the BAD side of FM residency programs

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sophiejane said:
You really are not paying any attention to what I have said, so this is going nowhere. You have decided that I am happy with the status quo and disrespectful of my profession, and not doing anything to change it, and you really won't hear otherwise. I keep telling you I am doing what I can while being a resident. I already CHOSE this field, which is the biggest thing I can possibly, personally do to remedy the shortage of FPs. Not only that, I am going to practice in an underserved area. Seriously, what more can I offer as proof?? What would you have me do differently? Am I not complaining enough on SDN about how unfair it all is?

There is a difference between accepting responsibility for the path I have chosen, which includes my debt, and saying things don't need to change. They do need to change. But expecting the medical universe to realign overnight is pretty naieve.

You can be exempt, you are not in it yet. Those of us who signed up for it have no excuse for being surprised at the average FP salary and all of a sudden getting indignant because the end of residency and the beginning of repayment is staring them in the face and lo and behold, reimbursements and salaries are pretty much the same!

Of course we know the answer is better pay, you are not really revealing a great truth there. But I can tell you, having just finished reviewing applicant files, there are some extremely qualified folks choosing FM because they like the lifestyle and the job.

No, really. I'm really out this time...
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Well I guess we can agree to disagree. I'm not sure if you realize the arguments you have been using in your posts, but they contradict each other. First you say you have come to accept your situation since you knew what you were getting into. Then you said things need to change. Then you said you are trying to do as much as you can to fix things in your limited ability as a resident. Then you said nothing will change. Then you said you are doing your best with what you have. Well at least we can agree that things need to change and can't be the same.
 
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I'd be interested to find out what the people on this thread would consider "fair" reimbursement for the work of a family doc. I'm not looking for a response like "we deserve to make more than radiologists". I want a numerical figure that you would consider suitable for your work. In my zip code, according to salary.com the median salary for a FP doc is about $140k. Exactly how terrible is that? I understand that med school debt racks up but hey that's life. There are plenty of people who borrowed $100k just to finish undergrad and now can't find a job at all.
 
[youtube]http://www.youtube.com/watch?v=78tf2eG88jY[/youtube]
 
Good lord!

I leave for one day and all hell breaks loose :eek:
 
I think we all agree that something needs to change...and we all agree that it involves loans and relative pay.
 
Wow! It's been a little circular, but it's good to see people getting fired up on this forum. First, a quick comment on the numbers. Inflation adjusted total income for FP's has dropped, but that has happened for most other specialities as well. There are exceptions, GI income came up when they cut down on medical management and started sticking scopes in any orafice that was still for more than 30 seconds. However, those "high" FP incomes were also in the time when there were no hospitalists and FP's were doing lots of OB in solo practices. If you adjust for the decrease in average work hours, there may have actually been an increase in hourly pay. I'm interested to see a comparison of the hourly wage for an FP compared to a general surgeon.

Low salaries plague all of the primary care specialities; salaries are basically the same for primary care IM, Peds, and Med/Peds. Again there are exceptions, but if you, and this is admittedly hard to do, invest/pay off loans with the extra ~100k a year you make as an FP while your classmate is finishing his big toe fellowship after an ortho residency, it will take a long time for him/her to catch up. There are again obviously exceptions to this, for example my best friend finished his ER residency at the same time I finished FM and he makes about 75K a year more than I do. However, none of my patients have thrown feces at me, and I only work 1/5 weekends and spend most nights at home. It hurts my ego a little sometimes, but I don't starve.

I'm not completely happy with FP salaries. Things could be better. If we don't take an active role in shaping our speciality, there are insurance companies/ physicians in other specialities/state and federal governments that will be happy to have us clean up after partialists... I mean specialists... for peanuts. We have to be politically active. We have to practice medicine that's good for our patients first, but also good for our speciality.

The sky is not falling. It may seem that way when my best friend from undergrad, who graduated from college with me, gives me a call to tell me he' s retiring from the software company he started working for immediately out of college. This is compounded by the fact that I had yet to complete residency at the time. Medicine is not a bad gig though. At least I like it.
 
