Kevin, M.D. - Medical Weblog

Welcome to today's reality of a flawed reimbursement scheme. Angry patients can't understand why access to primary care is so going away when their premiums keep going up for which they expect to get "free care".

Well, primary care is getting decimated in a margin squeeze of the century with dropping reimbursments, lead front and center by your beloved Medicare, with every insurance company joining the party. On the bottom end, you have market forces controlling all aspects of cost which, as you know is increasing in cost every year. Not a chance to decrease costs with ever increasing practice expenses, mostly due to the effects of an uninhibited paper trail just to get paid the decreasing reimbursments of third parties.

Throw in inflation and that decreasing reimbursment coupled with rising practice expenses make primary care the red headed step child of medicine (no offense intended to red heads). It is no wonder that today, in 2007 only 20% of medical students are entering primary care.

It takes 7 years of grueling training to become a doctor. You give up your entire 2nd decade of life to train. And you are rewarded with an unsustainable reimbursement scheme.

One way or another, to increase access , you need to bring primary care back front and center. And the only way will be to reverse the margin squeeze with increasing reimbursment, or have the patient pay in a cash only system of access.

You get what you pay for.
Primary care is the worst of all worlds.

Economics says so.

http://thehappyhospitalist.blogspot.com/
 

Perhaps students should think more than twice, before attending medical school.

Are they in it for the money or are they in it for some other reason?
 

“Who is going to take care of me in my aging life?” he asked. “What the hell do I do now?”

Now ain't that the most typical sentiment of old people. "Who's going to take care of me while I drool and crap my pants?" Would it ever occur to patients to actually pay their doc to stay in business? No they'll just whine because their problems are really some body else's problem.
 

Happy Hospitalist wrote: "You give up your entire 2nd decade of life to train."

I don't know about you doc, but I trained during my third decade, from age 21 through age 30. You must have been some kind of prodigy putting in all that grueling time from age 11 to 20.
 

Hey KoKo,

Does it mean I am just in it for the money if I would like to make enough to feed my family? If so then I guess everyone who works at any job is just in it for the money. How shameful.
 

Since when is $60K a year not enough to feed one's family? I bet a lot of this guy's patients would be pleased with that income. Not to say he shouldn't maximize his wealth if he wants, but to claim this income is insufficient for him to remain in a career he says is "the love of my life" is hypocritical.
 

I would hope a doctor understood my intention. Thanks for the sarcasm. I'm smart, but not that good.
 

Koko, if you think financial incentives does not play a big part in any job, you are living in a vacuum. Being a physician is no different. Follow the money and you follow medical students as far away from primary care as possible.
 

"Joseph Mondel, 78, said that his first reaction to the news was fear and then anger. “Who is going to take care of me in my aging life?” he asked. “What the hell do I do now?”

Joe, you could have paid your doctor a living wage. The free ride is over. You believed the democrat party and the crooked lawyers in Washington that you could get something for nothing.

You (and millions like you) foolishly killed the goose that laid the golden eggs with your greed and your false sense of entitlement.


Ed Sodaro MD
 

60,000 is a fine income for a person with a bachelors degree.

Considering that CPAs average 90k, lawyers average 115k, and dentists average over 160k (more than primary care doctors) you would be foolish to go thru 7 years of post-college training to make 60k per year.

Its got nothing to do with being greedy and everything to do with financial common sense.
 

re: still relatively low compared to many doctors and specialists, but a big expense when matched against shrinking Medicare reimbursements that most recently declined anotherer 9.9 percent.

Where do they get these morons that write these stories? The 9.9% reimbursement has not taken effect (yet) Jeez.
 

the contention that a physician would go to 12 years of post high school graduate work, study away their entire 20's, ascertain 100-200 thousand dollars of debt and lose the opportunity costs of all this time investment for the opportunity to earn $60,000 and then be "happy" with $60,000 is laughable.

It's not gredd. It's capitalism and nobody smart enough to get into med school would do it. I can't believe people think like this.

What is a fair wage for a unionized auto worker straight out of highschool, $15,000?
 

Doctors know what they're getting into. Or at least they should by now.

Any physician that as a medical student wrote in their medical school essay "I want to make lots of money" has a legit point of complaint.

All others that wrote "I just want to help even one person" you're getting what you asked for. enjoy your fulfillment and stop griping about money. 60k a year is a lot.

