Another comment
Dear Happy,
I am a second year medical student. And I would like to know if you picked your profession based on your grades in school ? I know everyone has their own interests, but I cant seem to separate the fact that money plays quite the role in deciding which speciality we would like to go into. Isn't that why derm, rad, orthopedics are such coveted fields. I find it hard to believe when people say that is what they've wanted to do all their lives. Because, growing up we want to help people, and the best way to help people is to start at the primary care level. What is your take on this ?
Derm, radiology and orthpaedics are coveted because they pay very well, not because they have some inherent value in them that attracts a disproportionate number of students. Double the income for cognitive care and I assure you that derm, radiology, and orthopaedics will become much less coveted. It's all relative. The specialties pay well because cognitive care doesn't. The RVU system created the skewed value it places on procedural type specialties. The inherent value of two or three years of extra training is not explained by the suppression of E&M medicine by procedural medicine in the fixed pot of Medicare Part B. The inherent values of RVU are flawed. The problem is the fixed pot. The problem is also how you divvy up the fixed pot. Both have destroyed comprehensive care. Why do cognitive care when you can do derm, radiology and orthopaedics for 2,3 5, 10 times the income potential
If we paid cognitive care specialties any where near what they were worth, on a relative value with other specialties, they would be flooded with applicants. The coveted specialties would not be so coveted. It's all relative to each other. It's also all relative to the other going rate of comparable professional tracts available to the best and brightest students have to offer.
I had excellent grades in medical school. I chose internal medicine because I loved hospital work. And it really is, I think, the most challenging type of doctor out there. It's too bad that most bright clinicians don't pursue it. Speciality determinations are based on money. I had a specialist tell me once that I should go back and do a fellowship so I could travel to Europe "on a whim" like he does.
Now tell me that money doesn't drive specialty decisions.
There is nothing inherently exciting about bones, or skin or xrays that make them coveted fields of practice, except perhaps the exciting allure of money.
8 Outbursts:
Why not do the fellowship?
Mrs. Happy would appreciate the extra free time and money.
You can always go back and work part time as a hospitalist once you're done if that's your thing.
Why, why, why are Primary Care Physicans paid such low salaries? Their Residencies may be shorter than some, but not others...it really makes me angry that some of the very besy doctors out there (yes, including mine!) are stuck in this awful situation!
They don't have to be paid low salaries. They have the ability to say no to insurance. To say no to low fees. Primary care is in the unique position to say, "This is what I am worth." But most docs are not willing to take the risk or the possible loss of salary in building their different practice. But I am.
Oh come on now. You know some of your former classmates sprang forth from the womb saying, "Me want hammer now. Me use hammer now. Me want to be an orthopedic surgeon."
anon 443: That is exactly what is happening.
I wish there would be a mass exodus. That is the only way gorilla change will happen.
And I fully advocate that as thesolution.
It's the chicken and the egg. Who's going to crack first. The government and their wish to insure access to the masses or the physicians who hold within their power as a collective whole to force change.
I'm not sure how I fit into your paradigm happy.
I enjoy my practice as a cardiologist. I am able to focus on acute issues and acutely improve people's lives.
Monetarily, I get paid to come in to see patients in the middle of the night. That's it. The rest of cardiology is fun. I don't get to work shifts. I work 24-36 hour at a time. I wouldn't do it anymore if it didn't pay well. Who would? If it didn't pay well I would be a hospitalist and spend more time with my daughter.
anon 114:
"I wouldn't do it anymore if it didn't pay well."
You have just hit the nail on the head as it applies to outpatient primary care and why hospitalist medicine is in high demand and why outpatient primary care is dying quickly.
As far as your schedule, that is an issue with your group. Many specialists have a night float where their partners take night call. Control their own post call clinic hours to their liking or have extenders take all overnight calls.
How you schedule your nights is entirely in your control. It shouldn't have anything to do with how much you get paid to see the patient or do a procedure on them.
I admire the dedication many specialists (as do most comprehensive care docs as well) have to their field of expertise. Do I think many take advantage of the skewed economics of the procedural arm? Yes, I do. Do I think that's unfortunate? Yes. Is that how the current payment system is set up to encourage? Yes.
O-kay, i know i'm dumb...but, i still don't get it.