Highlights of the important and the interesting from the world of healthcare:
Choose primary care, give up $2.5 million: It’s not quite that simple, but $2.5 million is the lifetime earnings gap between cardiologists (who average lifetime earnings of about $5 million) and primary care doctors (who average $2.5 million). To come up with the numbers, Duke University researchers modeled the lifetime income of cardiologists and primary care physicians between the ages of 22 and 65, taking into account medical school debt, earning potential and the age at which doctors begin earning an income. The numbers once again illustrate why so few med school students choose primary care. To make primary care more attractive, the study’s authors estimated that primary care doctors would have to receive a $1 million lump-sum payment or have an annual income boost of $100,000.
While that’s unlikely, the solutions to the problem are fairly obvious, if politically challenging. First, adjust reimbursements so specialists make less and primary care docs receive more. Second, whenever possible and practical, use nurse practitioners and other health providers to perform primary care services. But we before we go crying for primary care docs, it’s worth noting some other numbers from the study. Primary care physicians are still doing much better than most of us. That $2.5 million lifetime earnings compares to $846,000 for the average MBA, and $340,000 for the average college graduate.
A recent Senate report found that of six major insurance companies surveyed–Aetna, Cigna, Coventry, Humana, UnitedHealth and WellPoint–only Cigna would have met the proposed individual market target in 2009, Politico reports. Further, the report already singled out Wellpoint for shifting costs to increase its medical-loss ratio by about 1.7 percent, which equates to about half-a-billion dollars. One of the shifted costs was for a 24-hour nursing hotline, which seems legitimate and underscores how difficult it will be for regulators to clearly draw lines between what’s acceptable and what isn’t. The first draft of the regulations is due June 1, but expect the fight over what should and shouldn’t be included in medical-loss ratio to rage on for years.
“The death of private insurance”: Mike Turpin, a former insurance executive, has a lengthy and thoughtful take on what he calls “Managed Care 2.0,” which he defines as the era ushered in by health reform. Turpin’s piece attempts to answer the ever-present question “What’s next?” Generally, it’s not pretty. He suggests that because Managed Care 2.0 didn’t do much to solve the problems of costs, its greatest value may be in bringing about another new world, essentially a second age of 21st Century reform to address the inadequacies of the first.
The middle class will take it on the chin as they always do. At this point, we will rally around the cry for affordability. The pitchforks and torches will once again appear and we will look for a common enemy. It will usher in a new era and it may very well set in motion the next phase of Managed Care–an era characterized by the death of private insurance.
The biggest drugs of 2016: EvaluatePharma, a London-based research firm, projects the top 10 selling drugs in 2016. At No. 1 is Humira, an arthritis drug from Abbott Labs and Eisai, with projected sales of just more than $10 billion. Coming in at No. 2 is Roche’s cancer drug Avastin, with projected sales of nearly $9 billion. Pfizer’s Lipitor, today’s top seller, isn’t on the list since its patent protection expires in June 2011.
Photo from flickr user borman818
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As one of those “overpaid” specialists, I take real exception about this steal from the specialties and pay primary care. I’m not denying we need more primary care physicians, but specialists, especially those who take insurance, ie, Medicare, Medicaid, BCBS, have ALL been racheted down on their reimbursements for a number of years. All of us have taken it in the shorts while our costs of keeping a practice open, not buying new Mercedes, keeping a small business open has increased exponentially. In addition, here in Texas, over a quarter of the patients, including kids are uninsured, so am seeing a heck of alot more patients for free. What isn’t regarded in all this adoration of primary care, is that cardiologist or neurosurgeon must spend many more years in training ( not making a real salary), their malpractice costs are higher, and they are frequently in the ER taking care of someone for free. Primary care in most places requires three years. Specialty training requires up to 10 years after med school. Just like a high graduate gets paid less than one with a college degree, if you want to get paid better get the extra training and endure the extra sacrifice. If not, and you want out after just three, then don’t whine about it. You choose it. Pay all of us better, not just stealing from one group to fund another. That only leads to wars between specialties, and we don’t need a “divided you fall” thinking right now.
Comment by bnewtonmd — May 5, 2010 @ 12:39 pm
Cardiologists have taken a beating from Medicare with up to 40% cuts, so I sympathize with cardiologists.
However comparing years of training and malpractice costs doesn’t really matter; net income needs to be looked out. Many primary care doctors have taken out loans to meet payroll; when you consider benefits, NP’s and PA’s often make more than family physicians.
When a primary care doctor makes less than half a specialist and has three times more paperwork to complete after hours, the present situation is unfair.
All you specialists when you retire are going to want a good internist to take care of you, so don’t diss their training and value.
Comment by politicaldoc — May 5, 2010 @ 3:57 pm
Sounds like BNewton has entitlement syndrome. I made the mistake of doing an endocrine fellowship. I spent as much, if not more, time in training than BNewtonMD. Since I don’t do any expensive heart caths, do echos, or own a cath lab, I get the same pay as a primary care doc. The real difference in pay here is PROCEDURES, not training, not intelligence, not how many people we see in the ER, but PROCEDURES. The RBRVS scales are skewed in favor of procedures. So we have plenty of doctors available to do PROCEDURES, and not enough to think about whether or not they are necessary.
Comment by RealDoc — May 6, 2010 @ 12:14 am
Primary Physicians are underpaid, I went to med school when the Robert Wood Johnson Foundation was pushing primary care to all the med schools. I choose Med/Peds, and am happy with my choice, but I do envy the lifestyle of the specialists. The big issue is that the implied promises of better pay and better respect never came through. Specialists diss PCPs all the time, but we keep them in business.
I agree with RealDoc, as its the procedures that is the issue. For cardiology, no coronary lesion goes unstented, no preop goes unstressed/unechoed/uncathed, even for a minor biopsy.
The policy fallacy of cutting reimbursements for cardiology procedures is well documented, when you cut pay for tests,docs order more tests to make up the difference.
Give us the respect, and pay us for all the paperwork, emails, etc … and we won’t complain.
Comment by MedPedsDocTX — May 6, 2010 @ 4:19 pm
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