Physician tiers and advertising in the NY Times

Dr. Rob on the difference between physician have and have-nots:

This does say something about our system; primary care physicians are getting more scarce, people have no money for drugs that they need, primary care physicians cannot buy an EMR for their office as it costs in excess of $50,000 per doctor (often), yet these physicians in Tampa can afford easily that much for an ad in the NY Times e-mail, reaching out to patients all over the country, and even the world.
Despite the opinions of some, we really do have a two-tiered system in this country. There are the haves (the procedure specialists and those who perform cosmetic procedures) whose income is growing, and the have-nots (the thinkers and those who coordinate care for the average person) whose income is dwindling.

Comments

Anonymous
In life in general there are those who do and those who think, however it is foolish to think that surgeons, anesthesiologists, other specialties heavy of procedures do not think. In fact, their thoughts may result in immediate death or disability if incorrect.
Actions speak louder than words.
Just do it.
Those who can’t do, teach.
Get the message?
ObGynThoughts
you are not looking at the root of the problem. the cause of the afflications of the health care system is the lack of individual involvement with cost. If neither the patient nor the doctor need to care what something costs the result will be waste and overspending – no surprise there. And then the insurance companies try to control and a blizzard of paperwork starts that hassles everybody, and then the single payer ninkompoops think they will do good by ignoring the main cause of overspending – the disconnect between the patient and the cost – while in reality they simply continue on the same wrong path and put a bandaid on a symptom. The root has to be eliminated. The patient needs to have “skin” in the cost.
Focus on that and all will get better. And stop contracting with HMOs, do direct, good old pay the doctor direct cash medicine.
Eliminating the third party payer system is what needs to be done most urgently
ERP
I can tell you all I know more than a fair number of excellent internists who are totally on top of their patients’ problems and more often than not avoid calling consults whenever a patient is admitted. Others just call a thousand consults. It’s like “Pnemonia? Call Pulmonary!”, “Chest Pain? Call Cardiology!”, “Abdominal Pain? Call Surgery!”. The guy or gal who uses his or her brain to avoid all that gets no where near as much as the GI guy that just scopes or the interventionalist who caths and leaves the dispo to the others. Not that specialists are not needed – of course they are, but why not reward the PMD who has healthy patients that don’t incur massive costs when they get admitted?
Anonymous
Everyone must be made to be equal!
Of course, since I am the guy whole will be administering the system to make it all equal, I’ll be more equal than everyone else.
Anonymous
How about rewarding the healthy patients by not admitting them in the first place.
Anonymous
Ah yes. What would the average day be like without the obligatory screed on Kevin MD against specialists?
Dr. Rob and other class warriors: it’s OK to complain that we make more that you do, and we can engage in an honest debate about that. But the incessant cant about “thinkers” vs “doers” is getting old. Do yu really want to hear my “Stupid Consult of the Day” laundry list??
Rob
I am pleased to now be called a “class warrior.” Wow. I was not aware I had taken such a step. I’ll tell my mom.
The reality is that the SYSTEM is getting the shaft. I could go around the system and just do concierge/boutique medicine, or I could do a lot of expensive procedures. This does nobody any good but myself. This is why primary care docs are leaving in droves. The system will not handle this for much longer.

Physician tiers and advertising in the NY Times

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