Comments on: duh – money matters in specialty selection http://www.medrants.com/archives/3747 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Why certain doctors will be extinct in a few years | My Private URL http://www.medrants.com/archives/3747/comment-page-1#comment-529276 Why certain doctors will be extinct in a few years | My Private URL Mon, 28 Sep 2009 03:39:01 +0000 http://www.medrants.com/?p=3747#comment-529276 [...] think that DB’s Medical Rants spells it out correct in this assesment: Boys and girls, this is not rocket surgery or brain [...] [...] think that DB’s Medical Rants spells it out correct in this assesment: Boys and girls, this is not rocket surgery or brain [...]

]]> By: Matthew Mintz http://www.medrants.com/archives/3747/comment-page-1#comment-521146 Matthew Mintz Sun, 14 Sep 2008 21:37:21 +0000 http://www.medrants.com/?p=3747#comment-521146 Bostondoc, No question money matters and you are correct that separating reimbursement from money is difficult since low reimbursement leads to squeezing in more patients with leads to "hamster wheel medicine" that Dr. Bob points out. My point is that it is not simply the money but the entire system. If for example, primary care physicians had to deal with no paper work and could see far fewer patients in much longer visits, but not make one penny more, I beleive you would attract many more students to primary care. Conversely, if the only thing we did to solve this crisis is to forgive all loan debt for students going into and practing primary care, it is likely that some students will take the offer, but many may not because they would rather have $140K in student loans then practice primary care medicine as it is practiced now. Bostondoc,
No question money matters and you are correct that separating reimbursement from money is difficult since low reimbursement leads to squeezing in more patients with leads to “hamster wheel medicine” that Dr. Bob points out. My point is that it is not simply the money but the entire system. If for example, primary care physicians had to deal with no paper work and could see far fewer patients in much longer visits, but not make one penny more, I beleive you would attract many more students to primary care. Conversely, if the only thing we did to solve this crisis is to forgive all loan debt for students going into and practing primary care, it is likely that some students will take the offer, but many may not because they would rather have $140K in student loans then practice primary care medicine as it is practiced now.

]]> By: bostondoc http://www.medrants.com/archives/3747/comment-page-1#comment-521145 bostondoc Sun, 14 Sep 2008 21:19:54 +0000 http://www.medrants.com/?p=3747#comment-521145 Payment and lifestyle are hopelessly conflated. It is artificial to try to separate them. The major reason primary care lifestyles are so challenging is that primary care doctors who want to fulfill their salary expectations have to schedule high numbers of patients per unit time. That, and the ridiculous documentation requirements (again, a hoop to jump through to get paid). Also, what medical student is going to admit that money matters? Please. Since day one of applying to medical school, the notion that medicine is more like a priesthood than a job is drummed into us. Even our language of "reimbursement" rather than "payment" perpetuates this myth. A medical student survey is therefore meaningless. Revealed preferences--not stated preferences--are the way to get at this problem. If money doesn't matter, then please explain the phenomenon among UK medical students after a sudden jump in primary care payments. Payment and lifestyle are hopelessly conflated. It is artificial to try to separate them. The major reason primary care lifestyles are so challenging is that primary care doctors who want to fulfill their salary expectations have to schedule high numbers of patients per unit time. That, and the ridiculous documentation requirements (again, a hoop to jump through to get paid).

Also, what medical student is going to admit that money matters? Please. Since day one of applying to medical school, the notion that medicine is more like a priesthood than a job is drummed into us. Even our language of “reimbursement” rather than “payment” perpetuates this myth.

A medical student survey is therefore meaningless. Revealed preferences–not stated preferences–are the way to get at this problem. If money doesn’t matter, then please explain the phenomenon among UK medical students after a sudden jump in primary care payments.

]]> By: Dr. Bob (FP) http://www.medrants.com/archives/3747/comment-page-1#comment-521144 Dr. Bob (FP) Sun, 14 Sep 2008 02:24:31 +0000 http://www.medrants.com/?p=3747#comment-521144 I agree with Dr. Mintz. Nobody wants to practice hamster wheel medicine. That's what the current system wants us to do. Until it pays for something different, I don't see the tide changing. Maybe $300k a year would be enough to make you practice hamster wheel medicine, but not if there are other alternatives. A lot of med students rotating through like what we do, they just don't like the pace at which our medical system wants us to perform. I agree with Dr. Mintz. Nobody wants to practice hamster wheel medicine. That’s what the current system wants us to do. Until it pays for something different, I don’t see the tide changing. Maybe $300k a year would be enough to make you practice hamster wheel medicine, but not if there are other alternatives. A lot of med students rotating through like what we do, they just don’t like the pace at which our medical system wants us to perform.

]]> By: Matthew Mintz http://www.medrants.com/archives/3747/comment-page-1#comment-521135 Matthew Mintz Fri, 12 Sep 2008 00:44:06 +0000 http://www.medrants.com/?p=3747#comment-521135 While I completely agree that income is a strong factor leading students away from primary care, it is not the most important. As our study just published in JAMA showed, few students (2%) chose general internal medicine. However, the main factors were teaching, nature of patient care, and lifestyle. Salary was not associated. Students observe primary care physicians struggling to see complex patients in short visits and catch up on phone calls after hours and decide that this type of practice is not for them. That it pays substantially less while their debt is growing simply makes the decision more clear. Now, one of the main reasons primary care delivery is so unsatisfactory is low reimbursement for cognitive services. However the subtle difference is that just raising primary care salaries and/or relieving debt burden is not enough. We need to change the nature of practice entirely. I say more about this and our study on my blog at www.drmintz.com While I completely agree that income is a strong factor leading students away from primary care, it is not the most important. As our study just published in JAMA showed, few students (2%) chose general internal medicine. However, the main factors were teaching, nature of patient care, and lifestyle. Salary was not associated. Students observe primary care physicians struggling to see complex patients in short visits and catch up on phone calls after hours and decide that this type of practice is not for them. That it pays substantially less while their debt is growing simply makes the decision more clear. Now, one of the main reasons primary care delivery is so unsatisfactory is low reimbursement for cognitive services. However the subtle difference is that just raising primary care salaries and/or relieving debt burden is not enough. We need to change the nature of practice entirely. I say more about this and our study on my blog at http://www.drmintz.com

]]>