You act like thats not already happening, where I work it seems that everyone who steps foot in the ER gets a CT scan or some other imaging procedure. (Talk about not trusting your physical exam)The Radiologists are not to blame for that; we just read them, we don’t order them.

And if you want to know what antibiotic to use for your pneumonia patient look it up in your pharmicopia…it takes 2 seconds…and 2 neurons to do that.

C. Medicare’s system for calculating the practice expenses associated with imaging studies is unrealistic and results in ridiculous overpayments. Technological advances have allowed each CT scanner to produce more CTs per day, but Medicare still pays as if the scanner were slower (with a higher capital cost per scan). Because Medicare is such a big purchaser, it is impossible for private insurers to deviate too far from the CMS price schedule.

That is the reason. Period. And re: B, are you kidding me? The amount of money you radiologists make far exceeds any differences in malpractice premiums. As for reason A, it’s hard to know where to begin with such ignorance. I suppose you’ve never met a competent generalist. Believe me…you barely see the tip of the diagnoses we make on history and exam alone (a truly valuable skill not quite mastered by most midlevels, unfortunately).

If you need a little bedtime reading, treat yourself to a little Bob Berenson in Health Affairs. You’ll find it enlightening.

http://healthaffairs.org/blog/2008/02/13/interactions-between-the-sgr-and-rbrvs-making-sense-of-alphabet-soup/

“Stay with me here. The per unit resource costs of services that mostly represent physician work should not be affected much by the quantity of services provided — the physician’s work component is a variable expense; that is, it is associated fully with each additional service provided.(4) In contrast, the per unit resource costs of heavily practice expense concentrated codes do vary with quantity because much of these practice expense components are fixed costs and, therefore, do not vary with each additional service provided. For example, the unit cost of imaging equipment declines as it is used more.

Yet the Centers for Medicare and Medicaid Services (CMS) does not try to alter RBRVS values for quantity changes, even when the unit cost of fixed office expenses predictably drops as the volume of services increases. Thus, even though advanced imaging services double over five years, fees are not adjusted downward; instead, the per unit profit keeps increasing as the quantity of services delivered increases, raising expenditures and further promoting the incentive for physicians to purchase imaging equipment to self-refer imaging services.”

I thought the physical exam, cultures, and labs actually head something to do with diagnosis too. I guess we should just top to bottom CT everyone and let rads run the show. Please do let me know which antibiotics I need on my patient.

Good medicine is expensive. Deal with it or settle for substandard care delivered by nurses and mid-levels.

In the $2.3 trillion healthcare system, less than 10% is what physicians take home. We can easily afford to pay them more.

I guess there is, deep down inside every person, a strong anti-freedom “inner communists”; and every person who asks the question “does ….. make too much money” is letting theirs show. The market doesn’t disburse money by how much the provider of the product “deserves” to make it by the ultimate value of their product or by how hard they worked to make it. If it did, Madonna would be living on 5$ a year and fishermen would make $500,000.

So start aligning the incentives to encourage a redistribution of MDs to primary care, or continue to watch our health care system move closer to bankruptcy.