Raymond Kordonowy comments on a recent article in Forbes concerning the shortage of primary care physicians stemming from the pay disparity between specialists and primary care, “The Best- And Worst-Paying Jobs For Doctors”.
“On physician payment. The system of payment for physicians has become pegged to the Medicare fee schedule. In appx 1993 Medicare’s program stopped allowing physicians to bill above the allowed fee schedule for covered services (virtually everything is codified). When the RVU system was designed, office evaluations were assigned some of the lowest reimbursements. High tech stuff and procedures got paid more generously (and most likely they should have). The disparity in physician pay is a result of nearly 2 decades of price fixing which now involves all payers. Office evaluation has gotten much more complex and burdensome but the RVU system hasn’t made the proper accounting. Furthermore the demand side of this equation (magnified immensely due to minimal out of pocket per visit costs) has outstripped the supply side (primary physician availability and new trainees is at all time low). As long as we don’t allow a true pricing mechanism for health care services we will continue to see very lopsided earning potentials,unsatisfied customers and dissatisfied providers (in some cases). Overpayment of some fixed prices will drive overuse and underpayment will result in loss of services. Low pay will translate to a loss of that type of provider. This is very poor economics applied real world in the good ole US of A. It is no surprise to me as a provider that the country continues to be choking over what it is paying for health care- the model of payment is predictably flawed. The latest nonsense of ACO’s and shared cost risk will make it even worse.”