Monday, October 5, 2009

The hospitalist will be happy*

An op-ed in the Wall Street Journal details how the health care reform bills will punish medical specialists will helping the primary care doctors. It is widely believed that primary care physicians in this country are grossly underpaid relative to their specialist colleagues. Thus very few medical students, 5%, report wanting to go into primary care. But if everybody gets health insurance, there will be an acute shortage of doctors to take care of all these new patients. So the reform bills will increase reimbursements for primary docs.

But the pool of money is static. Thus reimbursement will be a zero sum game. If primary doctors get more money, somebody else will get less, much less. The article details some of the proposals, highlighting cardiology and oncology specialties. In 2010, cardiology will receive 11% less money while oncology will get 19% less. Echocardiogram reimbursements will fall 42% and cardiac catheterizations will drop 24%.

I shudder to think how much less anesthesia will receive. We already get less from Medicare than nearly all specialties. On average anesthesiologist are reimbursed only 33% of private health insurance payments versus 80% for other medical fields. Maybe anesthesiologists can reclassify themselves as the internists of the operating room, which we are. Then we can convince Congress to reimburse us better.

*With all due respect to A Happy Hospitalist.

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