ACGME would defund Radiology, Dermatology, Ortho residencies

[Taurus]

This is Dr. Thomas Nasca, head of the ACGME:

“Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition,” Nasca says.

http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

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[Silent Cool]

This is Dr. Thomas Nasca, head of the ACGME:

“Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition,” Nasca says.

http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

Taurus, I saw this over on AM. How realistic do you think this is?

 

[DrBowtie]

Increasing the spots at existing programs can potentially dilute the training producing poorly trained physicians. You need to have adequate volume to support the increases.

They should close weak training sites first and then redistribute funds. Then we can talk about other subsidy sources.

 

[Taurus]

Taurus, I saw this over on AM. How realistic do you think this is?

Not very likely near-term, but who knows down the road. Money is tight in the govt and they need more primary care people. They used the carrot method to lure people into primary care by increasing their pay slightly. Now the govt might use the stick method to get people into primary care by making it so expensive to go into the specialties. Pretty clever if you ask me.

I know that fellowship funding in many specialties across the country are being reduced. Bottom line, finish residency and do your fellowship asap because funding may not be there tmr.

I'm just glad that I'll be done with residency and fellowship in about 2 years. What field I tell my kids to go into 20 years from now is up in the air.

 

[Law2Doc]

Taurus, I saw this over on AM. How realistic do you think this is?

Last I heard, radiologists were having a rough time finding jobs, so I doubt too many would go down that route (5 years plus fellowship) if they had to rack up debt too. Ortho is also too long for that (5-6 years, often plus fellowship) to be realistic. Derm, however, might still be a good investment even if you had to buy in -- the residency is very short compared to how lucrative the field currently is, so you wouldn't see much drop off in budding dermatologists.

 

[Residentcool]

Not very likely near-term, but who knows down the road. Money is tight in the govt and they need more primary care people. They used the carrot method to lure people into primary care by increasing their pay slightly. Now the govt might use the stick method to get people into primary care by making it so expensive to go into the specialties. Pretty clever if you ask me.

I know that fellowship funding in many specialties across the country are being reduced. Bottom line, finish residency and do your fellowship asap because funding may not be there tmr.

I'm just glad that I'll be done with residency and fellowship in about 2 years. What field I tell my kids to go into 20 years from now is up in the air.

The problem is that you cannot fix something so complex in such a shortsighted way. Pumping more and more PCPs into the system is not the answer, and realistically, you cannot have medicine function without specialists. What happens when there is a huge shortage of radiologists or GI's? Then their pay exponentially goes up because they are in such short supply. That happened in rads in the early 2000's. Sure, you can perhaps reduce some spots, but no one in their right mind is going to PAY to go into these specialties unless they are wealthy, and if you are wealthy you likely wouldn't be going into medicine. How long do they think physicians can go without income?

While some specialties can see a reduction in the # of trainees, it's just short sighted that this would work. I wonder what PCPs without specialists will do-interpret images themselves? They will go into the OR to fix broken hip themselves?

 

[Taurus]

What happens when there is a huge shortage of radiologists or GI's? Then their pay exponentially goes up because they are in such short supply

That's what I'm counting on. Those who finish before the cuts come will be the beneficiaries. Everyone after us will get screwed. Isn't that how it's most of the time?

Politics is messy and most of the time the changes make no sense. So I wouldn't waste my time trying to understand the meaning or logic of things.

I hope people realize it won't be just these fields that would be affected if the changes happen. Many specialties and fellowships will see cuts.

 

[axiomofchoice]

This would also very much change the dynamics of training. Hard to get someone to do scut work when they're "paying" to be there. It would be just like being a medical student for a few extra years.

Maybe start by not funding the training of the enormous number of FMGs that benefit from US GME.

Unfortunately I feel like some variation of 'pay for residency' will become reality in the not so distant future.

 

[Residentcool]

This would also very much change the dynamics of training. Hard to get someone to do scut work when they're "paying" to be there. It would be just like being a medical student for a few extra years.

