Comments on: The PCP-specialist income gap http://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-73355 Anonymous Wed, 28 Mar 2007 16:41:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-73355 As a family practicioner I feel that specialists should be paid more for their added training. However, the discrepancy is huge. For example, I know a dermatologist who just finished her 3 year residency (plus a trasitional year) who was getting offers of $300,000 first year out. An primary care physician who has trained just as long gets less than half. So the relationship between time spent training and salary falls apart.<br/>Another point is that primary care physicians are held to the same standards as specialists when making a diagnosis. If a primary care physician was being sued for missing an appendicitis, a surgeon would testify against them. If they missed a melanoma, a dermatologist would testify against them. If the training is so much less, then what people expect out of an encounter should be less...but it's not. As a family practicioner I feel that specialists should be paid more for their added training. However, the discrepancy is huge. For example, I know a dermatologist who just finished her 3 year residency (plus a trasitional year) who was getting offers of $300,000 first year out. An primary care physician who has trained just as long gets less than half. So the relationship between time spent training and salary falls apart.
Another point is that primary care physicians are held to the same standards as specialists when making a diagnosis. If a primary care physician was being sued for missing an appendicitis, a surgeon would testify against them. If they missed a melanoma, a dermatologist would testify against them. If the training is so much less, then what people expect out of an encounter should be less…but it’s not.

]]> By: Robhttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72874 Rob Wed, 14 Mar 2007 22:36:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72874 Most everyone is saying the same thing. I think that surgeons do deserve more than I do, as well as cardiologists and other procedural fields. The problem is not the existence of the gap, it is the degree of the gap and the fact that it is widening. I have sympathy on anyone who decides to bolt for the specialty arena, but I really think there are ways to level the playing field now. <br/><br/>One of the main points of the post is being missed in this discussion: the fact that the lack of PCP's costs the entire system (including the specialists, in the long-run). The approach to the problem is not to just address the inequity, it should be focused instead on the systemic flaws that lead to this inequity.<br/><br/>Rob<br/><br/>PS - thanks for the link. Most everyone is saying the same thing. I think that surgeons do deserve more than I do, as well as cardiologists and other procedural fields. The problem is not the existence of the gap, it is the degree of the gap and the fact that it is widening. I have sympathy on anyone who decides to bolt for the specialty arena, but I really think there are ways to level the playing field now.

One of the main points of the post is being missed in this discussion: the fact that the lack of PCP’s costs the entire system (including the specialists, in the long-run). The approach to the problem is not to just address the inequity, it should be focused instead on the systemic flaws that lead to this inequity.

Rob

PS – thanks for the link.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72872 Anonymous Wed, 14 Mar 2007 20:56:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72872 Alot of specialists see more patients as well. I know an orthopod that sees 100 patients during his office days. Why should he get paid the same as someone seeing 20 patients. You can only cut the pie so may ways as well. There are more overall physicians in primary care than in specialties. If you bump up the salaries of primary care and decrease specialists you spend more money because of the higher number of PCPs and no one is interested in spending more than we are right now. Alot of specialists see more patients as well. I know an orthopod that sees 100 patients during his office days. Why should he get paid the same as someone seeing 20 patients. You can only cut the pie so may ways as well. There are more overall physicians in primary care than in specialties. If you bump up the salaries of primary care and decrease specialists you spend more money because of the higher number of PCPs and no one is interested in spending more than we are right now.

]]> By: Stormyhttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72866 Stormy Wed, 14 Mar 2007 18:16:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72866 I think primary care doctors should decide whether they are paid fairly or not, and argue that. I don't think saying you should be paid more or less than specialists is going to carry a lot of weight.<br/><br/>And remember, for the most part it's not your patients who decide what you are paid. It's insurance companies or congress or somebody else. I think primary care doctors should decide whether they are paid fairly or not, and argue that. I don’t think saying you should be paid more or less than specialists is going to carry a lot of weight.

And remember, for the most part it’s not your patients who decide what you are paid. It’s insurance companies or congress or somebody else.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72865 Anonymous Wed, 14 Mar 2007 18:13:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72865 Two residency programs same institution. One is primary care and has 3 spots a year. It has no call, regular hours and 3 years in length. 20 applied, 10 interviewed they filled 2 out of 3 spots. The other is specialty surgery 8 calls a month, wildly erractic hours, 5 years until graduation. 900 apply they interview 9 and accept 3. Ten with 95% or higher on the USMLE didn't even get an interview. Exactly why again should graduates of each make the same when they get out? Two residency programs same institution. One is primary care and has 3 spots a year. It has no call, regular hours and 3 years in length. 20 applied, 10 interviewed they filled 2 out of 3 spots. The other is specialty surgery 8 calls a month, wildly erractic hours, 5 years until graduation. 900 apply they interview 9 and accept 3. Ten with 95% or higher on the USMLE didn’t even get an interview. Exactly why again should graduates of each make the same when they get out?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72851 Anonymous Wed, 14 Mar 2007 13:04:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72851 This whining by non-procedurists sounds too familiar. I remember in the 1980's, the RVS system and E& M system were created by the feds to supposidly reward cerebral medical care and cut procedural care. Well,guess what: the Ivory Tower whiners fell for this and the feds CUT everybody(PCPs and procedurists). Until all of us(PCPs and specialists) get together and realise that we're on the same team, the feds and insurance companies will continue to control our destiny. This whining by non-procedurists sounds too familiar. I remember in the 1980′s, the RVS system and E& M system were created by the feds to supposidly reward cerebral medical care and cut procedural care. Well,guess what: the Ivory Tower whiners fell for this and the feds CUT everybody(PCPs and procedurists). Until all of us(PCPs and specialists) get together and realise that we’re on the same team, the feds and insurance companies will continue to control our destiny.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72849 Anonymous Wed, 14 Mar 2007 12:34:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72849 jb,<br/><br/>The point is this: When people realize that their work is not rewarded, they will stop doing that work. The payment system is built to reward those who do longer residencies, so everyone is comfortable with a cardiothoracic surgeon making much more than an internist. But when a radiologist does one more year than me, makes 3 times what I do and walks out of the hospital at night when I'm walking in, that grates.<br/><br/>Physicians in training have realized this and the mix of internits going into primary care has gone from 50/50 primary care/specialist to 25/75. Additionally, I know at least 10 people who have been out for one to two years and are matching into a specialty. That is not reflected in the ACGME numbers. <br/><br/>Those numbers are not bullshit. <br/><br/>To the FP who is feeling the pinch: Unfortunately, I think your only option is to go "commando" fire all of your staff and hire a one room office somewhere seeing only 8 patients a day. There are multiple stories on the web of people who did that and almost approximate their previous income while maintaining their sanity. If it makes any difference I know what you are going through.<br/>b jb,

