There has been much talk about reforming healthcare in the last several months. I wanted to take a few moments to share some thoughts on the subject.
Physician Reimbursements:
People often claim that physician make way too much money and they are a major reason for our healthcare debt. There is some truth to this, some physicians make quite a bit of money and certainly in recent history physicians could make huge sums of money. So, I’m not in complete disagreement. However, I would like to offer some food for thought. I invite you to listen to this brief interview of two young doctors from NPR and I encourage you to read the comments following the interview. Many medical students graduate with $200,000 or more in school loan debt just from medical school (obviously more if they have loans from undergraduate as well). This is a huge sum of money to owe and interest quickly takes this sum higher. In addition, primary care physicians on average earn around $130,000 per year. Now while that sounds like plenty (and I’m not minimized the income) it must be understood that there is tremendous overhead in being a private practice or even a group practice physician. Because of increasing amounts of paper work and insurance drama physicians often need the help of several office employees. Then there is malpractice insurance which for procedural based specialties (surgery, intervential cardiology, etc.) can be as high as $250,000 per year! Procedural specialties also are much more likely to be involved in litigation and have to spend more of their time defending their outcomes. This overheard must be paid upfront before the physician ever makes any money. Combine that with an average of 60 day delays in collecting insurance reimbursements and physicians are cutting it tight in the beginning many times. General Surgery has been particularly hard hit. They often make the same or less than non-surgical primary care physicians and have higher malpractice insurance and often longer work hours.
CMS (Centers for Medicare and Medicaid Services) has announced that they want to raise primary care physician’s salaries by 6-8% by cutting reimbursements of certain higher paid specialties such as interventional cardiology and radiology. While this looks appealing on the surface it does seem to place an element of blame on those greedy cardiologists and radiologists. However, as Buckeye Surgeon comments, these are not primary care specialties. This means that they only do those procedures and read those scans because a primary care physician ordered a consult or ordered a scan. The primary care physicians orders those consults and scans readily because they want to be sure they don’t miss anything lest they become involved in litigation. Therefore it is more of a system problem than individual doctor’s salaries. Again, I’m not saying salaries don’t play a role, but it’s just not the only problem. And while some physicians make perhaps more than they should, a greater number are underpaid and many have resorted to earning income by other means and no longer practicing medicine. Defensive medicine is a huge problem in my opinion and much more of a player than salaries. Read another opinion by Buckeye Surgeon here.
Healthcare reform is desperately needed, but I’m afraid the solutions are not simple. More to come later on other topics of this nature.
