Comments on: Should primary care distance themselves from specialists?

By: Anonymous

Anonymous — Fri, 08 May 2009 02:59:00 +0000

Somehow a physician earning over 400,000 dollars a year doesn’t seem quite right and yet I know MANY. Here is the Northeast I doubt there are many proceduralists who aren’t making that kind of money. Come on. We supposedly went into medicine for reasons other than bloated incomes that rape the public. No, Dr. Proceduralist, you really aren’t worth that kind of money, despite what you and your colleagues keeping telling yourselves.

By: Anonymous

Anonymous — Mon, 17 Nov 2008 15:21:00 +0000

Anonymous 9:59’s comment “And yet, the world over specialists are paid more than generalists…” reminded me of Martin Roland’s piece on primary care in last Thursday’s NEJM, in which he says “U.K. primary care physicians now have average earnings of $220,000 (in U.S. dollars), which is more than many specialists earn…”

By: Anonymous

Anonymous — Fri, 14 Nov 2008 21:00:00 +0000

Anon 7:37 is right about coalition building. The split isn't specialist vs. PCP, it is procedural vs. non-procedural.

Also, for people who complain that PCP complaining about income disparities led to the RVU system and budget neutrality, maybe the problem isn't the neutrality it is that the RUC is specialist/proceduralist heavy …. we spend enough money on healthcare in the US to cover everyone, but only if we accept the fact that the cost of that is surgeons making >500k taking a hit so PCPs make enough money to draw new grads into the field

By: Anonymous

Anonymous — Fri, 14 Nov 2008 00:37:00 +0000

Guys You act like “specialists” are a monolithic stalinst entity. It’s not. For every neurosurgeon/orthopedist rollng in the dough there is an ID doc or rheumatologist who is not. You do realize that oncology practices have taken a huge hit since the drug markup was disallowed (I don’t disagree with that, but CMS never made up for it in anyway. Oncology patients are as complicated as they come). Also don’t forget that even procedural docs in rural practices don’t necessarily do that well with such a medicare/medicaid heavy population. The simple fact is the way things are structured medicare/medicaid is not a long term financially viable operation for ANY OF US. Each year CMS will come after a different group of docs to minimize payments (see oncology above). Personally I think anon 18:25 is on the right idea. Stop taking medicare/medicaid. I know there is the two year rule, but if AARP starts harassing congress because their constituents can’t find docs, things will change. Very simply congress doesn’t give a crap about what docs think and most of us can’t unionize/strike. That is the fact.

By: Anonymous

Anonymous — Fri, 14 Nov 2008 00:27:00 +0000

I can’t agree more with anon 6:25. I have had it with the deafening whine of victimhood from passive primary care docs. Don’t like the way your are being treated? Take control of your practice and run your business yourself instead of letting others do it. Sure, it involves some risk, but nothing ventured, nothing gained.

By: Anonymous

Anonymous — Thu, 13 Nov 2008 23:25:00 +0000

This question is idiocy. What primary care doctors should do is stop taking insurance and government payments, and set their own rates. The purpose of insurance is to cover those costs that you cannot be reasonably expected to cover on your own. Thus you enter into an agreement with others to share the risk. Primary care is cheap enough that there is no need for insurance to pay for it. Honestly, what’s keeping you there, taking pennies on the dollar? If you work isn’t valued, drop out. See if they value you then.

By: Anonymous

Anonymous — Thu, 13 Nov 2008 15:49:00 +0000

what stops the primary care docs from negotiating money from the hospital to cover er call as the orthopedists did?

By: Anonymous

Anonymous — Thu, 13 Nov 2008 15:35:00 +0000

Yes, 10:27, it is a battle tactic called “divide and conquer” but one in which specialists have been willing participants.

By: Anonymous

Anonymous — Thu, 13 Nov 2008 15:27:00 +0000

Most of the bloggers taht have commented(including Kevin) do not seem to remember what happened the last time primary care/internal medicine tried to attack specialists by wanting to be rewardd more for their “more cognitive ” care. The government created RVUs and budget neutrality and basically all physicians lost income. Instead of attacking specialists constantly, Kevin, you should encourage all physicians to align and fight the real enemy. What the government is doing to physicians is a common battle tactic called “divide and conquer”.

By: Anonymous

Anonymous — Thu, 13 Nov 2008 14:51:00 +0000

Anon 9:17: ditto, ditto, ditto!

We PCPs are the Michael Claytons of medicine. We deal with the issues nobody else wants to acknowledge...but these are invariably the most important to the patient. We are the responsible adults in the room. We are the janitors cleaning up other doctors' messes. Because we do so much, and in so many ways, our jobs are quite difficult to understand without firsthand knowledge. But without us, everything falls apart. Done right, primary care is by far the most intellectually demanding field in medicine...and medical students are rightly intimidated by the breadth of knowledge the field requires.

Those who devalue primary care do not practice it. They have no idea what it takes. Anybody can be a bad PCP...just as easily as I can be a bad surgeon. Being a good PCP requires talent, intelligence, stamina, insanely good interpersonal skills, and a willingness to accept a learning curve that never levels off. Only the very best medical students have what it takes, and unfortunately the skewed payment system makes it financially damaging to choose primary care when you have other options. Regardless of whether payment inequity is the root cause of this evil cycle, we all know payment reform will end it.

It's time for primary care to form a new organization. I've had it with the AMA, my state medical society, and the ACP (which includes way too many procedural specialists). For primary care to resume its rightful place at the very top of the food chain, we need to be willing to engage in a long and divisive political fight. We cannot do this if we ask our lobbyists to also represent the pocketbooks of procedurists and imagers.