That is a fatuous and stupid comment. Dishonest, too.

You would lose money if all your patients had Medicaid. If you are lucky, only a small and predictable percentage of patients will have that coveage. But for all those whose coverage undercompensates for their care, there have to be two or three or more whose net payment leaves enough surplus to cover the loss. That is simple enough to understand.

But you weren’t so interested in understanding, you just wanted to drop off that deliberately misleading labor statistic, as if it were some kind of refutation, which of course it isn’t. That labor statistic doesn’t consider the much greater investment cost and opportunity cost to becoming a physician. It doesn’t count consequent reduced career length, or the absence of pension benefits and other typical non-pay personal benefits like paid vacation that other workers get, but which don’t show up on average gross income figures for an entire class of workers. Why not average all baseball players, or musicians.

So why not consider income per career years worked discounted by investment cost, normalized to a typical basket of employee benefits? Well, that might require some work, wouldn’t it? Far easier to dish out the lazy lie.

You did not say that caring for breast cancer patients was easy, and I did not allege that. I objected to your characterization of breast cancer care as being similar to your sleep study interpretation, which you described as “overpaid.” I will accept your description of your own work as overpaid. I earn every dollar that I get from my efforts. Considering the time and effort required, inherent responsibility, and difficulty of my professional efforts, I consider my reimbursement to range from zero to barely adequate. Maybe I could do a few sleep study interpretations on the side. I hear that they pay real well.

Not exactly, Dr Rack. 80% of consults for breast problems do not involve cancer, so there is no surgery to “make money on” for the vast majority. For the ones that do involve surgery, we might be reimbursed $1000 or so if we are fortunate enough to have an insured patient. That $1000 sounds like a lot, expecially for what most surgeons can do in 1-2 hours. That $1000 covers not only the surgery, but 30 minutes or so of immediate post-op work (dictating the op note, writing orders, talking to the family, then talking to the rest of the family who were out smoking when the first conversation was taking place. The patient will be in the hospital overnight typically, and will require standard discharge work (what you would bill as a 99238) the next day. May well require home health care, involving a discussion with Discharge Planner, and forms to fill out. Then the post op care- several visits for wound check, remove sutures and drains, phone calls from patient, family, home health nurses. Fortunately complications such as hematomas and infections are rare, but when they do occur they require multiple visits in additon (you would bill 9921x for these visits; we get 0). Phone calls and arranging consultations with oncologists, radiation therapists, and Reach to Recovery counsellors are needed typically. All this for 90 days, included in the global fee ($1000 if we get it).

It is very rewarding to help a terrified woman get through this ordeal and be able to tell her that she has a very good chance of living a long and healthy life once her treatment is completed. If she has a poor prognosis, it’s much less enjoyable, but still rewarding to help her get through a terrible situation in the best possible way under unfortunate circumstances. But, no, the rewards are not financial. Your implication that caring for breast cancer patients is easy money is offensive.

It might work out for you and the surgeon, but not for the rest of us primary care schlubs.