Monday, September 28, 2009

Drilling Down On Cardiology Cuts

Currently, cardiologists are on a treadmill of increasing patient visits to offset declining Medicare payments and increasing overhead. When the government plans on blanket cuts to cardiologists in favor of primary care, the impact will be felt first by those in rural areas that already have a shortage of cardiologists. Then will come pressure on small town practices as they are forced to close. Bigger cities with large health systems will be least affected.

But this is all part of the Grand Plan of health care physician reform: make sure everyone gets insurance so they can "prevent" cardiovascular disease while those that have it can't find a specialist.

I see how this works.

-Wes

4 comments:

Keith said...

Wes,

I would agree that we need to have balance so that we can offer the services we need to prevent what is preventable (I am sure both of us may have issue as to what is preventable) but to have availible those services for patients who need more advanced treatment. You are probably right that rural services will likely be impacted, but I would guess many already have great difficulty finding a primary care doc in those settings at present. And in fact, I understand that many primary care docs to the north of us are not accepting any new Medicare patients at present. Meanwhile, there seems to be an abundance of cardiologists.

What will likely happen is what has always happened in this country; unpopular specialties (currently most of the cognitive specialties) get their residency slots filled by foreign medical grads that for all our griping are more than willing to come here for the potential income they can make. Even as a primary care doc! If these services are cut, then these FMGs may take residency slots not filled by those willing to do the training in cardiology and these new cardilolgists will likely end up in rural regions. It is, after all, a global economy. As to the current cardiologists, where do you think they will go? Some may choose to retire, but I doubt most will suddenly pull up stakes. They will be stuck in a specialty where their skills are reimbursed at a lower level, but the pay still won't be that bad compared to alot of people. I doubt they will make less than primary care docs, which could be their other choice.

We in medicine are somewhat insulated from this global effect to some degree, but the increases in health care costs are not sustainable as jobs that once paid good salaries are outsourced to cheaper labor markets and our less educated brethren are left in low paying jobs, often with no health insurance.

Fight as you might, the writing is on the wall. Health care costs in this country are growing unsustainably, and will need to be cut somewhere. Where would you look to cut health care costs if you were in control and were confronted by a looming large deficit in the Medicare trust fund? On the one hand we complain about the goverment not controlling deficits, but on the other, every program has a contituency preaching some dire consequence if their revenue stream is cut.

DrWes said...

Keith-

Where would you look to cut health care costs if you were in control and were confronted by a looming large deficit in the Medicare trust fund?

Insurance portability across state lines, price transparency, tort reform (to a limited extent), and the ability to purchase old, proven technologies. One only has to look to the obsolete dual chamber pacers with large batteries, especially Medtronic's Thera models and St. Jude's Synchrony II's that last years and years and years, to see where we might be able to cut prices in my specialty. I bet there's plenty of similar examples of using old technology that others could follow, too.

But Americans (and cardiologists) demand the "latest and greatest" and if we want to pay for that, then that's okay. But without transparency to costs (which government shelters) and involving patients in the price discussion when possible, the chance for sustainable reform with devolve to government handouts that will quickly bankrupt our entitlement programs (as we've already seen).

Tom H. said...

Glad I live where I'm at. Don't have to worry about finding specialists, just worried from all the horror stories I hear that my insurance provider might drop me if I ever get too expensive.

Anonymous said...

Keith,
First of all, there is a shortage of cardiologists at this time and we are headed to a potential crisis in the future as the "baby boomer" generation is aging. As a Cardiologist, I work a tremendous amount of hours already. The cuts that have already occured and that are currently looming will have a profound impact on the way we practice. Many smaller groups are closing and joining hospital systems and the others are findings ways to decrease overhead, which involves cutting staff. As compensation continues to decrease, we will be forced to consolidate into bigger systems which will increase waiting times. Eventually, as occurs in other countries, specialists such as cardiologists will simply refuse to work excessive hours for decreased pay. There is no law that states that I have to work more for less pay. This will again increase waiting times. I expect to get paid more as a specialist because of the hours I work, and the training I had to complete. I trained until the age of 36. Likewise, the more complex procedures and studies I'm trained to do puts me at higher risk for litigation. Why is tort reform not included in the health care reform - because the trial lawyers give substantially to the democratic party. Until this is passed, what person will agree to enter the field of long hours and lower pay with a chance of losing everything after one mistake.