As specialists are threatened with declining revenue streams as our government Robin Hood compadres shift payments from specialists to primary care in the interest of "lowering costs," why aren't hospitals who have profitted handsomely from the high-tech procedures performed by specialists stepping up to stem the bloodletting?
I believe it's because the model for primary care medicine has changed dramatically over the last five to ten years. Primary care, as we know it now, isn't the all-encompassing primary care model that it once was in years gone by. No longer is it the norm for a primary care doctor to follow their patients in the hospital. Regretfully, the payments to doctors for the time spent have dwindled to the point where doctors have to stay in their offices to treat more and more patients in less and less time and resort to turning over their soon-to-be inpatients to "hospitalists" to manage them in the hospital.
They are turned over today to young, eager, relatively cheap hospitalists fresh out of their internal medicine residency. The same hospitalists who are often hired by hospitals because they order lots of tests and decrease the patient's length of stay. The same hospitalists whose salaries are typically subsidized by the hospitals. And the hospitals are eager to keep their hospitalists happy because they need even more consults and tests performed whose technical revenues exceed professional revenues by about ten to one.
Physician salaries are a relatively small piece of the health care cost pie.
So shifting payments might be a pretty good return on investment for hospitals: watch the specialists' salaries decline and shift funds to the hospitalists (your employees or employees in proxy) as you earn more for them and lots more for you.
I guess that's why they're in business and I'm in medicine and hospital leadership can gloat over a $2.25 million a year in a place with relatively low cost of living, justifying that income because "I'm a poor kid from a mill town. My father graduated from high school, and my mother didn't. And so it is a lot."