AMNews: June 29, 2009. AMA meeting: Don't shortchange specialists to fund care model ... American Medical News:
"Chicago -- In the discussion of how to pay for coordinated care under the patient-centered medical home model, the AMA House of Delegates agreed that primary care physicians should not be rewarded at the expense of specialists.
"At its June Annual Meeting, the house voted to advocate that additional pay to physicians for operating a medical home should not come from a reduction to the pay of specialists. Delegates approved language that medical home payments not be subject to requirements for budget neutrality in Medicare, where an extra dollar spent somewhere means a dollar has to be cut elsewhere.
"The house also approved recommendations that private plans and the Centers for Medicare & Medicaid Services develop one standard for a medical home, and that specialty practices as well as primary care practices should be able to serve as that home.
'Primary care needs more help. It just shouldn't come at the expense of specialists,' said Kim Williams, MD, a cardiologist from Chicago and a delegate for the American College of Cardiology."
I am aware that, in the House of Medicine, it is impolite to disagree with this notion that primary care physicians should get more money but there should be no adjustment of specialist reimbursement. It is not just impolite, it is also likely to start fights. I expect that the notion of knocking down the uber-specialists reimbursement lurks in the darkest places of the hearts of many a PCP and psychiatrist, the class-warfare-that-must-not-be-named.
But, consider the incomes of internists starting at $150K or so and neurosurgeons, radiologists (nuclear medicine), thoracic surgeons, invasive cardiologists and orthopedic surgeons starting at between $400K and $600K, it is hard not to wonder whether the economic disincentive of going into primary care can ever be overcome by raising PCP income by 20 or 30 or 40 per cent or more. Value is relative and simply increasing PCP income a bit and still having one's peers making vastly more explicitly marks the value we place on primary care.
Societies generally reward physicians with good incomes, but except for the incomes of specialists in the Netherlands, nowhere near as highly as we do. But, on the other hand, no country saddles their young doctors with the massive debt that we do. Heavily subsidized tuition is the norm, not the exception, and so young doctors around the world do not feel the economic imperative to enter the best paid fields as we do here. Nor do other countries have the massive overhead of physicians beyond debt: malpractice insurance, billing staff to fight with insurers and so on.
I expect that if we graduated medical school with debt similar to those of our non M.D. peers, incomes more comparable to our international peers would be more acceptable.
Monday, June 29, 2009
AMNews: June 29, 2009. AMA meeting: Don't shortchange specialists to fund care model ... American Medical News
AMNews: June 29, 2009. AMA meeting: AMA reaffirms stance in health system reform debate ... American Medical News
AMNews: June 29, 2009. AMA meeting: AMA reaffirms stance in health system reform debate ... American Medical News:
"Chicago -- Addressing what has become the hottest flashpoint in this year's health system reform debate, the American Medical Association House of Delegates at its Annual Meeting in June renewed its existing reform policies rather than declare a position on whether lawmakers should establish a new national federal health insurance plan that would compete with private insurers.
"Delegates agreed that the AMA should 'support health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients.'
"Both supporters and opponents of the public plan concept wanted the Association to take a definitive stand on the issue. But after AMA Immediate Past President Nancy H. Nielsen, MD, PhD, warned that such a move could handicap the organization as it tries to influence the health reform debate, delegates backed away from those resolutions.
"Dr. Nielsen said the resolution that ultimately passed would allow her and AMA President J. James Rohack, MD, to keep the AMA engaged in the debate without restriction but with a clear directive to advocate for choice for both physicians and patients."
An encouraging sign for progressives at the AMA House of Delegates. I am pleased to be wrong in expecting the conservatives to win the day and the resolution that passed gives wiggle room to the AMA leadership.
It is worth pointing out that there will be much struggle throughout this process. AMA policy language stands largely against any reforms leading to any expanded role for government in health care and specifically declares that an "Unfair concentration of market power of payers is detrimental to patients and physicians," and labels single payer as such and calls for continued opposition by the AMA.
Interestingly enough, however, the AMA has endorsed the principles of Medical Professionalism of the ABIM, ACP-ASIM and European Federation of Medicine. This Charter unequivocally advocates the physicians role in promoting social justice, fair distribution of finite resources and promoting fair access to care.
I am sure my conservative colleagues would argue that this can all be achieved by a more libertarian/Randian approach to health care, but I think, finally, that the number who believe that is growing smaller by the week.
