In real dollars, primary care and doctors generally have seen substantial drops in personal incomes. Practice overhead has tripled in many specialties while total practice income has remained flat or fallen.

120-140K seems like a lot to some readers. Compared to teachers and other essential public employees, it might seem excessive. But no other professions expect practitioners to take on $250 K of educational debt, and forgo ten years of gainful employment and savings. And unless you work for the VA, there is no defined-benefit pension plan. If you ever want to retire, that is your dime. So are a lot of other expenses that most employed people expect to have paid for by an employer. So when you are starting to earn “doctor’s incomes”, you are already in a catch-up game. And if you want to do anything crazy, say like have a family or buy a house, big debt and late starts just add to that pressure. A rise in practice overhead–like a hike in malpractice premiums, or a drop in reimbursement rates, or practice employees demanding a pay raise, all that goes against that doctor’s income.

Hand-wringing won’t solve this problem. Neither will EMRs and other expensive data processing mechanisms that will profit computer harrdware and software industries long before the benefits–if in fact there will be net benefits–are realized by the medical practices.

What medical practices need is to be able to raise their prices whenever their costs of service increase, just like any other business. Sure, patients don’t like it. I don’t like paying $2.20
a gallon for gasoline whenever I need a fill, but I have to do that anyway. And I don’t like paying higher practice operating expenses, but there is only so much economizing that can be done before the operations themselves suffer.

Private practice medicine is a profession, and it is a small business.
We have to discipline ourselves to treat it that way. That means refusing abusive insurance plans and demanding that patients responsibly participate in covering the costs of service, and not just at the levels of “co-payment” if that is simply not adequate. The cost issues associated with unconstrained tort liability and other parasitic social behavior have to be seen and felt by the people with the power to make real changes on election day, no physicians, but patients.

primary care is dwindling, just log onto
http://www.aafp.org/match and click on graph 5. the lack of interest by medical graduates is clearly seen.

Of course there are exceptions but pushing FP’s out of hospitals is becoming more the rule than the exception.

2% of FP’s earn more than $400K per year? Though I won’t quibble with that statistic per se, what I have to wonder…..are they really earning that money from the clinical practice of medicine? As opposed to, say, running a chain of walk-ins or similar business activities.

WE AS PHYSICIANS not only devalue our profession by subjugating ourselves to third party payors but also it seems subjugate our patients.

we have sold our professionalism to the concept of managed (mangled) care.

For the rest, those who have disposable income for a better car or vacations and all that, if you don’t feel primary care is worth paying for, you get what you deserve.

The cash-based practices I’m familiar with provide primary care for the farmers, the fishermen, the beauticians, the self-employed. Going cash-based REDUCES cost and reduces fees. The working-class people who attend such clinics do not have Medicaid, do not yet have Medicare, and do not have private insurance. They are ignored by the current system.

Such practices are NOT concierge practices with the annual fee and all that. Those opposed to the concept of consumer-directed health care deliberately confuse the two.

The physician author of the article could have continued to see her first choice of doctor, if she had simply paid him on an out-of-network basis. She would have retained coverage for testing, hospitalization, specialty care, etc. For maybe ten-twenty bucks more a visit with the higher copay, she could have stayed with her first choice of doctor.

I have working-class patients who choose to continue to see me on an out-of-network basis when their insurance changes. If the plumber and teacher’s aide can do it, the physician could have done it.

Problem is, SHE is the one who does not value primary care.

how many more years should primary care physcicians wait?
to whom else should we “plead” our cause?

ENOUGH CRAP.

while physicians plea year after year…Nurse practioners, clinical psychologists, pharmacists, optometrists are providing care .

the only way to maintain one’s profesional integrity in a SYSTEM that devalues primary care…is to walk away from the system. Integrity, professionalism are lost on every encounter where the physician is forced to be extremely busy in order to make the finances work.

hey ..if you accept working in Burger King like conditions, your clinical work is just about as valuable.

enough begging