Dr. Charles on family physicians

How to pay for it:

1.) Stop futile medicine. Multiple examples: Intubating septic contracted demented 88 y/o nursing home patients. Dializing noncompliant drug abusing patients. Vascular bypassing patients who continue to smoke.

Malpractice environment and unrealistic patient/family expectations prevent the above.

~50% of the healthcare dollar is spent in the last 6 months of life. ~1-2% of patients spend about 70% of the health care dollar. Unlimited spending and futile medicine on the few should not be a “right” while ruining the system for all.

2.) Decrease reimbursement for tertiary procedures (cardiac stent placement, knee replacement, etc.) and increase reimbursement towards primary prevention.

3.) Dream solution. Get rid of the fixed fee system by payers (government and private) all together and return to a true fee for service model. Good doctors can demand their price. Bad doctors fall by the wayside.

4.) Socialize medicine ONLY for primary/preventative care. You want to abuse yourself and then want the deluxe treatment then you pay yourself

CJD

I understand the power of the AARP. I am trying to make the same point you are. No one has the political will or power to place any kind of attack or limits on entitlements. It is a statement of “why” and not “how” to fix it. Until the country is completely bankrupt we won’t have the guts.

Of course you still remain naive about malpractice and costs. I spend easily 7 figures a year with the stroke of a pen to “rule out” that extra 1% that I can’t do on clinical judgement alone. Multiply that by every doctor and you are talking about a lot of savings to be had.

There is plenty of money spent on healthcare. A little redistribution could save primary care. It is not implausible for a specialist to make nearly a million a year performing procedures of marginal benefit and indication in factory like fashion. The same doc of similar skill, talent, brains that went to the same school but chose primary care is really struggling to make 100k. That is fine if people want to pay the specialist out of their own pocket for their services but it is not right for government payers to create this chasm.

Chucky, please let me know where this specialist can make a milion dollars. Does all it take is being unscrupulous? you really think that your three years of training can be equated to the 5 plus years that us greedy, dishonest specialists have to put in?

As long as primary care physicians keep playing the politics of envy, you’ll get nowhere.

I think the best way to go about making a beneficial change in the system is to stop rewarding procedures. When the cardiologists around the block (7 of them who each make more than 3 times what I make) purchased machinery to do carotid ultrasound there was a (surpise) huge spike in the “need” for carotid ultrasound. When they bought nuclear stress test equipment there was a huge spike in the “need” for NSTs.

Medicare pay ZERO for a physical and hundreds for an NST. That needs to change.

Killing the golden geese of colonoscopy, EGD, NST, cath and stent would go a LONG way toward improving preventive medicine.

The canadian system does not have the two tiered pay scale between PMDs and specialists that the US has.

Here in the US, its common for a specialist to make 3-4 times more money than a PCP. In CAnada, that ratio is much smaller, specialists make maybe 70% more than PMDs at MOST.

Canada’s ratio is much better IMHO. Yes, specialists spend longer in training and should get paid more, but not 5 times more than a primary care doc.

I worked in an interventional radiology lab where the fellows were getting starting offers greater tahn 700k.

Ummm, chucky you stated and I quote:

“It is not implausible for a specialist to make nearly a million a year performing procedures of marginal benefit and indication in factory like fashion.”

Am *I* the one who implied that specialists are greedy?? And likely dishonest?? How ELSE is one to take your comment? Please dont’ try to cover up your shoddy argument by accusing me of being defensive.

You want to talk about how to divvy up the finite pie? Fine. That’s what the thread is about and ALL of us are willing to participate in that exchange of ideas. Leave your prejudices at home unless you’re willing to stand by your assertions and back them up with facts.