Even with these problems that all doctors have I say try being a pediatrician. We have these problems and we drool over Medicare reimbursement rates which are in general 140% greater than ours. Medicare rate cuts are not taken but Medicaid cuts happen. Our practice gross is going down every year while seeing the same number of patients.
RVUs for a child’s physical are much lower than for an adult because – why? (I really don’t understand this part – there are a myriad of screenings and tests you are responsible for that are “bundled”). We are overrun by form requests from every kind of institution out there. (I think we should be able to charge the schools for the paperwork they generate for us.)

Parents love their children dearly, but think your office should do everything for free and that they have no responsibility to understand their insurance or lack of it. The AAP is always about “the children,” but never about what they can do for the pediatrician, and their website is all about the money, as opposed to the AAFP website. I have two pieces of advice in this age of Medical Home (which translates to more unpaid work for the doctor) for medical students: 1) don’t become a pediatrician, and if you do, 2)never take a capitated plan.

Specialists in the U.S., of course, make roughly double what their peers in other developed countries make and also about double what their primary care counterparts make here. Yes, they have more intensive training and higher malpractice costs, but these are captured by your overhead calculations that leave them with net incomes reflecting these lucrative disparities.

I did a similar comparison in my book on Obamacare (http://ourhealthcaresucks.com/obamacare-the-good-the-bad-and-the-missing/) based on a 2007 survey that showed the following:

All physicians $273,000 avg net income $240,000 at 100% Medicare rates

Cardiologists $483,000 avg net income $450,000 at 100% Medicare rates

Radiologists $488,000 avg net income $390,000 at 100% Medicare rates

While no one likes to take a pay cut, it’s pretty clear that we’ll never get our medical spending under control unless and until these incomes are reduced. And it’s not just physician incomes, but their ripple effects. Every dollar of income to specialists generates $3-4 dollars in hospital or ancillary service costs.

Until your colleagues accept responsibility for milking our fee-for-service system for all it’s worth, acknowledge that it’s no longer sustainable, and take leadership roles in reforming the corrupted RUC process that perpetuates these unsustainable physician payments, I’m afraid voices like yours will be lost in the wilderness.

Please know, however, that many of us appreciate your willingness to stick your neck out and incur the wrath of far too many of your colleagues. If only more of them would follow your brave example.

Unfortunately, as a rural, solo, self-employed family doc, who has superb quality data, I cannot make close to the so-called average salary of $189,00. Not close to even 20% of what orthos seem to be taking home. Yet we know that primary care, when done well, lowers costs and improves outcomes (work of B Starfield).

For many years this country has forced primary care to work with two hands tied behind its back, crushed in a myriad of ways, struggling to offer the comprehensive longitudinal first access care that we do well and that benefits patients. Hearing that my colleagues in orthopedics may make a half a million dollars, when I cannot make 20% of that, does call for speaking out and examining the path to change. Even if malpractice risk is factored in, looking at average costs around the country, an orthopedic doc comes out at $100,00 a year, every year, ahead of the highest earning family doc. This kind of disparity does not go unnoticed by medical students who head into specialties and leave the country with a dearth of what it needs most — primary care. If we cannot solve this disparity ourselves, others will do it for us

If we are to lower costs and improve outcomes int this country , if we are to put patient care at front and center and reduce barriers to primary care, we must realize that times in primary care are extremely desperate. Somehow or other we need to be willing to not get our backs up nor get ugly, and be willing to look openly at what has gone so badly wrong. Dr Rickert’s courageous thoughtful work should begin a dialogue. Otherwise when one of YOU needs primary care the lights will be out. and no one around to help.

Kudos to Dr Rickert for beginning a difficult conversation!!

This is from our Healthy Vision 2020 document (http://www.texmed.org/healthyvision if you want to read more):

The Medical Group Management Association’s (MGMA’s) data show that, for 2010, most physician groups were operating on razor-thin margins. MGMA each year compares physicians’ office costs and revenue in dollars per unit of service. (To simplify the accounting for the thousands of different types of services physicians provide, one unit of work is measured in relative value units or RVUs. This is a Medicare measure of the units of service produced. One unit of work is approximately the value of the simplest office visit for a new patient. Physician compensation is 30 percent of the total cost.) In 2010, physician-owned multispecialty groups brought in an average of $59 per unit of work while spending $60 to keep their clinics open, for an operating loss of $1 per unit of work. Family practice groups brought in less ($46 per unit of work) but only spent $45, for an operating profit of $1 per unit of work.

To stay open, any business must collect enough revenues to cover costs. Especially for patients covered by government insurance programs, this isn’t happening for physicians. MGMA data show that Medicare pays only 61 percent of physicians’ average costs. Medicaid payment per unit of work varies, but for most services, Medicaid payments cover less than half of the average cost to provide services. Faced with losses on every service delivered, physician practices are often forced to limit services to Medicare and Medicaid patients if they cannot make up the losses elsewhere. Physicians in a number of Texas communities say they have no other options but to move or retire.