If 60K is NOT enough for you, then hey get out of medicine. Be a dentist, or even a lawyer if you want the money.

FYI, my dentist friends all wrote they were fascinated by teeth. If they happen to be making more money than you docs more power to them.
 

anonymous, what you are proposing is already reality. $60,000 will never support any physician, no matter how good you think it is, in compared to the other options out there. The amount of training and education needed is not comparable with other less educationally intense fields, not even close.

If you want a bunch of hacks taking care of you, then pay for hacks. Otherwise when you someday find that you have no primary care doc to go to to take care of basic medical needs, you can blame it on your own displaced perception of greed. Greed has nothing to do with it. It has everything to do with opportunity and freedom to economically thrive. This is a capitalistic free market we live in.

What folks are doing is exactly as you propose, because that is reality, not greed. They are avoiding primary care altogether, because they know $60,000 is chump change for the efforts it entails when compared to the expenses and financial reimbursment of much less expensive and stressfull educational training tracks outside of medicine.

The reason dentist, and vets for that matter, make more money than primary care docs is because they recieve reimbursment by a CASH model between the patient and doctor, not some socialized, unrealistic reimbursment model called medicare/medicaid.

Do you think the dentists would be so happy if the public were brainwashed to believe that basic tooth care was a right and should be funded by the governement, for which their reimbursment would immediately drop in 1/2. Welcome to primary care, where patients believe that their care should be free.

You get what you pay for, and soon enough, you will be paying insurance that no one will take.
 

Did you all enter med school not having any idea whatsoever that you were running up debt? Didn't you know that student loans would have to be paid back? Did someone promise you that you would make 200,000.00 a year right out of school?

You knew the score from the beginning and that 78 year old man, I bet has paid far more for medical care in his life, than what you would ever imagine.
 

anonymous, your argument is so silly. You are arguing that primary care should accept $60,000. That is not an arguement. They are not accepting it and are leaving in droves, like the physician in this article. Medical students are talking with their wallet by not entering the field. You are left with a major shortage of primary care.

The reimbursment model in the last 10 years has decimated primary care. It was not like this years ago. That's why primary care thrived. So not, the older docs did not enter the field knowing this would happen.

It's like you taking a job knowing very well that you would receive no raise for 10 years and would be told ahead of time you would receive a paycut every year for the next 10 years. The reason you don't have medical students entering primary care is because they won't sign up for such a system, just like you wouldn't. The reason already established primary care docs are leaving is because the supressed reimbursment system that was forced upon them without control has created a disincentive to practice.

Your end result is a massive shortage coming to a neighborhood near you.

You bring up agreat point about being promised 200K right out of school. I can assure you just about every specialty out there pays well north of 200K a year, so the answer is yes, as a newly graduated physician, they could expect to be paid north of 200k.

Primary care does not lend that promise, anymore. That is why only 20% of medical students are entering the field. In case you didn't know, 10 years ago, that number was 50%.

And it is not greed, it is a matter of opportunity cost. Other fields with far less education and training and less risk and cost structures to run a business have similar compensation packages. If you want the smartest people taking care of you, you better pay well enough to entice them to enter that field. Otherwise you have average intelligence docs, the 2.5 GPA's, the "Oh, I'll take a C because it's passing" mentallity that doesn't cut it in the physician educational world. You must pay the best, the best, or they will never become your doctor. You will settle for substandard care.
 

"Other fields with far less education and training and less risk and cost structures to run a business have similar compensation packages."

Beyond professional sports, what other fields have those AVERAGES? Not a few people who start there, but averages?
 

there is no starting and ending wage. The compensation of a physician is completely independent of age. The longer I work and gaining experience, does not equal increased reimbursment from third party payers.

My lawyer in my same highschool class billed me $200 an hour to set up my estate planing, We are the same age. He jump started me by 4 years into the professional world.



My accountant charged me almost $600 to do my taxes, which I guarantee took less than 3 hours to complete.

In the medical clinical world, there is no ladder to climb, there is no expectation of increasing financial status. What you see is what you get. So starting at $200,000 means that is likely your ceiling, forever.

There is no becoming a Director, Vice President, CEO. There is no future income rise. The payment structure of medicine does not work like that.

You are arguing that physicians are paid to much. You are seeing the effects of your argument, with primary care leaving in droves.

