In which I fall in love with a complete stranger

[Immediate disclaimer for friends and family reading this post -- the following is strictly a fanciful jest. You need not call and offer the Better Half solace.]

I think I may have fallen in love with Uwe Reinhardt. I have never actually met Prof. Reinhardt, but I am so moved by his writing that I may need to sequester myself away from the computer to keep my feelings of love in check. Prof. Reinhardt, who is an economics professor at Princeton, writes for the Times' Economix blog, and his recent posts on health care "rationing" make my heart go pitty-pat. His first post on the subject covers the same territory that I did in my post at League of Ordinary Gentlemen. But it's today's post about physician pay that really makes me swoon.

He writes to address concerns such as this, expressed in his online comments:
Lee Beville, a radiologist, also wrote:

The proposed fee schedule for 2010 for radiologists and cardiologists is 21% less than this year! Instead of being reimbursed 36.00 per RVU, CMS proposes to reimburse at 28.00 per RVU. These reductions are the first signs of removing economic incentives for medical practice.
Please give us your thoughts about capping the number of work units and how this will put RATIONING on steroids? There will be few radiologists and cardiologists working after they hit the magical cap number.
In response, Prof. Reinhardt writes:
Like everyone else, radiologists and cardiologists certainly can claim to be sorely underpaid relative to the extraordinarily high compensation of bankers and corporate executives, which appears to have little correlation with contributions to society. But relative to their colleagues in internal medicine, pediatrics and family practice, radiologists and cardiologists actually are very well paid.

There are a number of sources on physician income (see, for example, this). All of them suggest that the median annual net income of radiologists and of cardiologists (around $400,000) is more than twice that of family practitioners, internists and pediatricians (less than $200,000). The median is a statistic such that half of physicians earn as much as the median or more, and the other half as much or less.

So even if Medicare cut fees of radiologists and cardiologists by 21 percent, the income of these specialists would still exceed that of their colleagues in primary care by 60 percent or more.
Halle-freakin'-lujah. I think I may have to send him a dozen long-stemmed roses.

Radiologists and cardiologists make as much as they do because they can bill per procedure, which is compensated at much higher rates than is primary care. I am not, in any way, questioning the value of radiologists or cardiologists. If my left side goes numb, or I suffer from crushing chest pain, I'd like there to be a competent radiologist or cardiologist on hand.

On the other hand, I make far, far less than $400K a year. (Faaaaaar less.) I get paid based upon how many patients I see, and how detailed the care I provide is. I cannot deliver competent, compassionate care for more than four (or, for simple problems, five) patients an hour, and for more complicated or sensitive issues, I allot a full half hour. And, of course, every so often I can handed patients like, for example, a newborn that's not breathing, with the expectation that I will fix it pronto. (Having been woken at 1 AM today for an emergency admission, perhaps I am not as objective as I could have been.)

I am not necessarily arguing that I should make more, though I wouldn't cry if they started shifting compensation away from procedure-based medicine and toward primary care. (Hint: if you want more people to go into that field, start paying people in that field more.) But there isn't such a vast difference in the importance of what I do and what a radiologist does that they should make three times what I do. If the Feds are looking for a place to make a cut, those reimbursement rates are a place to start.

And, for all their whining, the providers in question will still make a pretty penny. Heck, even I make enough to afford chocolates for a certain economics blogger.

1 comment:

  1. A couple of thoughts from a non-physician on this inside baseball post...

    Prof. Reinhardt claimed that if Medicare reduces payments, and in response, physicians reduce Medicare caseloads, it is nevertheless physicians who are "rationing" healthcare. I find this puzzling; if private insurers reimbursement resulted in physicians declining patients, surely the blame would attach to greedy private insurers rather than physicians. So why doesn't this logic apply to government insurance?

    Regarding the "magic cap" remark, I think the good professor chose another question to answer. Dr. Beville asked what would happen if economic incentives kicked in at some "magic cap" next year. The Prof. talked about long range incentives to enter the profession. The Prof. answer is all well and good unless you are on Medicare and need radiologist services in the next few years.

    Both questions are good ones, but answering one is not a substitute for answering the other. Dan, what is capped in this scenario? Is total compensation (you can only be paid for N procedures per month) capped? That would appear to be highly problematic if we haven't a surplus of radiologists today. Right?