That’s like saying if you don’t like America, you should leave.

The real answer is that if you can identify a problem for 1/3 of all doctors and find a solution for them all, that’s far superior to finding a solution for yourself.

Do people often do things exclusively for financial benefit? Yes.

Is that the only benefit that drives behavior? No.

Would specialists still be paid a reasonable wage at an average of $250,0000 per year? Of course.

In the same way that the payers have forced lower payments across the board down doctors’ throats, they could force a fairer payment scheme if they could find a reason to do so.

The reason to force lower fees for everyone was to lower premiums and make profits. The reason to change payment priorities is fairness. That is not going to happen based on the open market. It will only happen based on government fiat. And for that, we need a government based on fairness, which is not the watchword of the current administration (their idea of the Golden Rule is “them that have the gold make the rules”).

I’m glad you’ve found a part of medicine you find tolerable and reasonably compensated. Now acknowledge that for this positive outcome to be widely available requires some selflessness with our selfishness.

That shouldn’t be too much to ask of a profession that claims to care about the well-being of others.

David B. Ketroser, M.D., J.D.
Neurology

there are patients who value a primary care physician who really knows the patient. who knows what the patient likes, dislikes, who knows what kinds of stressors and hassles that the patient has to face, who calls the patient by first name and makes the pt feel welcome.

But the patient is not paying the doctor. the patient pays the insurance company who pays the doctor just a few dollars more than what it costs to operate the practice.

I agree that doc’s who wan’t the big bucks should not choose primary care. But doc’s should have some reasonable expectation that they can make enough money to make the effort worthwhile. If insurance companies devalue primary care, physicians will respond accordingly.

Kudo’s and warm sentiments from patients will not pay off the 100,000 -150,000 med school debt, malpractice premiums, continuing medical education costs, health insurance, licensing fees and salaries of employees.

The loss of physicians doing primary care is very real.
Those who leave the field lament the fact that they could not practice a personal caring kind of medicine in the current system. I did.

Okay, okay….but I do value a doc who knows me, remembers more about me than JUST the chart. I actually had one of those — in an HMO setting, no less. Took a while to train him. Did it with humor, attentiveness to him as a human being, not just as a doc. If he’d been a bluegrass musician in the bargain, it would have been nirvana.

Of course, he trained me, too: Get to the point, do what you’re told. Come prepared. I’m a WLS patient so labs are of extreme import. Once I made the case for them, he ordered them, probably catching flak from the admins.

Then he went off to private practice in Pasadena and now I have to start all over, and I’m not sick enough to see the new doc more than once a year for a physical and I’ll never get him trained within my lifetime at this rate.

To get, at last, to the point: I agree the Primare Care needs to be rewarded. I question whether the rewards should necessarily be monetary. I too don’t want a doc who’s in it for the bucks. Being related to a few, I’m getting good, I think, at spotting them.

How can we pay physicians in both monetary and non-monetary ways to make them want to get into primary care? And how can we do this in a managed-care setting (hey, HMOs were created by the excesses of fee-for-service, and they’re not going anywhere)?

I don’t want a doc who’s starting and stopping the meter, but I don’t want one who can’t take the time to know me. Are these mutually exclusive?

/jwb

Gods are not involved here, this is pure market economics. I bailed out of primary care a few years ago and now find life much less stressful as a hospitalist.

I get paid much more, have far better hours, have very minimal responsiblity for the patient’s long term needs and far far far far less paperwork. I am able to stabilize, improve or cure many things. If anyone is really sick I always can get a consult from any specialist always within a few hours. when I did high stress oupatient primary care work patients typically would have to wait 10-90 days to see a specialist.

I strongly advise to change your work environment if you do not like it. As a hospitalist, I never get a denial from insurance companies when I order big ticket tests such as MRI/MRI/cardiac or nuclear imaging. Meds I oder are never denied. AS an outpatient doc, I spent a lot of time talking to insurance companies explaining why I wanted a test.

why waste time fighting the system ? if you are not valued in primary care, you can either put up with it or bail out.

We currently have about two specialists in this country for every primary care physician. The average income of the primary care physicians is about $150,000 per year, while the average specialist earns about twice that. (I am a neurologist, so this is not about goring “the other side.”)

Only a fool would suggest that the specialists work harder, are smarter, or are more valuable than primary care physicians. The differences in our personalities that lead us to know something about everything or everything about something are just differences. They’re not virtues or flaws.

Simple math tells us that if the 2/3 of the physicians earning $300,000 give up $50,000 each of their income to increase the income of the 1/3 earning $150,000, everyone would make $250,000.

The specialists would be taking a hit, but why isn’t that less wrong than the primary care physicians living with twice the harm.

If the reason anyone entered medicine was to be rich, we don’t want them.

And if an average of $250,000 per year isn’t enough to justify doing what you do, you hate it too much and should quit.

Now, all we need to do is convince the overpaid Gods that working with your head is just as valuable as working with your hands and the problem’s solved.

Anybody see a flaw in the logic?

David

David B. Ketroser, M.D., J.D.
Neurology (still practicing Neurology after 25 years, and also a practicing Plaintiff medmal atty for 5 years)

Any practical suggestions to increase the “value” of primary care?

Just wanted to let you know, then, that as a patient who has a general internist as her PCP, I DO appreciate the time, energy, and mental accumen you all put into working with people like me. Do doctors accept tips?