FP and IM: Our leaders need more guts

Proceduralists dominate discussion on physician reimbursement. It’s time to get tough:

Everyone knows that medicine is a guild with little response to the free market. But here we have a situation in which a critical commodity (primary care) is systemically and significantly undervalued in a command-and-control economic system.
If I am wrong, and primary care is unnecessary, family medicine (and perhaps internal medicine, as well) will no longer exist in another 20 years. If I am right, the status quo is inherently unstable and ripe for revolution. The revolution will begin when our colleagues in leadership abandon conciliation and discover the guts that have allowed the proceduralists to dominate the herd.

Comments

Anonymous
Specialists are getting robbed in reimbursement too. You should be going after the insurance companies, not other doctors. Quit whining about people that make more $ because they have more training.
DDx:dx
Specialists are getting robbed??????
Our local hospital just hired a fresh radiologist, works 50 hrs/week, 1/3 call for $350K. I’m a family doc for 17 yrs and work 55 hrs/week and made $90k last year….
Lets all be honest. Numbers don’t lie.
Docs and income are like alcoholics. They can’t really tell you how much, and you can’t believe their wild exaggerations.
Anonymous
Fools! This is just what the creators of RVS want–to set the slaves to fighting over the slop instead of asking why they need remain slaves in the first place. Stop fighting among yourselves. The author of the original piece did not go after other doctors, but attacked the centralized price-fixing apparatus which, in defiance of all supply and demand information from the market place, undervalues primary care.
I do believe that the leaders will never have the guts to address the problem effectively. The only path to freedom and fairness is to opt out of socialized medicine and set their own fees at prices which the public are willing to pay.
It is a clear indication in regulated markets that the price is set too low when the service is not available.
Anonymous
lpcAt the current rate, the masses will be cared for by non-physician’s and specialists, often stuck on the treadmill of blinkered narrow care that never connects the dots to understand. At that time, primary care physicians will exist as an elite service for those with the money to pay outside the system and the good sense to know that it is worth it.
Primary care docs who, like most, persist in refusing to insist on being payed what they are worth, expecting instead that their ongoing self-sacrifice will be recongized without asking–who prefer heroism and martyrdom over asking for and collecting a fair fee–will be starved out of business.
Continuing to just take whatever value third parties who are not the beneficiary of the service choose to place on it is economically insane.
jb
Family docs whining about how much more radiologists earn is like schoolteachers whining about MDs is like nurses’ aides whining about nurses, ad nauseam. It’s not exactly a secret that some professions, and segments of some professions, earn more than others. The only thing that prevents family doc from earning that $350K is that for whatever reason, he didn’t do a radiology residency. Wasn’t interested, didn’t have the grades, was ignorant about the field, whatever. It’s your fault that whatever rewards led you to do family practice are not sufficient to make up for a substandard (for MDs) income. Rads residencies are very competitive to get into. FP requires a pulse and an MD (as often as not from Elbonia School of Medicine). Put your money where your mouth is and go back and do a rads residency. You will make up the lost income in no time after you finish. What? You can’t find one to accept you? All the other applicants are AOA and you barely got through MD school? You don’t have the visual skills to interpret images? Not to worry- you can always complain on the internet.
Anonymous
This incessant whining is getting old.
Anonymous
I was AOA and have visual-spatial aptitude in the top 1%. I choose one of the “low paying specialties”–but at the time the differential was not nearly so great. Envy is a sin and I do not allow myself that vice. I am not envious of the tremendous income gains of proceduralists.
I am, and have the right to be, resentful of the changes in the payment system that has put those who don’t benefit from or value my services, with snobby attitudes like jb, in charge of MY fees and my income. JB’s supercilious post is proof again that given the disdain that some specialists have for those who practice the core of medicine, letting committees composed of these arrogant snobs “determine” the value of our work is stupid, and those who play along are suckers.
I do not. The people who need my services value them more than those who don’t–which is logical.
The way for whining PCP’s to “put their money where their mouth is” is not to go do a radiology residency and do something no less valuable, no more challenging, and, for them, far less interesting–it is to declare their independence of collectivist fee setting and live in the free market where they will find patients value their care more than bureaucrats and their incomes will rise–when they have the guts to take the risk and endure the criticism.
It is the radiologist who read the film 2 days after the ER doc and the orthopod had read it and treated the fracture, but who charged more than both of them together who would find patients valuing his services far less than the central controllers in a real free market–especially since that digital image can be sent anywhere in the world, read by someone who earns a fraction of what he earns, and reported back soon enough to do some good. When the cartel breaks . . .
Anonymous
I am looking at my med school alumni–of the top 10, only 2 became proceduralists. The rest are are in primary care or other primarily cognitive specialites. It makes sense. I am not saying that proceduralist specialties are for the unintelligent, but doing the same thing all day everyday is a form of torture for the highly intelligent and curious, and a high tolerance for boredom is an additional qualification for some specialties that many top graduates do not have. Even among surgeons, it is natural that general surgeons earn less than urologists, because the work is more varied and stimulating and therefore more fun. Specialists are compensated in part for that boredom as well as for the stress and responsibility for outcomes–and it is natural that they earn more.
But do not imply that they demand a higher level of intellectual ability. That is poppycock. Specialty choice is far more a matter of temperament and personality than IQ. Granted some are far more competetive, but that is a function not of what is required by the nature of the work, but the differing effectiveness or desire of the leaders in limiting the training opportunities.

FP and IM: Our leaders need more guts

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