AwesomO said:
It's all about innovation folks. No one said you had to play by the medicare and insurance rules.
http://www.jayparkinsonmd.com/index.html
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Wow that is really cool and creative. I like it. :thumbup: No overhead/office staff. Good patient-doctor relationships. Ability to provide good care to your patients. I wonder what the catch is? I would love to pick his brain and see how he came up with the idea and what some of the major issues he faces are.
 
EdibleEgg said:
I'm not completely happy with FP salaries. Things could be better. If we don't take an active role in shaping our speciality, there are insurance companies/ physicians in other specialities/state and federal governments that will be happy to have us clean up after partialists... I mean specialists... for peanuts. We have to be politically active. We have to practice medicine that's good for our patients first, but also good for our speciality.
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I couldn't have said it better myself.
 
could you please explain the second link? CRNA survey? Who honestly cares -- not to be rude.
I highly doubt that a CRNA can make up to $200,000.
"Fair reimbursement" equals fairly getting paid for a fair amount of work. Not working like a maniac, 8 to 7 pm every day, taking call just to make adequate money, not having much of a family life whatsoever, let alone free time, vacation time is "catch up on sleep and burn out" time, and calling that a "life"
I don't know about you, but I didn't sign up for that aspect.
I want to make a decent living, and get paid to do so, plus I have significant debt.

Yours is a reasonable gripe. The basis for all of this compensation disparity is complex and far too extensive to address in the little time available to contribute here. However, part of the basis for this is related to the unfortunate presupposition in compensation for procedures. As insurance adjustors and administrators are not medically qualified/trained, the emphasis has been placed on coded procedures, rather than preventative medical advice or management of chronic medical conditions. Thus, one gets paid for what one does (procedures) rather than what one says (cognitive management). This is also why some of the sub-specialties that are non-procedure based receive relatively lower compensation in comparison to those that feature procedural intervention. This is, of course, irrational as it does not address disease prevention or careful, "evidence-based" efficacious management of the common diseases that account for the major causes of mortality and morbidity in Western countries. Family medicine, primary track internal medicine, peds, etc, all of the primary care specialties, are the front line for this purpose. I am continually amazed that the greed and avarice of the health insurance industry haven't led them to comprehend that rewarding the performance of countless unnecessary procedures and decreasing the compensation for effective preventative/cognizant-based management, will ultimately be far more expensive! This of course is very secondary to the over-riding fact that it will longitudinally result in an abundance of wholly preventable human suffering.
This is the reason why "middle level providers" such as CRNAs receive ridiculously inflated salaries. They are allowed to perform procedures that should be performed by anesthesiologists, i.e. physicians (no, not "MDAs"). Take note that there is an effort to name all in the "health professions", "providers". This is a means to equalize all under the same nomiker. This is incorrect as we are PHYSICIANS, not "health care providers". This may seem off the actual subject, however, I can assure it is not. The AAFP and the MSSNY are making a strong effort to address these issues. However, it will be difficult to effectively turn the tide against such an imbedded financial incentive.
 
Members don't see this ad :)
HarveyCushing said:
I couldn't have said it better myself.
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Harvey,

A word about loan repayment...many times the offer is not found on a website, but given by local hospitals. For example, I know the local hospital where I'm at has offered me 100K in loan repayment...this is from the hospital itself, no state organization or anything. Keep that in mind when you struggle to find loan repayment programs. :thumbup:
 
HarveyCushing said:
Wow that is really cool and creative. I like it. :thumbup: No overhead/office staff. Good patient-doctor relationships. Ability to provide good care to your patients. I wonder what the catch is? I would love to pick his brain and see how he came up with the idea and what some of the major issues he faces are.
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I emailed him a few times back in November and he always replied back. He may be a bit busier now as his practice has really taken off and he also serves as the Chief Medical Officer for a group trying to establish a more streamlined EMR. So I don't know how much time he spends answering his fan mail now adays.
 
sophiejane said:
snip

Those of us who signed up for it have no excuse for being surprised at the average FP salary and all of a sudden getting indignant because the end of residency and the beginning of repayment is staring them in the face and lo and behold, reimbursements and salaries are pretty much the same!

