Comments on: Primary care-specialty income gap: It’s worse than we think

By: Anonymous

Anonymous — Thu, 24 May 2007 09:59:00 +0000

Anon 11:34pm
Equating a medicare reimbursement to the doctor’s take home pay is ridiculous. Just like any business, there are costs involved and only a fraction of that is profit. Money has to go to pay the nurses, administrative staff, overhead, malpractice. It’s like saying that a car salesman makes $30k for every car he sells. You should direct your browser to wikipedia and look up the entries on revenue and profit.

By: Anonymous

Anonymous — Thu, 24 May 2007 05:08:00 +0000

The only people that downplay a surgical residency are those that have never been in one. The push for the 80 hr workweek was not because FP and rheumatology residents were driving off the road from exhaustion after a shift.

By: Anonymous

Anonymous — Thu, 24 May 2007 04:34:00 +0000

$180 per hour… OH NO!!! How will the poor allopaths survive on such a pauper’s pittance?

By: Anonymous

Anonymous — Thu, 24 May 2007 03:33:00 +0000

Wow, do primary care Doc’s ever moan, groan and whine. If you make 89.00 for every patient you see then you know you are well paid. I have not ever been to a promary care Doc who spends anythihg close to 30 minutes with me. So if you bill that code and then see 1 or 2 other patients in that half hour then you have just made out pretty good..

If the GIs have it so good then why didn’t YOU become one?

By: Happyman

Happyman — Thu, 24 May 2007 01:36:00 +0000

You're welcome. I can't think of any of my internal med colleagues who doesn't sympathize with what surgeons are putting up these days - if possible it's even worse than what's happening w/primary care:

1- taking ER call mandatory (hospital administrators getting away with being slavemasters)

2- crappy reimbursement for EMERGENCY operations like appys & ortho surgeries, and potentially NO reimbursement e.g. the drunk a--hole with no insurance who gets a femur fracture in a car wreck

3- malpractice, clearly a higher risk for surgeons than for me

I think that the general surgeons are getting REALLY screwed by all the 3rd parties in medicine. The only way this will change is if a critical mass, e.g., refuse taking ER call for free. Hospitals get money from the gov't to cover the costs of dealing with the uninsured/medicaid population, then hospital ceo's consciously choose to pass on NONE of that to those doctors taking call. I have stopped taking call for that reason, and am much happier for it. I lose a little business, but not enough to make up for the hassle of admitting an uninsured patient to the ICU in the middle of the night.

But I guess it's harder to divorce yourself from the hospital if you're a general surgeon & it's not really feasible to rely solely on an outpatient surgi-center (?am i right on that - that's what i hear from the gen surg folks in my area).

By: Anonymous

Anonymous — Thu, 24 May 2007 01:11:00 +0000

Thank you for the clarification Happyman. It seems that all too often the epithet of “proceduralists” is aimed at surgeons. ‘m glad to hear that (at least in your own opinion) that does not include surgical specialists

By: Happyman

Happyman — Thu, 24 May 2007 00:55:00 +0000

"more training is better" says anon 7:12;

well i have news for you - the length of training in neurosurgery & rheumatology differ by like a year! so i don't know what you're talking about, you're comparing apples to oranges. And if you think more is better, let your local neurosurgeon manage your diabetes (assuming he even WANTS to) since he has several more years "training" in medicine.

that'd be like letting an airplane mechanic fix your beemer.

People are getting exactly what they deserve - an NP to give them a z-pak on command when they have a cold, but nobody to adequately manage coexistent diabetes, hypertension, coronary disease, chf, etc.

The surgeons on these threads seem to be misinterpreting the PCP gripe with "procedures" to include surgeries - NO internist I know envies the tragically declining reimbursements for things like appys & lap.chole's nowadays - it's the echos and such (outpatient elective procedures reimbursed by medicare) that are the problem.

anon 5:04's implication that medicare's formulas for reimbursement have ANYTHING to do with market forces is just totally incorrect, and grossly uninformed. This has been highlighted time & again, and is the result of the RVU committee being composed mostly of procedural specialists.

By: Anonymous

Anonymous — Thu, 24 May 2007 00:44:00 +0000

As a non-doctor, I can say I am genuinely proud of the folks at Medicare for attempting to contain costs. Most government organizations do not attempt to do this. These are my tax dollars that are being spent and if $89 for a 1/2hr visit is enough to get docs to see patients then I dont want the gov using any more of my money than necessary. Someone at Medicare had the foresight to say,

"You know, if we lower the reimbursement to $89, I think enough doctors will continue to provide high quality care to our patients"

and they were right!!! kudos to them. Doctors do have a voice in this, if you are getting ripped off opt out of Medicare, or just see less of their patients. Until this happens I am an advocate of further reimbursment lowering to ensure that taxpayers are getting the lowest possible price for their dollar.

By: Anonymous

Anonymous — Thu, 24 May 2007 00:12:00 +0000

why not get the government to compensate the health professionals. socialize medicine. and increase the number of specialists. a little more education doesnt hurt.
id rather live in a town with more than 2 neurosurgeons. why are we capping the number of doctors we let subspecialize..?? because of economics. id rather see more peopel in neurosurgery and surgical specialities than doing somthing like rheumatology.. but we have more rheums in town than neurosurgeons.. more training is better. and theres so much to learn!.

By: Anonymous

Anonymous — Wed, 23 May 2007 23:42:00 +0000

Oh please!!! Delete this tired, childish, and divisive thread.

Stop complaining and SET YOUR OWN PRICES.

Why don't you propose an AMA resolution to allow this for ALL doctors, take it to court, and be proactive!