What the complaining generalists envy is pay for procedures, not the hours of postoperative care involved, or the preoperative evaluation or the additional years required to master those procedures, or the added costs of materials and supplies to be able to do those procedures or the extra malpractice insurance costs involved.

And how many family doctors do OB or colposcopy or colonoscopy? All that is within the range of available practice options, if you want to bill for procedures. What I am hearing is whining about not getting procedural pay for non-procedural work. Here’s news, specialists in so-called “procedural” specialties don’t get that either. In fact, many office visits associated with those supposedly lucrative procedures are bundled with the procedural fee and get paid nothing.

As a (sleep)specialist, I am paid at the same rate for office visits as a PCP.

Right now, to the public a doctor is a doctor is a doctor. Where the treatment comes from doesn’t matter .

I have spoken to one of my friends who’s a family physician and we get paid exactly the same for the same code?

One family physician colleague prefers be called a generalist and refers to specialists as partialists in his attempt to take some shine off of this apple.

There’s also financial pressure on primary care physicians to let specialists handle follow up, especially on low paying but complicated Medicare patients. When 25 grandmas come in expecting to get their laundry list of complicated chronic issues addressed at each 15 min. visit, most of us are happy to let the specialists take a few problems off the list. I’d rather spend more time and handle things at the primary care level but we can’t do that at what Medicare pays and patients are resistant to coming in more frequently.

Take it or leave it.

As opposed to come back every three months until the end of time.