Maybe start by not funding the training of the enormous number of FMGs that benefit from US GME.

Unfortunately I feel like some variation of 'pay for residency' will become reality in the not so distant future.

Doubtful. With the increasing costs of medical school, and if we have to pay for residency, pursuing medical profession will become financially impossible, especially if after 12 hours of schooling you get to only make 200k or something like that. It would make much more sense to become a PA or a nurse or CRNA. i guess I don't understand what they are trying to do. They realize how important doctors are, wouldn't it make sense to fix the system in a way that's sustainable?

If someone had 200-300k of debt from med school, plus another say 160k from residency (say 40k per year for 4 years), that would be close to 1/2 a million dollars when one is in one's 30's to make 200k? That would be madness and ridiculous. This entire system needs some major overhaul, and not working for peanuts should start soon.

How are we even able to work 80+ hours without extra pay under labor laws? Makes no sense.

 

[Textbookversion]

This is a ridiculous idea, and I say that as someone who is going into IM. Absolutely absurd. Not to mention the hospital would be making money off the trainees hand over fist even without government subsidies. If you are telling me that a resident doesn't do at least the work of a full time PA I've got a flying pig to sell you.

 

[Residentcool]

This is a ridiculous idea, and I say that as someone who is going into IM. Absolutely absurd. Not to mention the hospital would be making money off the trainees hand over fist even without government subsidies. If you are telling me that a resident doesn't do at least the work of a full time PA I've got a flying pig to sell you.

Yep. What's sad is that this ridiculous idea is coming from a physician. How sad is this?

 

[Paddington]

I know that fellowship funding in many specialties across the country are being reduced. Bottom line, finish residency and do your fellowship asap because funding may not be there tmr.

From what I've heard, up until the 1980's "self funding" of fellowships was very much the norm. Many cardiologists and the like were paid nothing for their fellowships (i.e. worked 80+ hours for free) and were supported by their wives (who did jobs like cleaning houses and waiting tables at restaurants).

 

[badasshairday]

Wow. I hope I can finish before this happens... unlikely because I still have 4 years of radiology residency followed by 1 year of fellowship to look forward too.

 

[neusu]

It might be worth noting that simply because medicare defunds the residency allocation for that specialty doesn't equate to the residents not being paid. Most of those fields are lucrative and the departments could (and have, in some cases) likely afford to offset the cost of resident training.

Say you have an ortho program with 2 residents a year e.g. 10 residents whose salaries would be $45-70,000, plus benefits/insurance. Let's just take $70,000 x2 x10 to get $1.4 million to pay residents. Those residents work 80 hours/week, and work their asses off. Alternatively, to simply get the same man hours you would need twice as many PA/NPs, working half the hours, getting paid twice as much.

 

[Law2Doc]

From what I've heard, up until the 1980's "self funding" of fellowships was very much the norm. Many cardiologists and the like were paid nothing for their fellowships (i.e. worked 80+ hours for free) and were supported by their wives (who did jobs like cleaning houses and waiting tables at restaurants).

There's a huge difference in self funding a 1-2 year fellowship (even ignoring the fact that student debt was much lower back when) than a 5 year residency...

Bottom line, this idea is just knee jerk type comment by someone who likely didn't think it through.

 

[end stage fibro]

What happens when there is a huge shortage of radiologists...

this is a joke

 

[Residentcool]

this is a joke

Haha @ Watson. No, not a joke. Remember the early 2000's? That scenario is bound to repeat itself if people continue fleeing rads and there is a shortage of rads like it happened back then. >20% of rads are 65+.

Like the family practice people on the forum say, if you think you can be replaced (in this case by Watson), then maybe you should be.

 

[Socrates25]

The Institute of Medicine, the health arm of the National Academy of Sciences, is also investigating GME issues. An 18-member committee has been appointed to analyze the entire GME system, from regulation to financing to governance. The group will release its recommendations for improving GME by spring 2014.

The IOM is a bunch of liberal academic feelgood idiots. I predict that their "recommendations" for 2014 are that GME residency slots should be open to NPs. No, I'm not joking about that.

