Posts Tagged ‘pediatricians’

Why Aren’t Physicians Paid For Talking To Their Patients?

Tuesday, July 5th, 2011

One possible reason that more physicians do not choose family practice as their specialty could be the fact that an essential part of the job is spent talking with patients – an activity that pays less than does performing procedures.   According to a recent study published by the Journal of the American Medical Association, just two percent of medical students plan a career in general internal medicine, pediatrics or ob/gyn.

Writing on the KevinMD.com website, Jennifer Adaeze Anyaegbunam says that “Family doctors spend more time talking to patients than performing procedures, but these doctors don’t get paid much to chat.  According to Dr. Sameer Badlani, a professor at the University of Chicago School of Medicine, when physicians are paid on a fee-for-service basis, specialists have the opportunity to make four to five times as much as a family physician.  Given the increasing debt of medical students, it is no surprise that the overwhelming majority choose to specialize.  In order to increase the supply of primary-care providers and meet the anticipated demand, family physicians need to be reimbursed more for their services.  Congress is looking into legislation that includes provisions for loan forgiveness and increased Medicare/Medicaid payments to primary-care providers.  Additionally, there have been talks of expanding the National Health Service Corps, program that utilizes scholarships and loan repayment to recruit primary care professionals to work in underserved areas.”

Primary-care physicians spend more time talking to patients and helping them avoid health crises to cope with chronic and incurable diseases than they spend performing tests and procedures. These doctors ask relevant questions, about health and life circumstances, and listen carefully to their patients.  These are physicians who know their patients and the circumstances and beliefs that can make health problems worse or hamper effective treatment.  The problem is that reimbursements are dictated by Medicare and other insurers.  As a result, physicians are not compensated well for taking the time to talk to patients.  They are primarily paid for procedures – such as blood tests and surgery — and for the number of patients they see.  Most spend long hours doing paperwork and negotiating treatment options with insurers.  The payments they receive have not increased along with increases in the costs of running a modern medical practice.  To earn a reasonable income of $150,000 a year, many primary-care doctors squeeze more and more patients into the workday.  “If you have only six to eight minutes per patient, which is the average under managed care, you’re forced to concentrate on the acute problem and ignore all the rest,” said Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center.  In a study of more than 3,000 patients with chronic obstructive pulmonary disease, 50 to 60 percent had one or more other illnesses, and 20 percent had more than 11 other conditions that required medical attention.  “There just isn’t the time to address them all,” Thomashow said.

Dr. Alan J. Stein, an infectious disease specialist in private practice in Brooklyn who treats many patients with HIV, described his practice as “heavily cognitive.  I spend a lot of time talking to patients — listening to them, examining them, interpreting tests and figuring out what’s wrong,” he said.  “I don’t do procedures in the office.  Over the last 10 or 15 years, the income of procedure-based physicians like cardiologists has increased significantly, whereas for those in primary care it has remained the same.”

Despite this, many physicians are reluctant to talk to their patients via e-mail.  Suzanne Kreuziger, a Milwaukee registered nurse, said.  “It makes sense to me to have the words laid out, to be able to re-read, to go back to it at a convenient time,  If I were able to ask my physician questions this way, it would make my own health care much easier.”  Her experience is shared by the majority of Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than 33 percent of doctors use e-mail to communicate with patients, according to surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project.  “The health care industry seems to be lagging behind other industries.”  Physicians have good reasons for avoiding e-mail exchanges with their patients.  Some are concerned that it will increase their workload.  Others worry about hackers compromising patient privacy.

Overall Physician Compensation Levels Fell in 2009

Thursday, August 26th, 2010

The bad economy cuts into 2009 physicians’ paychecks.  Doctors’ salaries fell slightly in 2009, according to the 17th annual Physician Compensation Survey compiled by Modern Healthcare magazine.

The most recent survey tracked 23 specialties and determined that only five had average pay increases higher than the 2.7 percent inflation rate calculated by the Consumer Price Index.  These were dermatology, which rose 5.3 percent; pediatrics, which rose 4.5 percent; neurology and pathology, which rose 3.3 percent; and hospital medicine, which rose 2.8 percent.  Orthopedic surgeons topped out the compensation list with their average pay climbing 1.9 percent to $485,297.

Eight specialties saw slight decreases.  Plastic surgery was down 3.3 percent to $376,849; gastroenterology was down 2.8 percent to $409,628; intensive medicine was down 1.7 percent to $257,797; radiation oncology was down 1.7 percent to $420,661; urology was down 1.4 percent to $391,406; emergency medicine was down 1.1 percent to $266,826; invasive cardiology was down 0.9 percent to $450,016; and noninvasive cardiology was down 0.9 percent to $393,181.

According to William Jessee, M.D., president and CEO of the Medical Group Management Association, “Clearly, there had to be some impact from the economy.  Actually, I was pleased the numbers were as good as they were given the recession.  Certainly, it showed a comeback in the second half of 2009.”  A pediatrician, Jessee, added that primary-care physicians saw their pay rise by 2.8 percent last year, which he views as part of an effort to attract more medical school graduates to that specialty.  He warns against over-reacting to the data.  “Keep in mind the increase is not anything to write home about – 2.8 percent is not a windfall,” Jessee said.