Bard-Parker asks: “Can the availability of fellowships leading to high-paying specialist postitions explain how IM and Pediatrics outperform FP?”
The answer is yes. Consider the following rant from an unhappy FP:
Finished FP Residency in 1992. The worst decision I ever made in my life was Family Practice! For the last 16 years or so I have have watched it continually decline in every single way. My income hasn’t kept up with inflation, while the other specialties are reimbursed more than double for way less than half the work. Huge decline in prestige….we are Primary Care Providers now….lumped in with nurses and PA’s and “advanced nurse practictioners”. I can’t believe that anyone would make Family Practice a career choice. Complete and total waste of my young adult years in training and waiting like a fool for FP to make a resurgence. FP is dead. It is no wheresville. I harbor so much anger towards the AAFP and all those who killed Family Practice. I cant even set up a no insurance practice without having to opt-out of medicare which would then make me unemployable. We as Primary Care Providers are held hostage by the Federal Government and insurance companies. Wasted my young life becoming a Family Practioner totally blinded by what others said about how noble it was. Any career choice would have been better for me. Most people with four year degrees have done way better than Primary Care Providers….what a demeaning term given to us now. I hate it.
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{ 7 comments }
Who is this doctor. If he practices in a rural area,he certainly makes more than most of his patients. If he went into to medicine for the money ,he clearly made the wrong choice. If he wanted to be a needed professional resource to his community,then he has no idea of his value.
He may be a hard-working and very frustrated physician who is being squeezed year after year by
his patients, who probably expect that they are entitled to whatever labor they want from him at whatever price their insurance companies feel like paying him, whenever they feel like paying him. Even if he does earn more than his patients, he probably has bigger bills to pay than they do, and a payroll to meet, before he sees his check. Most doctors eat a considerable amount of work-related expenses that the typical person employed by a company does not have to cover out of their personal income. And never mind the huge costs of medical education, which itself can amount to a mortgage without the house. If he makes more than his patients, maybe that is because he has invested more heavily in his professional skills and his labor is worth more. Is it wrong that he should be paid more for it then?
Medical practice is small business. There is no such thing as being able to run in the red for a year. If you do that you go out of business. So as an operator of a small business, private practitioners should seek a return for their enterprise risk. Or do you think that simply because others might “need” their services, they aren’t entitled to that. If you do, then you and I disagree.
Most doctors haven’t gone into medicine for the money. But the up-front costs are large, and have to be repaid at interest, and the opportunity to start to make any progress toward paying those costs off is significantly delayed by the length of education and training required, at a minimum seven years, and frequently more.
Personally, I believe the writer does know his value to his community. What is disturbing is to see how many people seem to think they are entitled to services without facing the responsibility of paying for what they consume.
CHenry
Two points:
(1) Notice the primary role that ego plays in this little tirade:
“we are Primary Care Providers now….lumped in with nurses and PA’s and “advanced nurse practictioners”
“Most people with four year degrees have done way better than Primary Care Providers….what a demeaning term given to us now”
Doctors are so ego-driven it’s really pathetic.
(2) No doubt primary care is undervalued by insurance companies, but that in some respects must reflect market realities. The point is that much of what primary care doctors is highly routine and can be performed reasonably well by PAs and nurses.
Now, if this were a market economy, people would pay more for an excellent primary physician–a generalists superior diagnostic ability, ability to synthesize and coordinate specialists, rapport with patients, etc.
But, it isn’t. FP are gatekeepers whose job it is to limit insurance companies costs.
To the last anonymous poster, two points: first, who cares whether the writer is “ego-driven” in his assessment of his own career. What else are you expecting? He has a gripe about the way he is being paid. Is he supposed to then salve it by adopting some communitarian or altruistic rationalization for the sake of those who would rather not pay for what they are demanding? Sure he is ego-driven, unless he is admitting that he is not worth more than lesser-trained “providers”, and I doubt that was his point. Second, instead of wallowing in self-pity, he ought to drop the plans that treat him poorly, including the Medicaids and their abusive fellow-travellers and seek payment directly from his patients. He should refuse all insurance plans that don’t pay promptly or adequately. As I see it, the worst failure of family practice is in its allowing insurance companies to define who they should be
to their patients and how much they should charge.
Their duty is to provide competent service to their patients. Their right is to demand fair pay in exchange for their work, from those receiving the work. They owe nothing to the insurers.
If this is the worst decision, than the best life decision would be to make a change.
I witnessed two family members (now FP Drs.) stuggle with their specialty choices around the same time period and don’t recall it being commonly viewed as nobel or prestigeous then. Both went to an excellent med school with a longstanding FP program, where professors would put down students who made mistakes with comments such as “What are you going into, family practice”? These Drs. were at the top of their classes and saw the specialty as among the more complex and intellectually stimulating, although it was assumed that only Drs. at the bottom of the class would choose FP. They also valued long term relationships with their patients.
Today they would not change their specialty choices. They have retained the ideals that drew them to medicine in the first place, and have plenty of opportunity to put those ideals into practice. One of these Drs. is my husband, and one of the things I still love about him is that he is willing to provide free care to the uninsured and working poor in his practice.
For those who are concerned about income, he makes approx. $250000 annually, hasn’t done anything to alter his patient mix, upcode his bills, or refused to see any patient regardless of payor source.
I am not sure I understand the logic in comparing to other specialists. I don’t think you can expect justice in any comparison group, and there is not any correlation between what people make and their value to society. If you really want to feel upset, you should compare yourself to CEOs or investment bankers.
I’ve always wondered whether there is justice in having Drs. control their own supply, which maintains their high compensation compared to other professions. Most Drs. even bad ones make a very decent living, which is atypical for any other profession.
Finally, if I recollect my history correctly, wasn’t it the insurance companies that helped raise physician compensation in the first place?
Lot of controversy in the medical blogosphere just now regarding doctors vs. their own egos. Probably feels more deserving. Worked hard to take a job fewer people are choosing off the bat. Point I see, he is aware of his value in the community but that isn’t what he’s talking about. Be good if others in the community [patients] saw value in their PCPs. One doesn’t just “go to the doctor” and he’s there. It takes a lot from “the doctor” too.
It sounds like this doctor is in a difficult situation and I can understand where the doctor is coming from. Other specialties come with higher pay, prestige and authority.
However, I find it hard to believe that most people with four-year degrees have done better. According to the Bureau of Labor Statistics, the average family practioner earns $140k a year (this is the salary, not what stays inside the business). In comparison, an RN earns $52k and a PA earns $67k. Perhaps the RNs and PAs start their careers earlier (earning $200k to $250k) and avoid $150k in student loans. For the physician to get ahead over a 35-year period (making up for loans and the delay in working), he or she only needs to earn an extra $12k a year. In fact, it looks like the family doctor returns to breakeven pretty fast.
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