Comments on: Are hospitalists killing primary care?

By: Anonymous

Anonymous — Mon, 29 Oct 2007 01:22:00 +0000

I managed patients intermittently through working ER shifts- an occasional military necessity- while a board-certified radiologist, so your comment isn’t entirely applicable in my case. In any event, if all these imaging tests ARE necessary, then you’re implying that I AM earning my income. My point is that specialist incomes are higher than that of most PCP’s because YOU guys overutilize us. Sure, some of it’s defensive medicine, and some of it is the consequence of 15 minute office visits. Nonetheless, if we were utilized more appropriately, our incomes would fall and be more in line with yours. I’m not out to pick a fight here- I always thought that the brightest minds in medicine should be in primary care, because that theoretically would require the broadest base of knowledge, i.e. the most smarts.

By: Anonymous

Anonymous — Sun, 28 Oct 2007 17:23:00 +0000

It is easy to sit in a dark room and call a test inappropriate when you haven’t actually managed a patient since transitional year of internship.

By: Anonymous

Anonymous — Sun, 28 Oct 2007 14:24:00 +0000

The PCPs could diagnose without all the tests, if they would have enough time with the patient, including time to call back in 2-3 days and check on the patient.

By: Anonymous

Anonymous — Sat, 27 Oct 2007 22:48:00 +0000

As a radiologist, I think one of the reasons we’re relatively well compensated is that PCP’s, at least in my part of the world, seem wholly incapable of diagnosing and treating conditions without ordering a battery of imaging studies, many of which are unnecessary (this in particular applies to ERMD’s). The main reason my income is 300K is because I’m reading almost 25K studies per year. I understand the concept of defensive medicine, but still….. Also, FWIW, the two docs in my county with the highest incomes are both busy PCP’s who use mid-level providers and J-1 visa “indentured servants” to maximize their revenue.

By: Anonymous

Anonymous — Sat, 27 Oct 2007 19:31:00 +0000

I worked as a primary care internist for one year fresh out of residency…for $120,000. Where oh where were these $160,000 jobs??? Not in upstate NY!

That’s beside the point. Primary care blows. Now I am an oncologist. Money talks and doctors walk.

By: The Happy Hospitalist

The Happy Hospitalist — Sat, 27 Oct 2007 19:11:00 +0000

I couldn’t agree with him more. The RVU system in place has caused primary care to get decimated. With that “zero sum game” called Medicare B, the only way to revive primary care is to either increase that pot, which will never happen, shift the pot towards primary care, which will never happen since the committee that determines the value of physician work is controlled by specialists (the RVU committee), or get out of the system–>ala cash only.

I really do hope that the 10% medicare cuts survive. The onslaught of primary care running for the hills will be blinding. Either this will cause a massive backlash by the AARP generation and every congressman and senator will be climbing over each other with “proposals to save primary care”,

or primary care will join the ranks of the dental and vet industries “THRIVING” businesses in a cash only model. I hope it’s the latter one.

Hospital medicine is about primary care getting out of that fixed pot of money by joining forces with organizations (hospitals) who understand the value of primary care within their walls. The cost savings alone by their subsidy of this field creates a ROI that is many times over makes up for their financial subsidy.

Now if only you could get Congress to see the wisdom in the ways of the hospitals, primary care might not only survive, but thrive, and the cost savings alone through the rest of the health care system would be incredible.

The Happy Hospitalist

http://thehappyhospitalist.blogspot.com/

By: Anonymous

Anonymous — Sat, 27 Oct 2007 18:09:00 +0000

I dunno. I wonder if there’s a blessing in disguise with the crisis, in that the remaining PCP’s may decide to go insurance-free. With that, they may well find the rules that shackle them are not state licensure rules, but insurance rules. When you are not contracted with Medicare, Medicaid, the Blues, etc., you find that a lot of the regulations we bitch about…..no longer apply.