The point is this: When people realize that their work is not rewarded, they will stop doing that work. The payment system is built to reward those who do longer residencies, so everyone is comfortable with a cardiothoracic surgeon making much more than an internist. But when a radiologist does one more year than me, makes 3 times what I do and walks out of the hospital at night when I’m walking in, that grates.

Physicians in training have realized this and the mix of internits going into primary care has gone from 50/50 primary care/specialist to 25/75. Additionally, I know at least 10 people who have been out for one to two years and are matching into a specialty. That is not reflected in the ACGME numbers.

Those numbers are not bullshit.

To the FP who is feeling the pinch: Unfortunately, I think your only option is to go “commando” fire all of your staff and hire a one room office somewhere seeing only 8 patients a day. There are multiple stories on the web of people who did that and almost approximate their previous income while maintaining their sanity. If it makes any difference I know what you are going through.
b

]]> By: jbhttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72848 jb Wed, 14 Mar 2007 10:51:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72848 I'm calling bullshit on this one.<br/>I have done primary care and I have done specialty care (I am a general surgeon).<br/>The longest PC residency is the same length as the shortest SC one.<br/>The surgical residencies are not only longer but more intense than the primary care ones, as a rule (more call, more stress).<br/>The stress of the OR, the stress of post op care when there is a problem, the responsibility of being the "last resort-" are all greater than being the primary care doc who has the luxury of trying this or that and then referring to a medical or surgical specialist if either the patient or physician are not happy with progress being made.<br/><br/>I'm not saying that every internist or FP works less than every specialist, or earns less. It's just that I did not hear any complaints when you were starting your 6 figure jobs 3 years post-MD and I and my colleagues had another 2 or 3 or 4 years of low pay, high hour, high stress training to do.<br/><br/>It's all about money, isn't it? Would you be complaining if we all made the same income? I’m calling bullshit on this one.
I have done primary care and I have done specialty care (I am a general surgeon).
The longest PC residency is the same length as the shortest SC one.
The surgical residencies are not only longer but more intense than the primary care ones, as a rule (more call, more stress).
The stress of the OR, the stress of post op care when there is a problem, the responsibility of being the “last resort-” are all greater than being the primary care doc who has the luxury of trying this or that and then referring to a medical or surgical specialist if either the patient or physician are not happy with progress being made.

I’m not saying that every internist or FP works less than every specialist, or earns less. It’s just that I did not hear any complaints when you were starting your 6 figure jobs 3 years post-MD and I and my colleagues had another 2 or 3 or 4 years of low pay, high hour, high stress training to do.

It’s all about money, isn’t it? Would you be complaining if we all made the same income?

]]> By: nurse ratchetthttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72846 nurse ratchett Wed, 14 Mar 2007 04:30:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72846 happyman- I agree with you 100%. In particular the specialists thinking they have the market on simple diagnoses, and the "Give the patient what they want" mentality. I work in a managed medicaid/medicare plan, and belive me, these patients are as demanding as anyone else. They see a specialist for a diagnostic eval, something that can be managed by their PCP, but said specialist and patient must have another 6 visits. For no abnormalities- just for "monitoring". I feel for the PCP's- you get paid next to nothing, and have the burden of being the one who has to try and convince a patient they really don't need surgery, or specialty consults, all in just a few minutes while still trying to actually provide the care they DO need. happyman- I agree with you 100%. In particular the specialists thinking they have the market on simple diagnoses, and the “Give the patient what they want” mentality. I work in a managed medicaid/medicare plan, and belive me, these patients are as demanding as anyone else. They see a specialist for a diagnostic eval, something that can be managed by their PCP, but said specialist and patient must have another 6 visits. For no abnormalities- just for “monitoring”. I feel for the PCP’s- you get paid next to nothing, and have the burden of being the one who has to try and convince a patient they really don’t need surgery, or specialty consults, all in just a few minutes while still trying to actually provide the care they DO need.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/03/pcp-specialist-income-gap.html#comment-72845 Anonymous Wed, 14 Mar 2007 04:08:00 +0000 http://clients.emmense.com/kevinmd/2007/03/the-pcp-specialist-income-gap.html#comment-72845 Anon903,<br/>I agree with your assessment. However you should feel fortunate that you are an internal medicine doc where you can apply for worthwhile fellowhips (cardiology, heme/one, GI, etc.). I am an FP and in FP the fellowships are, in my opinion, typically wothless. Anon903,
I agree with your assessment. However you should feel fortunate that you are an internal medicine doc where you can apply for worthwhile fellowhips (cardiology, heme/one, GI, etc.). I am an FP and in FP the fellowships are, in my opinion, typically wothless.

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