It’s no secret that, in an attempt to increase the pay of primary care doctors, Medicare is going to run in serious resistance from the specialists. In this article from Bloomberg, for example, we’re seeing backlash from cardiologists.
What caught my attention was how cardiologists in residency programs may now harbor resentment against primary care doctors in training. Consider what Ted Epperly, president of the American Academy of Family Physicians says:
Specialist colleagues have implied his support for the Medicare changes may cost his students, he said.
While family-care students typically spend parts of their three-year residencies training with specialists, “What I’ve heard is ‘maybe we just won’t have time any longer to teach your residents,’” Epperly said.
From my experience, I would have a hard time believing that cardiologists would allow these reimbursement battles prejudice their desire to teach primary care residents.
But with specialists facing increasing reimbursement pressures, to the benefit of primary care doctors, the situation bears watching.
(via Dr. Wes)
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- Will nurses solve the primary care crisis?
- Primary care disrespect starts early in medical school
- Primary care
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- Pay primary care by the hour, again
{ 9 comments }
And so the house of medicine falls.
Oh please, these are professional adults who are mature enough not to take their frustrations out on students and understand doing so doesn’t change the situation.
Personally I don’t think the answer is to pay less for these procedures. What will happen is that they will just do more procedures. I think the answer is to keep the pay for these procedures the same but change the indications for reimbursement. So if you don’t meet certain evidence based criteria you don’t get your cath paid for. (you can still get your cath, but not paid for with PUBLIC money). Now, I think there has to be some leeway since everyonce in a while someone will go outside the evidence based on experience or our gut. So you could say in a given year 90% of your procedures should meet evidenced based guidelines.
Can you imagine the paperwork that would create. You would make a great well meaning beurcrat PICUdoc
Anybody who says that, just cut off his or her referrals. Easy enough.
Don’t forget who has the power here. Use it!
I wish that Amy were right and “professional adults” never yelled at medical student.
One of my more traumatic experiences in medical school was getting screamed at by a Cardiologist when I told him I was going to study Family Medicine. He was infuriated that I would waste my mind on such a career.
Getting demeaned and yelled at by specialists is already a right of passage for primary care students.
With all the money the cardiologists have been able to generate over that last 20 years they should be able to slide by a few more years. They will just dump more work back on the PCPs. In our area it is routine for them to send our mutual patients to our office with a long list of labs they want done with directions to fax them the results. This beharior will accelerate and they will focus more on being cathetiers.
Healthcare costs are going to increase with the aging population. If nothing is done to the present “system” Medicare and others will continue to see the solution as chipping away at physician and other healthcare providers income. If we change the system we can get some of the money from tort reform, CYA medicine, reduction in administrative costs (billing for all the insurances and the games they play overlapping programs Medicaid, Medicare, VA, community clinics who receive relatively large per patient fees and medically indigent programs) and drug costs .
why do we not have a primary care union? i do not understand why the aafp does not come out in support of this. with strength in numbers, we could change the health care system. this system is broke because we are an ‘after the fact’ nonsystem instead of a preventative health system. big pharma, big insurers, and alot of our specialists’ livelihoods depend on the continuation of preventable chronic disease. pharma depends on us prescribing their drugs, reading their glossy media. specialists rely on our referrals. insurance relies on us being the bottleneck in prolonging or delaying their need to pay any money-the referral system-whether it be for a test or to a specialist; and the prior authorization system-another great stalling technique. good preventative care requires time to develop good repoire and trust with one’s patients. it doesn’t work in our favor from a reimbursement standpoint, but it is the only thing that is going to help change bad behaviors and inspire healthy ones, and to prevent or reverse chronic disease. if we had a union, we could make these points and refuse to work as hamsters in a wheel, providing less than ideal care. all talk, no action.
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