Divide and conquer is on full display, as specialists are against increasing primary care reimbursement:
On Friday, May 16, the American College of Surgeons and 13 surgical specialty societies sent a letter expressing strong opposition to a Medicare Payment Advisory Commission (MedPAC) recommendation, which calls for increasing payments to primary care physicians, while cutting reimbursement for all other physician services.
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This reveals the shortsightedness of the subspecialists. They’ve been getting overpaid for years, and the increasing gap is unsustainable. Perhaps they’d like to do all of their own “dirty work” medicine consults? The new CMS guidelines for “consults” coming out will put pressure on them to dust off that Internal Medicine Board Certification.
Deep down, they all know that what’s been going on is unfair. But surgeons are in a far better position to negotiate. They can have cash/private insurance patients for their base, and if a hospital wants them to cover Medicare/Medicaid/uninsured? Well, I think, as in many instances, it’s time for hospitals to start picking up the tab rather than taking it out of physicians’ pockets.
I did not become a physician because of money. My brother, who is 2 years younger than I (age 40), went to Wall Street out of MBA school and essentially laughs at ALL of our incomes. I am now retired from clinical practice after having founded a software company, so, “no dog in this fight anymore”. However, like I used to tell medical students, you better pick a specialty based on what YOU LIKE to do, not how much money YOU THINK will be there when you are done. Likely, within five years, (with the exception of cash-only specialties), the gap between specialists and PCPs will be narrowed and will mirror what is seen in England. In fact, it will be no longer cost effective to spend 5-7 years in training when compared to 3 for a PCP. So, if its truly about money, quit your whining and find something else to do.
It is about the money.
I didn’t go to med school for the money either. I picked a generalist specialty because I loved the work compared to the specialties and didn’t care that they’d make more than me. But now, many of us won’t have any take home pay if current trends continue. I owe it to my spouse and kids to at least make enough to cover the bills each month.
In between all the whining, I’m busy planning something else to do, like many of us.
In my city, the average IM/PCP makes between 150-250k. Pretty typical for a large southern city. Anon, how can you not “cover the bills” with that? Granted, you might have a loan payment. Let’s say, gross/month = 15k (low end in my city). Take home 9k. Subtract 1k for loan. Still have 8k net left over for everything else. Most Americans do just fine with that amount. The problem does come when you see your proceduralist buddies bringing home 3x or more. I think many young physicians still think there is a little “gravy” left on the train that the previous generation did not rob and everyone is diving on the floor to get it. Don’t waste your time. If about the money, save yourself some heartache and go to MBA school. Become a well-paid suit.
Being at the bottom of the physician earning scale, I agree that the problem is not that it isn’t enough but bad cases of comparisonitis.
But it has long been thought by reformers that the enemy of medical utopia is the House of Medicine–and long been their goal to fracture it. The RVS was the stroke of genius in that regard and people fall for it all the time–it has pretty much completed it’s work.
It will only end and be replaced with something rational when enough people refuse to play.
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