snip
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Well said, Sophie. Personally, I don't take huge issue with the "average" FP salary because I don't plan on being an "average" FP. Perhaps you (and I) would be more perturbed by the whole thing if we wanted to practice in NYC or LA. For the time being I plan to focus on my training, try to be truly excellent in the field, and have a largely self-pay practice when I graduate. Not price-gouging, mind you, but a fair price. You don't see good mechanics or skilled trades-people accepting cut-rates for their quality work, so why should we? Of course in 3 years time our situation could be entirely different, so who knows...
 
the future of medicine is moving toward acute care, specialty, end-stage disease care...basically, people wont be able to see a doc until they're about to die. and so there goes the bigger bill, and bigger bill will eventually bankrupt the economy. and finally will people realize that preventive care is actually important. until then, the trend will continue, sad to say.
on another note, im happy with my 140k. and if it takes 60k to buy happiness with your job, its well worth it
 
thedman888 said:
the future of medicine is moving toward acute care, specialty, end-stage disease care...basically, people wont be able to see a doc until they're about to die. and so there goes the bigger bill, and bigger bill will eventually bankrupt the economy. and finally will people realize that preventive care is actually important. until then, the trend will continue, sad to say.
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Can I borrow your crystal ball for my stock portfolio, please? ;)

Really, no one knows what's going to happen, but I think the above scenario is a bit extreme.
 
thedman888 said:
the future of medicine is moving toward acute care, specialty, end-stage disease care...basically, people wont be able to see a doc until they're about to die. and so there goes the bigger bill, and bigger bill will eventually bankrupt the economy. and finally will people realize that preventive care is actually important. until then, the trend will continue, sad to say.
on another note, im happy with my 140k. and if it takes 60k to buy happiness with your job, its well worth it
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Except that the more quickly the government can kill people off, the fewer the benefits they have to pay out. It's a horrible thought, but from a purely financial standpoint they have something to gain from people who die early from MIs, GI malignancies, etc. Remember a few years back when there was a big stink about how tobacco companies should be responsible for the medical costs they were driving up? When they ran the numbers it turned out they saved the government money by killing people before they made it to their 70s/80s where the really big bills are. I'm sure there are different ways to crunch those numbers, but I don't think it's safe to assume that healthy is always cheap.
 
andwhat said:
There are specialists reading this, thinking thank goodness that they made the correct career choice in pursuing a specialty.
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You're right.

I had a great experience with a family med doc during my 4th year of med school....but with nearly 200k in debt couldnt even consider it an option.

Being debt free with money in the bank, practicing a specialty I enjoy, with plenty of time off is wonderful.

I too wish family med docs made more.

Sad, but our nurse anesthetists make more than a family med doc.

Theres no rhyme nor reason to that.

But hey, I didnt make the rules....reality is reality.
 
Unfortunately it is possible for a CRNA to make 200K in one year, particularly if they work "overtime" or in a rural area or in an area where no one else wants to work. It makes my blood boil every time I think about ANY meid-level provider (especially CRNA's) making more than primary care physicians (or any physician for that matter).
 
