Physicians

Grumpy doctors, but is it really worse now?

An essay in the NY times explains how terrible life is for doctors. Reimbursement is down, more time is spent arguing with managed care companies, there are more restrictions on the what they can prescribe, etc, etc.

Now I understand that primary care is in crisis, but overall physicians’ salaries in the last couple of years have gone up, and the first doc in the article is a cardiologist. Cardiologists, as this salary survey suggests, tend to make more than double what a primary care doc gets. And of course, fewer docs are primary care only now, and more are specialists (who make more money!). But whether or not physicians are getting paid less than they were, their perception surely is that that’s the case.

I am surprised that the burden of operating a practice and the demands of “managed care” are felt to have increased. Most observers would suggest that insurers have, since the days of Len Abramson & US Healthcare in the 1990s, backed off the extremes of medical micro-management. In fact, the most profitable health plan of recent years (Aetna) has bent over backwards to appear to be physician friendly. Whether or not it’s just window dressing is less certain.

If a doc living in the 1970s was forced into a 1990s world, I would understand the depression. And the surveys I was part of in the 90s indeed showed dismay at what was happening for them. But we’re now more than 10 years on from those times, and (as the politicians say) is it really worse now than it was four or five years ago?

Answers on a post-card (or at least in the comments), please!

 

Livongo’s Post Ad Banner 728*90

Categories: Physicians

Tagged as:

13
Leave a Reply

13 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
12 Comment authors
James Lynch, MD, Major, U.S. ArmySteven GeanopulosBarbararbarjd Recent comment authors
newest oldest most voted
James Lynch, MD, Major, U.S. Army
Guest
James Lynch, MD, Major, U.S. Army

I’d like to present a different perspective. I am not a military health care recruiter nor have any specific interest in convincing other physicians that the grass is greener in my clinic. However, as an Army Family Physician for the past 5 years, I would not describe my life as “terrible.” This includes my time spent deployed to Iraq in support of the War on Terror, as well. I can only speak to my experience, but I think it’s worth sharing. For me, this attitude stems from working with an incredible group of Americans–Soldiers, their families and retirees. It is… Read more »

Steven Geanopulos
Guest

In New York State over the past 5 years you can see that the profits for the major insurers have taken a stright path up, while the reimbursement rates for Dr’s have declined in an equal and opposite fashion, this is a fact. One of the reasons why the salaries of specialists are so high is that they do not get paid a living wage to take a history and conduct a physical and render a diagnosis. However they get paid very well to conduct a diagnostic procedure, thank god for the widespread rapid decline of the individual Americans health… Read more »

Barbara
Guest
Barbara

Doctors are making a lot less than they used to and working longer hours to get it. All available information cites serious upcoming shortages of primary care drs as well as a lot of oversued specialties like obstetrics, neurosurgery and orthopedics. Doctors incomes may sound big, but they have to pay a larger work force to manage managed care, and higher bills for utilities and taxes – add to that the possibility that they may have Medicare reduced by 40% over the next four years and kiss your doctor bye.

rbar
Guest
rbar

I think I can provide some perspective since I have worked/trained as a doctor in Germany, France, and in the US. From the financial perspective, I don’t think that US physicians have a lot to complain (except maybe for some overworked PCPs in certain areas). I don’t think there is a country on earth with higher physician reimbursement. Student loans need to be factored in, but specialists with very long training tend to be interventionalists and make from 300 K (at the least) up to the 7 digits. PCPs may occasionally start with a 6 digit loan, but they also… Read more »

jd
Guest
jd

I’m surprised you didn’t comment on this howler from the article, Matt:
Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges.
Uh huh, so it’s the Internet that’s responsible for people demanding antibiotics for colds….even though this misconception predates the Internet and I’m sure is hardly, if ever, promulgated through it.

jd
Guest
jd

I was having a conversation last weekend on this very topic with a doctor (heart surgeon, actually). I couldn’t believe he was saying physician incomes were going down and he couldn’t believe I was saying that, with the exception of primary care, physician incomes were going up faster than inflation. After some discussion, we decided that some of our different perceptions could be explained by two facts: 1. He was focused on payment rates for standard procedures that have been done for years. These indeed are pretty much flat, and some have even gone down. 2. I, on the other… Read more »

Peter
Guest
Peter

“If, for example, nationalized or socialized health care is enacted, there will be a new glut of patients…” New glut of patients?!! New because there will be perfectly healthy people seeing doctors just because, or new because those in need of care will now be able to afford it? “and at the same time, many health care professionals that will flee the profession unless conditions for them improve.” Improve how? Less patients and more money? Isn’t that what what every body wants for their job, more time to do it better with more money. How abour social workers with case… Read more »

Herbert Rubin, M.D.
Guest

I hope the writer will find a good doctor when he need one. Medical care is theoretical and abstract, until you’re sick or have an accident. In Los Angeles, doctors have been retiring and going bankrupt, as expenses outpace reimbursement. Doctors and hospitals are price-controlled, so fuel costs, and every other cost increase, can’t be passed through to the consumer. Medicare is cutting 10.6% on July 1, and another 5% January 1, 2009. Doctors have been forced out of business, or quit. Some salaried academic and large group doctors haven’t felt it yet, but the lower reimbursement will shortly trickle… Read more »

Greg Pawelski
Guest
Greg Pawelski

Is it just “primary care” that is in crisis? According to the Society of Thoracic Surgeons, a five-year shortfall in applicants for cardiothoracic surgery training positions threatens to create a shortage of physicians qualified to perform open-heart surgeries, lung resections, and other major procedures. Five consecutive years in which there were fewer applicants than open positions. With half of currently practicing cardiothoracic surgeons expected to retire in the next 10 years, the specialty society is warning of a “brain drain” of increasingly dangerous proportions and compromised patient care in the very near future. http://www.medpagetoday.com/Surgery/ThoracicSurgery/tb/9827 The situation with student loans makes… Read more »

docanon
Guest
docanon

Matt is right. Saying “doctors are [sad/frustrated/etc]” means nothing…it’s the kind of doctor that matters. I have no sympathy whatsoever for procedural specialists making piles of money. Their incomes are incredible, and any dissatisfaction is self-inflicted. Awww…poor cardiologist. Feel like you’re working too hard? I have a suggestion: cut your clinical volume. You’ll still make a very comfortable living, considerably more money than a full-time primary care physician. And patients will be better off…Dartmouth data show that areas with a higher share of primary care services (rather than specialty procedures) have lower costs, higher patient satisfaction, and higher quality of… Read more »

retmd
Guest
retmd

The NYT article expresses the opinion of many doctors very well. America needs to wake up about this. If, for example, nationalized or socialized health care is enacted, there will be a new glut of patients and at the same time, many health care professionals that will flee the profession unless conditions for them improve. But policy makers and insurance company execs either are blind to this or do not want the public to know the growing discontent among those who perform the hands on work in health care. This is a growing powder keg that is not likely to… Read more »

pat
Guest
pat

The money is better now for almost everyone, but student loans are a big issue. However, in primary care, I now see as many patients in two days as I was seeing in four days in the 1980s, and more things need to be done for each patient (there is no watch and wait any more….it’s an immediate MRI instead). There is also the mentality that everything can be fixed and also must be fixed right now. There is little tolerance for ambiguity or just old fashioned being sick for a couple of days. And just anecdotally, people seem to… Read more »

Helen
Guest
Helen

Yes, it really is worse and becoming more so. Perhaps you need to be operating from the inside in an effort to gain real and sane perspective.