Remember you heard it here first. I'll be sure to bump this thread back up in 2014

 

[Silent Cool]

From what I've heard, up until the 1980's "self funding" of fellowships was very much the norm. Many cardiologists and the like were paid nothing for their fellowships (i.e. worked 80+ hours for free) and were supported by their wives (who did jobs like cleaning houses and waiting tables at restaurants).

Yeah, but they also made WADS of cash after their training and had very little academic debt.

 

[Law2Doc]

Haha @ Watson. No, not a joke. Remember the early 2000's? That scenario is bound to repeat itself if people continue fleeing rads and there is a shortage of rads like it happened back then. >20% of rads are 65+.

Like the family practice people on the forum say, if you think you can be replaced (in this case by Watson), then maybe you should be.

Actually people have been trying to teach machines (wastson and others) to perform image pattern recognition or provide useful computer aided detection of lesions for radiology for the past couple of decades, and the results have been far less impressive than hoped. It's simply not a field that can be translated to an easy algorithm. Sort of like defining pornography - "you know it when you see it" -- is not something a machine would ever be able to define. So it's looking like radiology will actually end up being the hardest specialty to replace and last specialty to be replaced with machines. I'd expect to see machines like Waton take over a lot of primary care functions far earlier. The machine is really well suited for taking histories, being fed the results of te physical exam, and coming up with differential diagnoses and suggesting the appropriate tests to narrow the diagnosis, and then the appropriate treatment.

 

[deleted87716]

The machine is really well suited for taking histories, being fed the results of te physical exam, and coming up with differential diagnoses and suggesting the appropriate tests to narrow the diagnosis, and then the appropriate treatment.

Yeah, that sounds much easier to develop than good pattern recognition software...

http://www.shazam.com

 

[Ronin786]

Yeah, that sounds much easier to develop than good pattern recognition software...

http://www.shazam.com

I actually believe it is much easier to develop. To be frank, most of medicine can be summarized in a series of algorithms. If x then do y. Its evident in the guidelines that are set forth and in multiple disease processes.

Its not too hard to develop software, feed it the odds of each disease in the population and provide it with the necessary tests and results needed to come up with a differential. I'd bet it would be able to give you the exact likelihood of each disease as well. Furthermore, computers don't have any inherent bias based on what you saw previously. That can be a plus or a pitfall, but theres an argument to be made that approaching each patient as the first patient youve ever seen has its benefits.

I don't know enough about computers to speak about pattern recognition, but algorithms are extremely easy to implement.

 

[VA Hopeful Dr]

Yeah, that sounds much easier to develop than good pattern recognition software...

No kidding. Hell, our ECG computers are wrong about half the time in my experience and that's just a bunch of squiggly lines. I'd like to see one actually get a useful history out of any of my patients - maybe it can practice on Abe Simpson to get the idea.

 

[Residentcool]

Actually people have been trying to teach machines (wastson and others) to perform image pattern recognition or provide useful computer aided detection of lesions for radiology for the past couple of decades, and the results have been far less impressive than hoped. It's simply not a field that can be translated to an easy algorithm. Sort of like defining pornography - "you know it when you see it" -- is not something a machine would ever be able to define. So it's looking like radiology will actually end up being the hardest specialty to replace and last specialty to be replaced with machines. I'd expect to see machines like Waton take over a lot of primary care functions far earlier. The machine is really well suited for taking histories, being fed the results of te physical exam, and coming up with differential diagnoses and suggesting the appropriate tests to narrow the diagnosis, and then the appropriate treatment.

Yes, that was my point, that the idea that Watson would replace rads is pretty preposterous. Maybe my sarcasm abilities are not as good as gutonc's. Anyways, I think that radiology is more than just "pattern recognition" I think it's pretty harsh to just make radiologists into pattern recognition monkeys but I'll put that aside. I do think that primary care software could be created to at least reduce the need for some primary care encounters, no saying it could replace doctors. I don't think anything could replace doctors, not even midlevels but whatever.