andwhat said:
Its true that this is a more difficult time for Primary Care. However comparing to nurses, well then you can say that there are Rheumatologists and Infectious Disease docs that earn in the upper 180s, that are earning lower than CRNAs.
Also I know people in their twenties, that worked for google as teenagers, that have millions in the bank -- so what does that prove? Absolutely nothing.
Sorry I just do not buy it. I worked in an OR, and knew that those CRNAs that tried to net around $140 K and above ended up having mental / psych issues, due to working so much and getting burned out.
Well we could look at other perspectives also. For instance who would want to be an Anethesiologist? You will never EVER be your own boss, you will always work for the Surgeon or Specialist. Can you start a case before the Surgeon finishes his or her breakfast? Or makes it through rounding, I do not think so. You work for the Surgeon.
True the money is pretty decent as of right now; however there is also Malpractice, and you are constantly in the OR, the 12 hour days, PLUS call. Is that lifestyle worth it? Certainly not for me. You will pretty much ALWAYS work for the General Surgeon, or Specialist, and will never ever be your own boss as an Anesthesiologist.
You better as heck get used to early morning hours, because thats exactly what you will be doing, waking up early, for the rest of your life. Again NEVER for me.
You will never ever have decent working hours, and you have to take call -- and then think about it, you have to work for the Surgeon for the rest of your life, the Surgeon is busy rounding, you better wait for him or her. Surgeon is busy reading the newspaper, guess what? The case is not starting without the Surgeon.
Think about it, Urgent Care docs make in the $200 - $250 K range even in bigger cities like Phoenix, but don't have to take call? WOW wonderfully amazing!
You have to look at the positives, and the negatives of a Specialty.
Yes there are certain aspects of Family Medicine that are very good.
Traditional Family Medicine needs to be restructured, and you can STILL make over $300 K in Family Medicine, doing Endoscopies and Colonoscopies in rural areas.
My gripe, is that Family Medicine doesn't have the scope of other practices at times. However you can still make alot of money if you play your cards correctly. You can live in a rural area, where you are allowed to do more procedures, than say that Family Doc in the middle of New Jersey or New York.
Plus -- yes you can be your OWN boss, and no you don't have to answer to anybody.
As an Anesthesiologist, you are basically the ball and chain help -- to the Surgeon and Specialist.
That is CERTAINLY not for me, no matter how much it supposedly pays.
And as for having "money in the bank"
Yeah I could work in a rural town and bank more than $300 K doing procedures -- Endoscopies and Colonoscopies for a couple of years also, and be my OWN boss most importantly.
Yes this is changing the tune of my previous remarks, if not significantly; albeit those are some wild claims that need to get clarified.
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I respect you defending your specialty. I'm not "defending" mine, or "bashing" yours.

Your facts are a little skewed about the hours, however.

Alot of what you say about anesthesia is true. We cater to surgeons. All specialists cater to someone. Heart surgeons cater to cardiologists. Surgeons in general cater to primary care docs. My S.O. is a general surgeon..alotta her work (mostly breast issue to rule out sinister masses) comes from OB/GYNs.

Night call certainly is terrible. In my situation it is tolerable since I take one weekend in 6 (split with another MD) and about 4 weekday first calls per month.

Most days I'm outta the hospital by 3pm..but hey, we start at 0630....a few days a month I'm there til 6 or 7; a few days I'm out in the morning around 9-10am. Overall I work a little less than 50 hours a week. We have a large group so call is distributed to a tolerable level and if you are at the hospital late one day you generally get out early the next.

The docs in my group all have 9 weeks vacation annually.

I'm not trying to convince you to "buy" anything (in reference to your comment ...."I'm not buying it"..)

Just agreeing with the consensus of this thread that primary care docs arent paid enough....and that sole fact eliminated it as an option for me.

Thanks for your reply.
 
andwhat said:
yeah but it could be better ;)

no sir, jetproppilot
I think that Anesthesia is an awesome specialty, there are pain doctors also, and they can work independently. Wasn't by any means trying to "bash" your specialty.
I am just stating that there are positives and negatives to each and every specialty.
I personally know a General Surgeon who loves Boston, about a year and a half out of residency roughly, and he will not leave his painful gig -- even though he is working LITERALLY like a resident. He makes around $100 K -- he is the Surgeon hospitalist, again HORRIBLE lifestyle and hours, but he LOVES Boston, and has family there.
Right now, Family Medicine needs some restructuring that hasn't even surfaced as of yet.
Family Medicine caters to specialists also.
The beauty in our case of "catering" to a specialist, however, is not having to deal with incredibly complicated issues, you can just pass them on if you are not comfortable dealing with them.
The minus side of that, is yeah occasionally Family Medicine gets dumped on "Vicodin and Xanax? Call your Family Doctor."
No I do not think so, call the Pain Clinic.
Part of Family Medicine is also continuity, seeing your patients again. I must admit that about 1% of patients you truly do not want to "see again", however.
Like I hammered again and again, each and every single specialty has its positives and negatives.
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Good Lord, man, if you sound in person like you do online people must think you are borderline manic. IMO, you might be more effective in drawing awareness to the issues facing FM if you could tone things down just a smidge. Seriously...
 
Aw I understand Frijelero, did I hurt your feelings? Do you feel underrepresented, and or underappreciated, here and possibly elsewhere in your life? Do you feel as if you are stating irrelevant things WAY off topic, such as Cigarette sales, and nobody is paying any attention to you? Well I cannot help you with your life woes, but I can help you here buddy. The forum's all yours big guy! Ha ha
 
iatrosB said:
Good lord!

