fracture, which takes me about 15 minutes and has no real liability risk, intense follow up etc. It doesn't make sense but that's how it's set up.

 

[BPKurtz]

As a future pediatrician, part of me is glad peds pays less than other specialties. It keeps out the riffraff moneygrubbing types who go into surgical subspecialties or the like.

bpkurtz

 

[edmadison]

Originally posted by seattledoc
e.g. in my office I get paid the equivalent of 5 office visits if I Dx/cast a simple radius buckle fracture, which takes me about 15 minutes and has no real liability risk, intense follow up etc. It doesn't make sense but that's how it's set up.

Here's another interesting example: At a hospital I did a rotation at, one of the pediatric oncologist told me that if he does a bone marrow biopsy and the associated sedation he gets paid $120 for the biopsy and nothing for the sedation because its associated with the primary procedure. However, if he calls a gas-passer to do the sedation, he gets paid $120 for the biopsy and the anesthesiologist get $1000 for the sedation. If someone could explain that to me I'd feel a lot better.

In any event what makes me the maddest is that we don't compensate people for their brain power. Thus, there is a brain-drain waya from the specialties that need it. I really can't b*tch too much because even with a lowely academic apointment paying 90K I'll be in the top 2% for income. GO PEDS!

Ed

 

[seattledoc]

It's called "bundling". If the same doc does two procedures that are realted, the ins co. "bundles" them into one payment. If two different docs do the two procedures, then there is no way for them to bundle the payment, tricky huh?!

 

[desalmada]

Originally posted by edmadison
I really can't b*tch too much because even with a lowely academic apointment paying 90K I'll be in the top 2% for income. GO PEDS!

actually, making 90K/year would put you in the top 10%. To be top 5% nowadays, you need to make over 100K, based on 2000 joint economic committee data.

that being said, obviously as a doctor, no matter what specialty, private practice or academic, you'll never starve.

 

[neutropeniaboy]

I'm not going to address the political issues (i.e., "no one cares about the kids," etc.). I have no idea if that participates in the poor reimbursement that pediatricians get.

These are my thoughts.

Pediatricians compete with family care physicians for the treatment of children (internists also compete with FPs for adults, but keep reading). Not all kids go to peds doctors. Furthermore, like most adults, children are for the most part healthy and just need routine maintenance care.

There's no money to be made in maintenance care -- pediatric or adult medicine. Pediatricians have their patients at best up to age 20. Internists and FPs have them until death.

There are more adults than children.

Adults need more routine screening and procedures than children.

Adults need more elective procedures. Some FPs and internists do their own sigmoidoscopies, biopsies, suturing, etc.

Adults create more reasons so see physicians in general for small things.

Parents don't like to take kids out of school; people often don't mind taking time off from work themselves. (It's amazing how many tubes and tonsils are done during the summer and how precipitously the numbers drop once school starts up.)

As previously stated, Medicare and medicaid certainly help the adult care providers.

And as I said previously, billing, billing, billing.