 

[deleted87716]

Its not too hard to develop software... I don't know enough about computers...

Clearly.

There's already differential diagnosis software out there. Try it. It sucks.

computers don't have any inherent bias based on what [they] saw previously

The best ones, like Watson, do. That's why they're called "learning" computers.

 

[Doctor D]

The institute of medicine is the same group that recommended unlimited scope of practice for nurses and an expansion in the number of nurses in the workforce. Will be interesting to see their recommendations for the GME. I agree with the previous poster.

 

[reno911]

I think it will be a very long time before this idea is implemented (if ever). However, I don't think that there is anything fundamentally wrong with doing this.

Although I am a dermatologist (and for a while I was an academic one), I still do not think it is a bad idea in principle. And that's not just because I am done and won't have to worry about it affecting me.

It doesn't really make sense that people in training for a very competitive specialty with a higher income potential would be paid (as residents) the same as people training for a non-competitive specialty with a lower income.

I can tell you that when I was a student I would have gladly have paid tuition for my residency training. I would have had to take out a lot more loans, but I would have done it. And with the benefit of hindsight, the only mistake is I would have made is that I would not have been willing to pay enough.

There are several reasons for the aversion to something like the proposed change. A lot of it is the fact that we are just used to things being the way they are. Part of it is also probably because we don't want students to choose their specialty based on how much it costs -- we would prefer that everyone chooses what they enjoy the most. Another part of it is that some might be afraid that this would make specialty training only available to wealthier trainees.

However, I think these types of objections are fairly weak. I'm not really motivated to type out detailed responses to all of them, but I'm sure most can come up with reasoned responses on their own.

The only reason I qualify my opinion by saying it is a good idea in principle is that I am sure that there are ways in which this basic idea could be implemented very poorly. The devil is always in the details. But as a basic prinicple, I have no problem with this. Fortunately, for those that do have a problem with this, I doubt that it will be an issue anytime soon. The status quo is just too established.

 

[jazzman84]

The problem is that this is coming at the same time as all the cuts to compensation so the high salary once finished with training is no longer guaranteed. It is entirely unreasonable to expect that new docs will go 10+ years not only without earning a salary but to have an even more astronomical debt burden at the end.

Sent from my SCH-I605 using SDN Mobile

 

[reno911]

The problem is that this is coming at the same time as all the cuts to compensation so the high salary once finished with training is no longer guaranteed. It is entirely unreasonable to expect that new docs will go 10+ years not only without earning a salary but to have an even more astronomical debt burden at the end.

Sent from my SCH-I605 using SDN Mobile

Well it wouldn't have to be all or nothing. Maybe the salaries would be lower for specialty residencies and higher for primary care ones.

But you're right that this is an implementation problem. If specialty reimbursement were cut dramatically (bascially to primary care doc levels), that would probably be enough to drive plenty of med students into primary care (who would otherwise go into specialties) and then doing what the OP suggested would possibly be redundant.

In a free market, this really wouldn't be a problem as the uncertainty in future salary would be factored in to the market rate at which a resident in specialty X is paid. Unfortunately, we don't have anything resembling a free market in medicine and never will. In our highly regulated market this would happen also (if it were allowed to), but not nearly as effiiciently.

 

[badasshairday]

The institute of medicine is the absolute most stupid organization ever. I don't take anything they say seriously.

 

[Silent Cool]

I think it will be a very long time before this idea is implemented (if ever). However, I don't think that there is anything fundamentally wrong with doing this.

Although I am a dermatologist (and for a while I was an academic one), I still do not think it is a bad idea in principle. And that's not just because I am done and won't have to worry about it affecting me.

It doesn't really make sense that people in training for a very competitive specialty with a higher income potential would be paid (as residents) the same as people training for a non-competitive specialty with a lower income.

I can tell you that when I was a student I would have gladly have paid tuition for my residency training. I would have had to take out a lot more loans, but I would have done it. And with the benefit of hindsight, the only mistake is I would have made is that I would not have been willing to pay enough.

