That does not sound like occasional work, that’s four ER calls a day, on average. Unless that particular hospital has an extraordinary number of plastic surgeons on staff.

I’m not a specialist, I’m your basic FP. Can’t say I blame the consultants, though. Even if the plastic surgeon wins, I’d say the publicity of litigation would put a damper on someone trying to build an elective cosmetics practice.

The public wants to be able to sue doctors, they shouldn’t whine when they can’t find doctors. If I were a plastic surgeon, I’d save the charity work for well-defined overseas missions.

To jb:

Although you deny contempt for primary care, your assumption that I am “lazy” betrays a prejudice that you lack the insight to admit you have. I don’t know you, you don’t know me; I can assume you’re a “typical” surgeon but I believe in giving people the benefit of the doubt. What conjured my ire was your comments that primary care was “easy to get into” and that other fields are “more challenging”, further manifesting your prejudice against primary care physicians. These are your words, you can retract or modify them but you cannot deny them.

You also assume I am an employee, which is incorrect; I own my own practice.

As for anonymous 2:52pm:

The argument that I am not a team player is interesting. Whenever primary care complains about being treated badly by consultants, we are told we are not good team players. Whenever we complain about disproportionately low reimbursement, we are told that we are all in this together.

The irony is that this whole debate began when an er doctor wrote about being treated badly by plastic surgeons regarding follow up visits; whose not the team player in that picture?

As I originally stated, there are two classes of physicians, and an ever-expanding divide between them. I actually believe primary care as provided by physicians will die, replaced by cheaper mid-level providers. That’s basic economics and demographics; I wish I could say quality would suffer but I kind of don’t think it will.

However, once we primary care physicians become extinct they’re going to come for you next.

Signed,
underpaid, overworked and underappreciated family practitioner in upstate New York

Any public “debt” related to residency training in dollars is more than made up for by the value rendered by underpaid residents/fellows working perpetual overtime while interest accumulates on their loans and opportunity cost exponentially escalates compared to other career choices. Hospital ED’s have been getting a free ride from private practitioners for too long. And for the non-emergency medicine docs out there who might be swayed by the ER docs taking care of the underinsured, be aware that hospital subsidies often make up for this “charity care”.

And no, thanks for the compliment, but I’m not Plastic. I’m a general surgeon, one of the blue collar specialties. I’m very proud of what I do and my work ethic. In over 2 decades of covering ERs, I have never (Never) declined to come in when requested by an ER colleague (my career began way before EMTALA), and I have never (as in never, ever) asked about insurance coverage when called from the ER. I am very proud of the close respectful relationship that I have cultivated with ER and primary care colleagues. The ER physicians that I work with have too much respect for me to call me for abusive crap like what you pester your consultants with. My contempt for people like you has nothing to do with your choice of a primary care specialty. It has everything to do with your choice of primary care combined with your endless whining about its perceived disadvantages, coupled with your unsuppressed jealousy of those MDs who chose a different path, succeeded, and left you in the dust, professionally, financially, or personally. I never said that I’m the only one who has trouble getting paid or gets called in at night. It’s a routine occurrence for all of us who serve as ER consultants. You know that, yet you insist on calling consultants in not for medical necessity, but for the patient’s preference, and you criticize them for being unenthusiastic. Your viewing of me and others whose training was subsidized by taxes as public utilities for the remainder of our careers is an expression of contempt as well.

And no, I do not recognize any debt due to my training, any more than any other State U. grad owes a debt because of his or her training. Back when the profession was allowed to govern itself, we felt a responsibility to make sure that people did not die in the streets due to lack of medical care. Now that we are governed by tens of thousands of pages of federal regulations, price controls, and oligopolistic insurance companies, and the threat of liability suits if our efforts in a free clinic go bad, I have a hard time conjuring up any feeling of need to repay any debt to society. Most of the time, I have to actively try to protect my self from those I try to help/

Lets be clear about something: having taken a residency funded by HCFA/MMS does not create an obligation or levy a debt to be repaid, no matter what you might want to believe. Consider that the government is getting someone with a doctorate and fresh training to work between one-and-a-half to two full-time equivalent jobs by hours worked in a single year for the wages of a public schoolteacher, and the balance is clearly in their favor. Neither you nor the public have a right to collect on any debt or demand of anyone but yourself alone the service of the “needy.” If you think that you do, then you really are nothing more than a thief, demanding to take from others what you cannot or will not give yourself. Dressing up those demands as “ethics” is nothing but the cynical rationale of the robber who pretends virtue because he only steals from those he thinks have too much.

I don’t know what JB thinks, but I don’t think I “owe” the public anything and I certainly don’t owe any payback for having done a residency. I did plenty of free care then and have done plenty since, and not because I owed anyone.

Maybe you need to adjust your own understanding, Dr. Underpaid (or is that Comrade Underpaid?) Just because someone does work that isn’t paid doesn’t mean it is done because it is “owed”. Doctors who see patients in EDs ahead of getting payment are behaving generously and ethically, placing a sense of mission and trust before their fears of liability–real fears, mind you–and their own need to be paid for work.

Your own moniker reveals your apparent resentment of those who work hard and earn well. Why is that?

In a way ER doctors have become victims of our own success in that we can handle lots of things. Now ist seems that many specialists want me to do what even they do not do routinely.