Monday, April 27, 2009

On Over-priced Specialists

There's a primary care physician (not "provider") shortage.


They are underpaid.


We should redistribute money from the "rich" specialists and give it to the primary care doctors.

This is being proposed.

Here are some considerations:

#1) Medicare costs are derived from two locations, a doctors fee and a "technical fee." Some examples (estimates only):

A left heart catheterization:
Doctor fee: $270
Hospital fee: $1250
Open heart surgery:

Doctor fee: $2000
Hospital fee: $20,000
So, by all means, cut the specialists' portion of the fees to save costs, okay?

But there will be repercussions with reduced access to specialists. (Funny how we never hear about technical component cuts, but then again, they've got more lobbyists...)

#2) What happens when we pour in more primary care doctors (as is being proposed)?

More primary care doctors find more disease: good for specialists.
More primary care doctors that are paid better find primary care attractive stay in primary care: good for specialists.
More primary care doctors which cost more, both to primary care and to specialists: bad for sustainable model of health care delivery.

Unless, of course, people realize we'll have to eat our spinach and ration the care delivered.



Anonymous said...

Primary care compensation is not just a question of how much doctors are paid, but also how much they themselves spend on the cost of doing business. A Loser Pays law like the one almost the entire rest of the world has would reduce the money spent on malpractice insurance. Government deregulation would save primary care money as would laws that allow primary care practices to garnish the wages of deadbeat patients who have not paid their bills after a good faith effort by the practice to collect. Cracking down on non-payment or delayed payment by third party-payors would help as well.

Making primary care less expensive to practice should be at least as important as raising primary docs' income. I'd love to get paid more and I suspect we will see PCPs incomes go up in the future, but let's make medicine less costly to practice too.

DrWes said...


Great points. "Loser Pays" laws would be good for primary care, specialists, hospitals, and ultimately patients (due to lower costs).

Unfortunately, they'd be bad for lawyers.

Given that lawyers donated $43 million vs health care professionals' $11.5 million and because lawyers write the policy and laws, I'm not overly optimistic that we'll see Loser Pays laws anytime soon.

(It's also interesting that this issue is rarely discussed by the main stream media.)