There are several reasons for the aversion to something like the proposed change. A lot of it is the fact that we are just used to things being the way they are. Part of it is also probably because we don't want students to choose their specialty based on how much it costs -- we would prefer that everyone chooses what they enjoy the most. Another part of it is that some might be afraid that this would make specialty training only available to wealthier trainees.

However, I think these types of objections are fairly weak. I'm not really motivated to type out detailed responses to all of them, but I'm sure most can come up with reasoned responses on their own.

The only reason I qualify my opinion by saying it is a good idea in principle is that I am sure that there are ways in which this basic idea could be implemented very poorly. The devil is always in the details. But as a basic prinicple, I have no problem with this. Fortunately, for those that do have a problem with this, I doubt that it will be an issue anytime soon. The status quo is just too established.

I'm glad that a dermie chimed in. It's interesting that you would have been willing to attend an unfunded residency (or even paid tuition), because many of the Osteopathic Derm residencies are actually unfunded. Check this one out:

http://www.phlb.org/DermatologyResidency.htm

 

[Silent Cool]

I think it will be a very long time before this idea is implemented (if ever). However, I don't think that there is anything fundamentally wrong with doing this.

Although I am a dermatologist (and for a while I was an academic one), I still do not think it is a bad idea in principle. And that's not just because I am done and won't have to worry about it affecting me.

It doesn't really make sense that people in training for a very competitive specialty with a higher income potential would be paid (as residents) the same as people training for a non-competitive specialty with a lower income.

I can tell you that when I was a student I would have gladly have paid tuition for my residency training. I would have had to take out a lot more loans, but I would have done it. And with the benefit of hindsight, the only mistake is I would have made is that I would not have been willing to pay enough.

There are several reasons for the aversion to something like the proposed change. A lot of it is the fact that we are just used to things being the way they are. Part of it is also probably because we don't want students to choose their specialty based on how much it costs -- we would prefer that everyone chooses what they enjoy the most. Another part of it is that some might be afraid that this would make specialty training only available to wealthier trainees.

However, I think these types of objections are fairly weak. I'm not really motivated to type out detailed responses to all of them, but I'm sure most can come up with reasoned responses on their own.

The only reason I qualify my opinion by saying it is a good idea in principle is that I am sure that there are ways in which this basic idea could be implemented very poorly. The devil is always in the details. But as a basic prinicple, I have no problem with this. Fortunately, for those that do have a problem with this, I doubt that it will be an issue anytime soon. The status quo is just too established.

As much as I hate to say it, there is logic behind slashing the funding for the more competitive (and thus higher-paying fields). Perhaps not totally eliminating it, but shifting some stipend money to the primary care fields during residency training.

 

[reno911]

I'm glad that a dermie chimed in. It's interesting that you would have been willing to attend an unfunded residency (or even paid tuition), because many of the Osteopathic Derm residencies are actually unfunded. Check this one out:

http://www.phlb.org/DermatologyResidency.htm

Well obviously a paid residency would be better than an unpaid one. But I would have rather paid for derm than done anything else. I'd much rather pay to spend my entire career in a field that I enjoy than get paid to eventually do something I didn't like as much. It certainly would have been hard, but I would have done it.

 

[RadOncDoc21]

I refuse to pay for residency or take out anymore loans. When is enough enough? There is no way this can even be possible. I rather spend my money being an astronaut!

 

[michaelrack]

I refuse to pay for residency or take out anymore loans. When is enough enough? There is no way this can even be possible. I rather spend my money being an astronaut!

http://discovermagazine.com/2008/apr/05-space#.UTq2zDevQik

 

[RadOncDoc21]

http://discovermagazine.com/2008/apr/05-space#.UTq2zDevQik

Ha! Freakin awesome

 

[Textbookversion]

People keep coming up with all these obscure answers to low primary care interest.

Let's lower medical school to three years!

Let's not pay residents in other specialties!

Let's just increase the number of medical students so much people will be forced in!