I leave for one day and all hell breaks loose :eek:
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Jeez. No kidding! Can't a guy go on vacation for a few days!

Good discussion, tho. Glad to see the "warmth" about the topic.

Disagree that Sophie is inconsistent by saying that she loves FM and is committed to it, but has problems with parts of it. If you have to love EVERYthing about something you partake in, there wouldn't be such things as marriage, parenting, friendships...or the Ellen DeGeneres show.:D

Any NP who makes 200k/y is going to end up spending half of it on counselors, anti-depressants and lawyers. :scared:
 
Looking at future job opportunities. :laugh:

Nah, actually, I wish they would add business development to FP practices. You guys can rake it in if you do it right, i.e., cash only/high insurances. That kind of practice gives you flexibility to play more golf, do charity cases if you want to, spend more time with patients. Anyway you slice it, capitalism brings better quality of care.

SomedaySoon said:
I'm switiching into family and couldn't be happier, but to avoid being disillisuioned, especially since my med school exposure was shorter than I would have liked, I want to find out about the bad side, the disappointments, frustrations, etc of being a fammed resident.

What annoys you, angers you, makes you want to quit? :mad: :eek: That way, when it happens to the rest of us, we'll know that it is normal and will get better! :cool:

On the flip side, you can share the happy stuff too. :D

TIA!
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The guy should open up an urgent care center and only take cash/high paying insurance patients. Make your services valuable by providing fast, efficient care, give the people what they want, make the cake.

It's really that simple. FP's can have licenses to print if they have some business saavy...and training...

sophiejane said:
Where is Kent when I need him....ahhh....

Okay, so, what are YOU doing about it? You knew what it was like, you chose it, now you are unhappy, so go out there and do something about it. Run for office, vote, but for Pete's sake, going on and on about how unfair it is will get you nowhere. Again, nobody put a gun to your head and made you do FM.

A little less talk and a little more action, my friends.
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They are easily making that much.

You're right, they are high salaries, and the market is dictating that. You're also correct in stating that they are doing things that only physicians should do, but hey, when you legislate your clinical prowess instead of earning it, you're in big trouble when it hits the fan. Thankfully, not all CRNAs are militant, but it only takes a few bad apples to spoil the barrel.

Finally, we are physicians, not providers, and verbage is what works in the legislative processes and public marketing, so the nurses are a step ahead of us (as usual). We all have to become aware of the issues that play into the decreased reimbursements, as they directly effect our ability to provide optimal care for the doctor-patient relationship which is at the heart of medicine.

herpmed said:
could you please explain the second link? CRNA survey? Who honestly cares -- not to be rude.
I highly doubt that a CRNA can make up to $200,000.
"Fair reimbursement" equals fairly getting paid for a fair amount of work. Not working like a maniac, 8 to 7 pm every day, taking call just to make adequate money, not having much of a family life whatsoever, let alone free time, vacation time is "catch up on sleep and burn out" time, and calling that a "life"
I don't know about you, but I didn't sign up for that aspect.
I want to make a decent living, and get paid to do so, plus I have significant debt.

Yours is a reasonable gripe. The basis for all of this compensation disparity is complex and far too extensive to address in the little time available to contribute here. However, part of the basis for this is related to the unfortunate presupposition in compensation for procedures. As insurance adjustors and administrators are not medically qualified/trained, the emphasis has been placed on coded procedures, rather than preventative medical advice or management of chronic medical conditions. Thus, one gets paid for what one does (procedures) rather than what one says (cognitive management). This is also why some of the sub-specialties that are non-procedure based receive relatively lower compensation in comparison to those that feature procedural intervention. This is, of course, irrational as it does not address disease prevention or careful, "evidence-based" efficacious management of the common diseases that account for the major causes of mortality and morbidity in Western countries. Family medicine, primary track internal medicine, peds, etc, all of the primary care specialties, are the front line for this purpose. I am continually amazed that the greed and avarice of the health insurance industry haven't led them to comprehend that rewarding the performance of countless unnecessary procedures and decreasing the compensation for effective preventative/cognizant-based management, will ultimately be far more expensive! This of course is very secondary to the over-riding fact that it will longitudinally result in an abundance of wholly preventable human suffering.
This is the reason why "middle level providers" such as CRNAs receive ridiculously inflated salaries. They are allowed to perform procedures that should be performed by anesthesiologists, i.e. physicians (no, not "MDAs"). Take note that there is an effort to name all in the "health professions", "providers". This is a means to equalize all under the same nomiker. This is incorrect as we are PHYSICIANS, not "health care providers". This may seem off the actual subject, however, I can assure it is not. The AAFP and the MSSNY are making a strong effort to address these issues. However, it will be difficult to effectively turn the tide against such an imbedded financial incentive.
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Jayzzz, Soph. They're pounding you in here! Hotheads! Hotheads, I tell ya!

