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Friday, December 15th 2006

Okay, We Get It, You're Barely Feeding Your Family…

That Man Spent 4 Years In Medical School…
…And All He Got Was This Lousy T-Shirt Shack

I actually believe it is imperative to cut the earning gap between procedural based medical specialties and primary care. This WSJ editorial (by a PCP) agrees (stunningly).

If I do a screening colonoscopy at the hospital to check for colon cancer for the same patient in the same time, my average reimbursement is $478 with essentially no office overhead. It’s no wonder that medical students want to go into procedural specialties like gastroenterology and fewer want to pursue cognitive specialties such as general medicine.

When I do a 15-minute office visit for managing high blood pressure, the average reimbursement is $45. If my nurse drew a panel of four common blood tests in the same time, it would bring about $50, on a patient with private insurance, after paying the lab company. (With the government’s Medicare program, I get paid $3 for blood work; Medicaid, nothing.)

If the lab work were done at the local hospital instead of the office, I wouldn’t make anything even though I would be responsible for interpreting the results and notifying the patient.

Despite joking above, this is very true. There are seeming contradictory scenarios playing out. Rising health care costs versus the fact that primary care loses money on general office visits:

For Texas Physicians

And so the pressure is very much there, not just to money grub, but to actually keep practices afloat, to add

ancillary services such as ultrasound, physical therapy and x-ray equipment to boost the bottom line.

We’ve tried to resist this trend since I think it can contribute to unnecessary testing and expense. What’s good for business can be bad medicine.

Just to make up for the cost of the actual visit itself. It is tough balance, one that can only be fixed by reconfiguring Medicare’s fee schedules and boosting compensation for actual time and actual brainwork by physicians. Even if you don’t see the physical results you do when they spend the time to remove a mole from your back or perform a colonoscopy.