Let's blah blah blah

The real solution is just to pay more for E&M codes. Not hard to figure out.

 

[JGimpel]

Actually people have been trying to teach machines (watson and others) to perform image pattern recognition or provide useful computer aided detection of lesions for radiology for the past couple of decades, and the results have been far less impressive than hoped. It's simply not a field that can be translated to an easy algorithm. Sort of like defining pornography - "you know it when you see it" -- is not something a machine would ever be able to define. So it's looking like radiology will actually end up being the hardest specialty to replace and last specialty to be replaced with machines. I'd expect to see machines like Watson take over a lot of primary care functions far earlier. The machine is really well suited for taking histories, being fed the results of the physical exam, and coming up with differential diagnoses and suggesting the appropriate tests to narrow the diagnosis, and then the appropriate treatment.

Nighthawk

 

[dantt]

No kidding. Hell, our ECG computers are wrong about half the time in my experience and that's just a bunch of squiggly lines. I'd like to see one actually get a useful history out of any of my patients - maybe it can practice on Abe Simpson to get the idea.

Actually...a study was done comparing computer interpretation to expert cardiologists at Hopkins and the computer did better...

 

[reno911]

\

The real solution is just to pay more for E&M codes. Not hard to figure out.

That would probably help dermatology more than anyone else I can think of.

It will help primary care too, but not as much as derm. Perhaps the solution is harder than you think.

 

[Textbookversion]

That would probably help dermatology more than anyone else I can think of.

It will help primary care too, but not as much as derm. Perhaps the solution is harder than you think.

Nope that really is the solution. Incidentally everyone would make more for thinking rather than doing procedures... which is sort of the point.

 

[Law2Doc]

Nighthawk

Um, we were talking about machines. But no, if you are talking about foreign nighthawks (ie international outsourcing) this too has been tried for decades with nominal success, and the independent state licensing requirements, litigation issues, need for physicians at each facility, and need for clinicians to come to the reading room and have things shown to them, make this never likely to happen wide scale.

 

[lowbudget]

I would rather derm, rads, etc residents get paid. But I would also rather they keep open the slots as unfunded positions than eliminate the positions altogether. We need these doctors, but the 1997 budget freeze on total residency slots prevent us from increasing primary care residency slots without cutting specialty slots... Enter mid levels.

This is really really bad. Primary care really is at a crisis. Once again, our predecessors are screwing us.

If they can't fund it on the federal level, states, county, and local communities (businesses and non-profits) need to step up and pay for resident and medical education for all doctors.

It's so sad. I listen to all these doctors support cutting "entitlement" (which in federal budget terms includes defense, social security, Medicare and Medicaid)... But do they realize that if you cut Medicare/Medicaid that you cut medical education and residency training?

 

[Law2Doc]

.... But do they realize that if you cut Medicare/Medicaid that you cut medical education and residency training?

they realize but have already got their nest egg. Politicians push these cuts because the public has no problem cutting the salaries of future rich doctors.

 

[reno911]

Nope that really is the solution.

If I had more time, I might type out something longer explaining why your simple solution is insufficient. But I've got better things to do, and you will likely be unpersuaded. So, I'll leave you to ponder this. Which of the following do you think is more likely:

1. Paying more for E&M codes is the "answer to low primary care interest".
2. This problem is more complicated than you realize and there is something that you don't understand which makes the solution more complicated than this.


I suspect that it will be obvious to anyone but you which of the above is more likely to be true.

 

[badasshairday]

I would seriously feel like quitting if I had to pay for residency. Definitely would talk anyone I know from making the same mistake I did choosing a career in medicine. The sad part is, I like what I do, but all these external political pressures, regulations, debt, poor debt to income ratio, etc, make it not worth it.

I can't believe they are seriously talking about defunding residencies and having residents PAY for spots. Not only that, it sounds like they would not care if certain number of spots in some residencies just vanish. What about the residents that get terminated in the middle of their training due to "funding shifts"? So messed up.

