I've been wanting to write about this for a while. Recently, the Wall St Journal Health Blog highlighted a letter the American College of Surgeons sent to MedPac, the advisory group that makes recommendations to Congress with regards to Medicare funding. Essentially, the ACS objects to a plan to raise Medicare pay outs to primary care physicians in a "budget neutral" manner. What does this mean and why is the surgical community outraged? Because "budget neutral" is a code phrase for "take money from from those evil, greedy surgical specialists and give it to the family practice docs".
The headline of the WSJ article is frankly disingenuous. Surgeons aren't opposed to primary care docs getting more money. We're all for that. But don't obtain that funding from the already dwindling surgeon's piece of the pie. Many surgical procedures have seen reimbursements cut 40-60% over the past 20 years. And that's not an adjustment based on inflation; those are real, bottom-line dollars. If you want all specialties to be paid the same, that's fine. But if that's the case, then we all better share in the liability and the risk. You want part of my earnings? Then make sure we all pay the same malpractice premiums. Oh, and make sure that I get paid like an attending during my fourth and fifth years of residency and any additional years of fellowship I might pursue, to ensure my salary is equal to the family practice doc from the get-go. It's all about equality, right? It would only be "fair".
I believe Sid Schwab touched on this earlier, but it bears repeating. This is a perfect scenario for the federal government and the insurance companies: doctors from different specialties fighting each other for the piddly scraps of revenue that they decide to dole out to us. I don't need to write a treatise to defend the concept that some specialties ought to be paid more than others. It would be insulting to everyone's intelligence. Let's get beyond that. Primary care certainly needs to be better remunerated. Being forced to see 50 patients a day just to break even isn't a sustainable business model, nor is it good medicine. But the fault doesn't lie with the surgeons. We're right there in the trenches with you.
As an analogy, imagine major league baseball without a players union or a collective bargaining agreement. Owners with their multi-billion dollar TV contracts could dictate player salaries to be whatever they chose. Maybe the power hitting first basemen gets a lucrative contract because he produces and is a gate attraction. But what about the slick fielding shortstop who steals a lot of bases and hits for a high average? Maybe he doesn't hit a lot of homers, but he is arguably just as valuable as the first basemen. It wouldn't be fair to pay him a pittance for his efforts. Would he begrudge the power hitter his salary? Of course not. He might be jealous, but he would never demand that the first baseman fork over a portion of his salary to "make things more equitable". He knows the owner is sitting on a pile of cash. He'd call the owner and say, Pay me what I'm worth, dammit.
There's plenty of money to go around. The discrepancy in pay between the GI doc and the PCP is not the reason why health care is so expensive. The giant HMO's and the pharmaceutical conglomerates would love to have you believe that. There's a reason both are multi-billion dollar industries. Let's not nickel and dime each other. A united front is our only hope of ensuring that the backbone of the American health care system, i.e. the physicians, does not deteriorate into a collection of second- rate, infighting, backstabbing special interests.