Zero sum game

Bingo writes:

Why, DB? Why must other physicians lose? Why is it a zero sum game with respect to physician compensation? Isn’t that one of the core problems with the RBRVS system, that the original construct (conceit?) was that moneys would be shifted from the Sub-Specialist to the General Medical Specialist? Weren’t we ALL played for suckers, falling for that, making it so easy for TPP to play divide and conquer? Would (the collective) you (of Generalists) really feel better about the state of American medical economics if specialists, sub-specialists, and other interventionists were complaining even louder than we do now because our compensation declined?

No, DB, unfortunately and quite sadly you are propagating the canard that it is the unreasonably high compensation of non-General Specialists that is the barrier to more reasonable compensation for General Specialists. It is high time for thought leaders in the General Specialist community to take up the flag of rational PHYSICIAN COMPENSATION. If there is to be a zero sum game in health care GNP then is it not folly, professional suicide, for groups of physicians to work at cross purposes rather than look for the low-lying fruit in the 78% of health care expenditure that is NOT physician compensation?

Over the past 10 years (or so) the relative pay scale for the higher earners compared to internists and family physicians has increased dramatically.  The money is a zero sum game as long as the government influences compensation rates.

Yes I would be happier if subspecialists chose their subspecialty independent of the huge financial differential.  I would be happier if more graduates chose internal medicine and family medicine because they want those specialties, rather than the ROAD (radiology, orthopedics, anesthesiology and dermatology) to riches.

The money really does matter for graduates who have huge debts. 

The pay rates for many subspecialties have negatively influenced an appropriate distribution of career choice. 

I would prefer a true free market system of payment, but that would require such a massive change in health care financing that I cannot reasonably expect it.

Talk to medical students and residents and you learn that many really do make decisions based on money.