 

[anonperson]

If I had more time, I might type out something longer explaining why your simple solution is insufficient. But I've got better things to do, and you will likely be unpersuaded. So, I'll leave you to ponder this. Which of the following do you think is more likely:

1. Paying more for E&M codes is the "answer to low primary care interest".
2. This problem is more complicated than you realize and there is something that you don't understand which makes the solution more complicated than this.


I suspect that it will be obvious to anyone but you which of the above is more likely to be true.

Primary care is unpopular because the pay is relatively low compared to other specialties for the amount of crap they have to deal with. Managing chronic conditions and performing preventative care isn't reimbursed well in this country. The PCP isn't held in as high regard among the medical community related to other specialties. I don't think the answer is that complex to be honest.

If primary care physicians made more money, I honestly believe there would be more people interested in those specialties. There will still be that subset who pursue subspecialty training because they are generally interested in that topic/area of care but for a lot of people, a job is a job.

If a derm or rads was only pulling in 150K a year, the interest in these specialties would most likely decline.

But back to the topic, defunding residencies is a stupid idea. It's just another manifestation of people abusing physicians, thinking that we can sustain an unlimited amount of debt because of our future salaries. People think doctor and equate "rich" without realizing the staggering amount of debt that can be amassed and the poor pay in residency related to the hours worked.

 

[goofball]

Does anyone else think that if this went through, the powers that be wouldn't stop at Rads/Ortho/Derm? That they'd eventually hit all the other "desirable" surgical specialties as well?

 

[reno911]

Primary care is unpopular because the pay is relatively low compared to other specialties for the amount of crap they have to deal with. Managing chronic conditions and performing preventative care isn't reimbursed well in this country. The PCP isn't held in as high regard among the medical community related to other specialties. I don't think the answer is that complex to be honest.

If primary care physicians made more money, I honestly believe there would be more people interested in those specialties. There will still be that subset who pursue subspecialty training because they are generally interested in that topic/area of care but for a lot of people, a job is a job.

If a derm or rads was only pulling in 150K a year, the interest in these specialties would most likely decline.

But back to the topic, defunding residencies is a stupid idea. It's just another manifestation of people abusing physicians, thinking that we can sustain an unlimited amount of debt because of our future salaries. People think doctor and equate "rich" without realizing the staggering amount of debt that can be amassed and the poor pay in residency related to the hours worked.

Raising the reimbursement for E&M codes (which is what was proposed) will not pull the PCP up to the level of most specialists. Lots of specialists do a lot of E&Ms too. In many cases, the specialists are not making more because they are doing procedures instead of E&Ms, they make more because they are doing procedures in addition to their E&Ms.

For example, there is probably no physician that does more E&Ms in a day than a busy dermatologist. That is just one reason why this, this simple, well-intentioned, reasonable-sounding measure is insufficient to solve the problem that it purports to.

In other words, paying primary care docs more and specialists less is not at all the same thing as "just paying more for E&M codes" (which is what the post I was responding to said). The former would be a valid solution to the stated problem if an effective way to implement it was designed. The latter is a misguided attempt at implementation.

 

[Law2Doc]

Does anyone else think that if this went through, the powers that be wouldn't stop at Rads/Ortho/Derm? That they'd eventually hit all the other "desirable" surgical specialties as well?

Of course. Once you start down this road the necessary conclusion is to create a ranking order of fund worthy and debit worthy residencies, and fund, defund or charge people accordingly. We need more FM so they get a salary. Derm is a privilege so they get a bill. Everything in between gets positive, negative or neutral treatment. The problem is that each path is a different number of years, so there already are some built in disincentives and for something which already has a long residency and fellowship, and it really wouldn't take much to disrupt the delicate equilibrium and result in shortages, short term, until the market corrects itself by driving up salaries in those fields. So the quality/quantity of specialty care would always be in flux. But this plan isn't about worrying what will happen down the road, it's a shortsighted approach to try to push people into primary care by making other paths suck more. (and in this respect it's a bit insulting to primary care, to boot).