What's the deal, peeps? Sophie's right - reimbursement isn't as good as it should be and it NEEDS to be protected from dropping even more, but in general it's a good job.

I'll say it again: FM IS A GOOD JOB. PEOPLE WHO DO IT LIKE IT...JUST AS IT IS. Most of us would like to see better pay, and if the trend continues, there will be major problems. But it really isn't such a bad gig.

I don't, however, agree that renting is just fine. Nobody is going to choose a profession with this much oversight and stress if they can't even live an upper middle-class American life after years of sleepless training. Yeah, it's an expectation. Yeah, it's a feeling of entitlement. I don't apologize for that. I made HUGE sacrifices to get to this point. So did my wife and kids to help me get here. That's the whole point of school...short-term sacrifice for future gain. Sure, it is gratifying to help other people...but you can do that at a gas station (the guy who just towed my van and precious family back home after our vacation was more a savior to me than our FP). Nobody should be asked to endure medical training and not expect a good lifestyle afterward. Nobody should expect me to live an austere Spartan life awash in nothing more than the glow of altruism as payment.
 
The real problem is that most of FP isn't set up in a market-fashion: it's controlled by the government through medicaid/care. This is a fundamentally flawed system. It will always produce less quality, less productivity for any given dollar spent as compared with a capitalistic as opposed to socialistic model, leading to physician frustration and, in the end, sicker patients. Get the government out of the equation, get back to the doctor-patient relationship, and you'll get happier docs and patients.

Of all specialties to tell the socialists to go forget themselves, FP can lead the way.

secretwave101 said:
Jayzzz, Soph. They're pounding you in here! Hotheads! Hotheads, I tell ya!

What's the deal, peeps? Sophie's right - reimbursement isn't as good as it should be and it NEEDS to be protected from dropping even more, but in general it's a good job.

I'll say it again: FM IS A GOOD JOB. PEOPLE WHO DO IT LIKE IT...JUST AS IT IS. Most of us would like to see better pay, and if the trend continues, there will be major problems. But it really isn't such a bad gig.

I don't, however, agree that renting is just fine. Nobody is going to choose a profession with this much oversight and stress if they can't even live an upper middle-class American life after years of sleepless training. Yeah, it's an expectation. Yeah, it's a feeling of entitlement. I don't apologize for that. I made HUGE sacrifices to get to this point. So did my wife and kids to help me get here. That's the whole point of school...short-term sacrifice for future gain. Sure, it is gratifying to help other people...but you can do that at a gas station (the guy who just towed my van and precious family back home after our vacation was more a savior to me than our FP). Nobody should be asked to endure medical training and not expect a good lifestyle afterward. Nobody should expect me to live an austere Spartan life awash in nothing more than the glow of altruism as payment.
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andwhat said:
Aw I understand Frijelero, did I hurt your feelings? Do you feel underrepresented, and or underappreciated, here and possibly elsewhere in your life? Do you feel as if you are stating irrelevant things WAY off topic, such as Cigarette sales, and nobody is paying any attention to you? Well I cannot help you with your life woes, but I can help you here buddy. The forum's all yours big guy! Ha ha
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No, you haven't hurt my feelings, but it appears I've hurt yours and I apologize. You just seem passionate about the material at hand and I thought you might be taken more seriously if you could chill out your posts a bit. Evidently you're not in the mood for advice.
 
