Insurance doesn’t equal access. Why is this so difficult to understand?

The only solution will be for the AMA to further restrict the supply of physicians at that point. Although it’s possible the public, or lawmakers, may start taking a harder look at the available medical school slots and how they are chosen and expand the number.

Now take away the profitable operating days from his schedule. Do you think he is going to be able to afford to take emergency call in the hospital. The answer is no, and I have known physicians that have faced this very dilemma. The result that I have seen is surgeons will stop being one of the “general” surgeons in the town, and will switch to smaller, quicker, and less risky surgeries with less followup. These can often be done in an outpatient surgery center.

A hernia repair for instance lets a surgeon bill about 12 RVUs (~$1200) this translates into about $280 for the surgeon after overhead. If you gave up all hospital call and other difficult general surgery procedures and just did simple hernia repairs, say 10/wk with 2 days of clinic you would end up making $2800 after expenses for the hernias and $1000 per week from seeing say 20 clinic patients each clinic day ($25/pt). This translates to around $3800/wk which would be equivalent to $160,000/yr with 10 wks vacation. I have known surgeons that end up making the move to some variant of this schedule to give up the difficult general surgery lifestyle. So the end result is that yes medicare may have saved some money by reducing the reimbursement to this surgeons in this area, but the end result is one less general surgeon available to a town when patients need an operation in the middle of the night.

But at the end of the day, where are physicians going to go? Where else are you going to find a job paying an average of $150K, and $250K for surgeons, in a recession, and still maintain your current lifestyles? (those averages come from the Dept. of Labor). Simply put, you won’t.

Now, maybe it will force you back into the market, but a lot of you would struggle to compete as the rest of us professionals do. You have to market your services, you have to figure out how to bill, and you have to collect from at times insolvent parties. How many physicians still know how to do that? I’m betting not many.

But maybe you can figure it out. I for one, hope so. But I don’t think your lobbyists are really working hard to push you back into the market. They’re looking to preserve their own clout by cutting deals within the existing system.

Honestly, I think it would be great if there were a Medicare cut of 25% because of the SGR. The whole deck of cards would come crashing down when all doctors refused to see Medicare patients. Medicare would have to start paying at sane rates and congress wouldn’t play a game of chicken every year with physicians and the AARP.

The Wall Street Journal article cited by Frank was just published this past Friday. I have not heard any official AMA response, but I would imagine they would not be too thrilled with a 25% cut to physicians seeing medicare patients.