Certainly polls indicate that most physicians now recognize that our system is broken and that the cure is not rearranging the deck chairs on this sinking ship and clinging to a heyday that hasn't offered us or our patients much "hey."
Thursday, June 25, 2009
In case you're wondering...
why I'm not blogging...
I hope that link works!
I'm on va-ca in the mountains of western North Carolina.
See you next week!
Friday, June 19, 2009
Median Physicians' Salaries - Health Blog - WSJ
Median Physicians' Salaries - Health Blog - WSJ:
"Good news for med students worried about their debt loads: Physicians coming out of residencies last year reported increases in their starting salaries in many specialties, according to a survey by the Medical Group Management Association, a trade group for medical groups.
"Here are the specialties with the biggest jumps in 2008 from a year earlier based on data from 3,520 physicians:
Neurology: $200,000 to $230,000 –- up 15%
Non-invasive cardiology: $350,000 to $400,000 – up 14.29%
Anesthesiology: $275,000 to $312,500 – up 13.64%
Emergency medicine: $192,000 to $215,040 – up 12%
Internal medicine: $150,000 to $165,000 – up 10%
"And as if we needed any more reminders about why there’s a shortage of pediatricians and family practitioners, the report also contains data on the extremes: The lowest starting salary in 2008 was for pediatricians — $132,500. The other lowest-paid specialties, in ascending order: family practice, geriatrics, urgent care, internal medicine and infectious disease.
The highest specialty salary was for those starting out in neurological surgery — $605,000. Others at the top of the heap, in descending order: radiology (nuclear medicine), thoracic surgery, cardiology and orthopedic surgery."
I've blogged about this before, but coming out of medical school in massive debt, knowing that you are going to make low wages for your three to seven years of training, and still choosing one of the lower income specialties requires some significant altruism. God bless everyone who does this.
But, this should not be such a stark decision. We really do need to do something about reducing or eliminating the cost of medical school to encourage (or at least make it not an economically crazy thing to do) students to enter primary care and other lower paid specialties.
Wednesday, June 17, 2009
Attacks on Dartmouth Atlas Rebutted
Health Affairs Blog:
"[HA Blog]Editor’s Note: In the post below, Amitabh Chandra responds to criticisms of the Dartmouth Atlas and offers his vision of the lessons of the Dartmouth findings on variations in health care costs and practice styles. Watch the Blog tomorrow for a roundtable discussion on Atul Gawande’s New Yorker article on McAllen Texas and the policy implications of the Dartmouth work. Roundtable participants will include Robert Berenson, Elliott Fisher, Robert Galvin and Gail Wilensky."
I heard Sen. Judd Gregg this AM on CSPAN pontificating at the Budget Committee meeting on health care, fretting that any kind of health board would result in "control" of health care by "Washington". If it's staffed by people like Dr. Chandra, we'll be OK.
But, more to the point, he still lives in the DC bubble fantasy land where he thinks patients have control of their health care, and not the private health insurers. He worries about a board being formed to guide decision making by clinicians. I think this is absolutely critical to reigning in health care costs, though, as Dr. Chandra so clearly indicates, this is as complex a set of problems as we're ever going to face in our life times, so it will require multiple iterations of progress to get where we ultimately wish to go.
And that was another thing Gregg lamented: the complexity of the bill. If he wants straight-forward, then HR 676 is his bill. But I'm guessing a single payer system is a non starter for him. So, given that we're talking about 20% of the economy, it's gonna be a complex solution!
What we're up against...
Terry Jeffrey : Obama: "There Are Countries Where a Single-Payer System Works Pretty Well" - Townhall.com
I was going to post over at TownHall on this piece, but after reading the comments, the ignorance is just too staggering to event try to overcome.
This is a hard fight. Many Americans think the opinions expressed at this site (and are articles of faith among many conservatives) are based upon facts instead of the ideologic fantasies that they are based upon
*sigh*
Monday, June 15, 2009
Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign
Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign:
"The scare ads and op-ed pieces featuring Canadians telling us American how terrible their government health-care systems have arrived - predictably.
"There's another, factual view - by those of us Americans who've lived in Canada and used their system.
"My wife and I did for years, and we've been incensed by the lies we've heard back here in the U.S. about Canada's supposedly broken system."
Read on...