The dilemma facing private practice cardiologists today:
As such, he refuses to perform what Happyman calls the “trifecta” of ECHO, stress test and holter on every person that walks through the door. This left him the option of seeing, as he puts it “100 patients a day”. He is now joining a practice at a hospital across town.So the message appears to be that if you are a smart clinical cardiologist, and you decide that a patient doesn’t need a bunch of expensive tests, you will actually LOSE money. If you are not clinically skilled, or if you just need to make more money, then doing a bunch of unnecessary tests becomes NECESSARY to stay afloat.
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Why can’t cardiologists live off E&M fees? Many other medical specialists do. I think what is really meant here is that he can’t live like all of the other cardoiologist do without practicing the way they do. No one ever said personal integrity is or should be free.
part of it is patient expectations:
if a patient with palpitations goes to cardiologist A and he evaluates him & says to observe for now, cut out caffeine, etc.(sometimes appropriate), then he goes to cardiologist B who does hits the trifecta, who d’ya think he’ll like better.
oh yeah, also cardiologist B is telling him: “what, dr. x didn’t even do an echo? that’s crazy – you definitely NEED an echo” – going through his mind is “cha-ching!”
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