"Choosing a higher-paying career in a subspecialty is an obvious choice"

I’m happy to see mainstream media starting to publicize the death of primary care:

“Why do we pay somebody $1,000 for a half-hour of surgery and pay someone $100 for a half-hour of thinking?” he asked. “I do a preventative test on someone that keeps them from getting cancer – a pap smear, a colonoscopy, whatever – and I get my $50,” he said. “But if I cut off a mole, I get $200.”

Comments

Anonymous
Why do we pay someone with an MBA more than we pay someone with a business degree?
Primary care physicians can cut moles off so what are we talking about here? This is a terrible comparison.
If I take out a gallbladder I am paid around 300 bucks. I have to visit them before the surgery, during the surgery, and in the days following the surgery. If anything goes wrong over the next 90 days even if it is not my fault I have to take care of it for free.
This doesn’t even take into account that choosing a higher paying career in subspecialty may be an obvious choice, but not a choice everyone gets to make. People compete for these spots. Shouldn’t people who performed better in school and in clinic be rewarded for their aptitude like in law school, business school, the real world, free market, etc?
Medicare has the primary care docs right where they want them. Make them think that specialty medicine is screwing them over, that specialty medicine is destroying the system. Open your eyes!!! It is medicare and insurance companies that are screwing everyone.
Primary care is in the best position to step out of the box and start a new business model that could be highly successful. You have collateral in your patients. You are able to charge amounts of money for your services that realistically 90 percent of the country can afford.
Step out the system. That is the answer!!! Do you think a neurosurgeon can open a boutique practice that doesn’t take insurance? No! Because no one plans on going to a neurosurgeon multiple times per year and no one can afford to go to a neurosurgeon without insurance. They can’t even pony up the money in advance until insurance pays them back.
If primary care opens its eyes, it will see that it is in the best situation to open successful boutique medicine practices for all income levels!!!! Just do it and primary care will thrive. Instead, you complain and moan that the specialists are screwing you over. It is pathetic. Quit waiting to get easy handouts from the government.
Anonymous
So if we have to make everything equal, are all of the primary care physicians going to go back to a surgical residency for a couple of years?
Anonymous
Anon 4:16 hit the nail on the head. I am also a surgical specialist and we are getting screwed just as bad as primary care. The strategy used by Medicare and the insurance industry is a well known military strategy called divide and conquer. Remember the 1980′s when the PCP’s bitched about not getting paid for “cognition”- the RBRVS system was created and everyone got screwed. You guys need to wise up and cognate.
The Happy Hospitalist
Dr Wes had a grate blog called Delayed gratification and how general surgery is dying the same death as primary care.
I agree. RVU is killing all doctors. It is fixed. The reshuffling of money is not the answer between fields.
The revenue should be independent of each other and compensated on their own merits, not at the expense of each other.
Inspite of the assertion that primary care is being rewarded, the
Global fees are also ridiculous and I’m going to blog on that at some point.
It affects incentive to care, and may actually increase costs in the long run.
Medicare is screweing the system. YOu are absolutely correct.
You and I are on the same page.
Market economics would do wonders for primary care.
Surgeons are correct as well.
The RVU system is screwing everyone. The only problem is that right now, primary care and some general surgery are crossing their respective lines of cost outweighing delayed gratification.
Allowed to last long enough, all fields will eventually be decimated. It is the nature of RVU.
Anonymous
Ditto from another surgeon working harder and making less, along with plenty of uncompensated pre- and postoperative visits. Remember that old Soundgarden lyric: “The grass is always greener where the dogs are sh*tting”

"Choosing a higher-paying career in a subspecialty is an obvious choice"

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