It's a completely silly and unfounded stance. IF you want the best and brightest taking care of you, you have to pay for it. That means valuing physician pay above almost all other professional fields, including unionized auto workers. Otherwise you get what you pay for, mediocracy
 

Oh, I forgot, my mechanic charges $75/ hour for labor.

that's $150,000.

I am not aware of any mechanic that requires 12 years of post highschool training.
 

my wifes massage therapist charges $55/hour, + tip, so lets say $70/hour. That's $140,000/year.

I'm pretty sure they don't require any college degree.

The average dentist makes $180,000, with 3 years less training than primary care.

IT jobs coming are coming out at $100,000 staring salaries because that is what the market will pay.

The reimbursment market for medicine is fixed. It is killing your best and brightest from saving lives.


Do I need to keep going?

Your stance is without merit.
 

Happy, you're saying that the longer you're in school, the more you should be making. While I agree that makes initial sense, look at PhD's that go for 7 yrs or longer and come out making 30-50k.

My point is that the length of one's education really has nothing to do with pay...it has to do with one's perceived value.

Women who balk at buying health insurance for a couple hundred a month, walk in and drop 10k on a breast augmentation, lipo and tuck (CASH!) without batting an eye.

But I'm not saying anything you or anybody else on this forum don't already know. I'm honestly kinda defeatist about this issue at this point...I say heck bring in the NP's or PA's and have them be our primary care providers. I'm sure some things will be missed that will end up hurting a small percentage of people....that otherwise would have been caught by an alert doc...but if that's where society is pushing this then so be it.
 

I'm saying that medical students will expect north of $200 right out of school and if you don't pay them that, they will not enter primary care. Does length of school have anything to do with it? of course. Does making sure the best and brighest enter the field Of course, even more importantly. To get that result, you will have to pay well, and that is north of $200,000

Speaking from a position of knowing, I can tell you that a PA and an NP could care for a cold, or a techinical skill trained by a specialist, like post op wound checks.

I would never trust a PA/NP to be able to practice medicine. They simply lack the training, knowledge, and capability. W'ere talking about 2 years of training compared to 7 years for an MD. I know because I have them come through in their clinicals, in their last months of schooling, and they are incapable of diagnosing complex medical conditions, and interplaying medical conditions, medications. They are great data gatherers, but they do not have the ability to connect the dots. That's what MD's do. You try an pretend that primary care docs can be replaced with "providers" Like I said. You get what you pay for. I would never send myself or family to a PA or NP for diagnostic and management of any condition.

Can they diagnose a cold? Sure, so can my wifes med aid sister. I'm sure the public could as well. Can they care for multiple medical conditions that require extensive training to understand how they interplay with each other. Absoluetly not. They don't have the type of training to do so. You are willing to sacrifice a "few percentage" of people. Interesting. You are willing to accept less. Even more interesting. You would rather pay a PA/NP's to give care you would consider substandard, than pay a primary care doc a wage which gives access to standardized care.

You bring up an interesting argument. PhD's practicing for $30,000 a year. That equates to $15/hour. Good luck filing that postition for very long. It won't occur in medicine, which apparently you are willing to dumb down.

Primary care is more than Google, as much as you'd like to think otherwise. You can't google your way to adequate healthcare

Accepting failure is the first step towards defeat. I won't go down that road.

Would you accept a PA to do heart bypass surgery?, How about your heart cath? You colonoscopy? Would you see a NP to manage your chronic lung disease?

If the answer is no, which for me it would be a resounding no, why would you accept less for your basic health care, the type that would prevent you from ever going to a specialist because a PA "missed" the diagnosis.

It makes little sense that you have been brainwashed to accept less for your basic health care needs. It is quite sad.

The system will suffer in your accepting defeat.
 

Anyone who plans to spend 6 to 7 post-college years earning a Ph.D. for which the market offers $50K is every bit as much a fool for doing so as would be any medical student following a residency training path that only earned $100K.

Arguing that M.D.s should accept substandard wages just because Ph.D.s do so is patently absurd. Neither field is worth the efforts if that is all their markets will offer, not enough to qualify to buy a home in most major cities.
 

"Anyone who plans to spend 6 to 7 post-college years earning a Ph.D. for which the market offers $50K is every bit as much a fool"

I don't know any PhDs earning less than $200,000/year but then they all have their own labs and are full professors.