Frijolero said:
No, you haven't hurt my feelings, but it appears I've hurt yours and I apologize. You just seem passionate about the material at hand and I thought you might be taken more seriously if you could chill out your posts a bit. Evidently you're not in the mood for advice.
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oh wow! Thank you so very much!
Don't take it to heart when people ignore you though; if you are irrational, and not on point with the conversation, obviously your comments are going to get overlooked.
You were hurt and upset Frijolo, and I am truly sorry for that.

Keep your chin up Frijolo!
Thanks again. You are an inspiration to all, truly. :thumbup:
 
jetproppilot said:
I hate to be the bearer of reality, but it is true.

They make 150K pretty easy....W2 that is....plus benefits.

Add in some overtime and presto!! Two hundred large.
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:thumbup: I'm surprised people don't research before they post their opinion rather than the fact.
 
Play nice or go home, kids.

This thread has been skirting the edge of collegiality for some time now, let's not let it get personal.

Carry on.
 
Please Sophie Jane, you are one of the few purely genuine nice people on this board.
Don't waste it here, or on hypocrites, and nonsensical ramblers, it is obvious who that is here.
Its obviously a waste of time trying to post anything sane, or even .00000001% resourceful here.
 
EdibleEgg said:
Low salaries plague all of the primary care specialities......

I'm not completely happy with FP salaries. Things could be better. If we don't take an active role in shaping our speciality, there are insurance companies/ physicians in other specialities/state and federal governments that will be happy to have us clean up after partialists... I mean specialists....
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:laugh:

Partialists???

What does that mean, Slim?
 
:thumbup: I'm surprised people don't research before they post their opinion rather than the fact.

I hate to be the bearer of reality, but it is true.

They make 150K pretty easy....W2 that is....plus benefits.

Add in some overtime and presto!! Two hundred large.


Please note that you are both attributing a "quote" to me that was in fact made by andwhat. I am well aware of the salaries and state of the circumstances under discussion (see my comments as posted and this will be clear). I was responding to his question and cut/pasted the OP's comment at the top of my reply. One should carefully read (or, "research") the material under consideration prior to posting a critical comment.
 
lets compare apples to apples.

i did a year of internal medicine. saw patients in the clinic, rounded on them on the floors, i get it...

please don't pretend like you have ANY idea what it is we do. last week i managed a sick preemie with a hypoplastic ventricle - pressors/echo, did on pump bypasses/valves, major thoracic cases, desaturating sick floor patients, managed sick OB patients, put in 10 different nerve blocks with catheters under ultrasound, managed unstable patients in PACU, difficult airways, etc...what did you do? prescribe lipitor? think about hyponatremia? the reason we make more money (obviously right now it's purely market driven, but the reason we SHOULD make more money) is because we have a much higher level of immediate responsibility for people's lives, perform invasive procedures, and we make FINAL critical treatment DECISIONS. FPs and internists will consult out most advanced management and NOT make critical decisions - every single day.

i agree, the market is cooling and anesthesiology will not continue to have the competitive reimburs. of today. but, it should ALWAYS have a higher reimbursement than a general specialty. that's only fair.
 
Jeff05 said:
but, it should ALWAYS have a higher reimbursement than a general specialty. that's only fair.
Click to expand...

Meh Fair has nothing to do with it, it's all about what the govt dictates and if the market can handle it. If we based it on importance of job I'm sure every specialty would have a 10 page rant on why they deserve the highest reimbursement.
 
AwesomO said:
Meh Fair has nothing to do with it, it's all about what the govt dictates and if the market can handle it. If we based it on importance of job I'm sure every specialty would have a 10 page rant on why they deserve the highest reimbursement.
Click to expand...

Yeah, but managing DKA in the ICU setting will always reimburse more than managing HgbA1C's in an outpatient setting.

Managing emergent airways will always reimburse more than Rx'ing albuterol MDI's.

Why? Fewer people can do the more emergent stuff. The more emergent stuff is more valuable.

You are right, the govt dictates too much. We should all be fighting this on every level of medicine. Gotta keep it between the physicians and patients.
 
Coastie said:
Yeah, but managing DKA in the ICU setting will always reimburse more than managing HgbA1C's in an outpatient setting.
Click to expand...

And why is that, exactly? Which of us is going to save more lives (and money) in the long run? Where's the real value? I think we all know the answer...we just don't want to pay for it.
 
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