I Want My Slice of the Pie!

Greed, for lack of a better word, is good.
Gordon Gekko in 1987's Wall Street

It's human nature to look out for our own self-interests.  Which is what makes (the business of) medicine so difficult to understand.  After all, when the rest of the nation is mired in a miserable recession, it's very difficult, if not impossible, to listen to primary care physicians complain about their average $189K salaries (funny, I'm about $30K short!), tied for 19th place w/psychiatrists & pediatricians.  That is, until you compare us to an orthopedic surgeon's average $519K, cardiologist's $512K & urologist's $461K take home pay as noted in Forbes last Friday.

I thought about this as I made a house call (and no, Nevada doesn't reimburse for gas & mileage as I drive my own car) this past Sunday afternoon to visit a 91yo lady w/dementia who'd fallen the previous night.  I thought about this as I arranged to have a mobile radiology service come out to confirm my suspicions: broken hip.  I thought about this as I spoke with the on-call orthopedic surgeon to arrange her admission and pre-op.

And then I read an article in the latest issue of Bloomberg Businessweek about some surgeons in Silicon Valley.  Apparently, some surgeons had made out-of-network arrangements such that they were pocketing upwards of $960K a year in dividends (in addition to their average salaries as noted above).  In 2007 & 2008, a $10K investment for 1% of the surgery center would return $24K in annual distributions.  This amount tripled in 2009.  The following year, it only went up to $6.7K/mo or $80.4K for the year.

Of course, Aetna, UnitedHealth Group, Cigna, and Blue Cross & Blue Shield aren't too happy about this turn of events.  But then, the health insurance CEO's only made $7.3M-19.1M last year.  So your premiums (and mine) continue to escalate each year while my primary care visit reimbursements continue to decline.  What's our average business response?  See more patients in the same (or less) amount of time in order to keep our revenues even.  Does this help explain the long waits for & short visits with your primary care physician?  Envision us as the hamster running faster & faster in his wheel but getting nowhere.

Don't get me wrong.  I'm not advocating that we switch to socialized medicine.  And I'm not smart enough to have the solution to this quagmire in which we find ourselves.  But, if we valued our primary care physicians more, this might encourage more of our brightest to become family physicians & general internists to help care for the extra millions about to be foisted upon us by legislation.  At least consider the comments engendered by an opinion published in the Wall Street Journal last week comparing numbers of applicants, numbers of graduates, debt incurred, and starting salaries of MDs compared to MBAs.  What does this say about our social priorities?  Especially when you can make even more money than a CEO just for hitting a baseball or putting a basketball through the net.

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