Your petulant whine about specialty pay is so tiresome. You sound like a whining liberal in that your plight must be because somebody else has more.

The answer lies in doing something for yourself, advocating for yourself, lobbying for yourself, reinventing yourself. The answer does not lie in some type of socialist redistribution. It does not help that a large part of primary care could be done by midlevel providers.

Also as others have pointed out, most primary care people are not sweating bullets on an emergency case at 230am on saturday and sunday mornings.

Just as flawed an assumption.

Not even wrong, Evan.
The cardiologist has similar overhead in his office, just as every physician’s office has- rent, utilities, computer, employees pay and benefits. After paying for these expenses, just as in primary care, he then has to put up the cath facility at a million plus, and pay extra employees, insurance, utilities, etc., if he wants the full facility fee that is under discussion.

Every medical student knows about the disparity in specialist income. If they choose primary care or another relatively low paid specialty, they are trading a shorter/easier training period, or a less competitive specialty, for lower income in the future. Am I to believe that any senior student is unaware of this when she fills out her match form?

I may love my job but there is no way that I am getting out of bed for $50. Sorry.

The truth is things are horrendous in primary care. Practices are starting to close, not because the partners want to “get out” but because they are going under.

And stop with the free market nonsense; with the exception of cosmetic procedures, medicine does not obey free market dynamics. It just does not. Is someone not going to have their cancer treated or not get a cardiac cath because they cannot afford it? Is that the country you want to live in?

Comerade Underpaid

Sounds like communism to me. The RVS is a means of an all-knowing all wise central committee setting payment now. You can’t force equality by arbitrary power 1. It never works just as it isn’t working now–some pigs are always more equal than others. 2. It just results in escalating levels of more and more control–like now.

Let the free market set the rates. Open up Medicare to balance billing for all on a case by case basis and let the chips fall where they may. If people value cardiology so much more, then so be it, go to a communist country if you don’t like it. I suspect that wouldn’t be the case, that you would see cath labs competing on price.

How about the mention of the excessive radiation to which cardiologists are subjected? I personally know several cardiologists with lymphoma and cataracts from the radiation. Are you poisoned with radiation in the office seeing patients? Also, are all these caths taking place during daylight hours or is the cardiologist in the cath lab all hours of the night?

PLEASE, Kevin, stop these attacks!

Regarding your other comment regarding the pay discrepancy between primary care and specialties in todays market is a tough argument. I believe across the board everyone is affected by the decreased reimbursements, and the increased cost of running a profitable healthcare practice.

Your assumption is that primary care physicians have no overhead either.

Just as flawed an assumption.

1. What the previous poster said about having to own the 1,000,000 cath center.
2. I am 90 percent sure that the cath covers the global fee of seeing the patient pre operative and post operative, whereas a primary care doc gets to bill for each separate appointment (note there is no global fee for bringing someone’s hypertension down).
3. I am sure there are some other points, but I am tired of typing.

Kevin, I love your blog, BUT you are observely not a disinterested third party in this debate. If I didn’t know any better I would say this intellectual dishonesty on the topic is because you are biased. I hope I am wrong and I hope I do not see posts with poor logic like this in the future. Otherwise, love your blog and agree with 95 percent of what you have to say.