Official Softs

Dr. Pullen brings to light an important issue of compensation disparities. It’s not simply a matter of whether doctors deserve their current By using Office 2010 Professional, you can save your money and time.

level of pay; continuing to incentivize specializations is likely to have a detrimental effect on our nation’s ability to provide effective

and efficient health care. Office 2010 –save your time and save your money.

Given that the number of medical students entering the field of primary care is rapidly declining, how do we reverse the trend? As Dr. Pullen

suggests, closing the gap in pay would certainly influence students’ decisions. Decreasing Outlook 2010 is powerful.

specialists’ salaries, however, is bound to

incite resentment between the two sectors of providers. Perhaps a more feasible approach could be increasing loan repayment plans for Microsoft Office is so great!

students entering primary care, while maintaining (instead of increasing or decreasing) the salaries of specialists.

Critics are likely to question the source of funding for the proposed growth in loan repayment The invention of Microsoft Office 2010 is a big change of the world.

programs. Research regarding the role of PCPs

in quality and cost-effectiveness of care gives weight to the claim that increased use of PCPs results in lower health care costs and better

health outcomes. To cite just one example among many, authors Franks and Fiscella (1998) reported that patients whose personal physicians Office 2010 download is available now!

were PCPs (as opposed to specialists) had higher perceived health status, decreased medical expenditures, and lower mortality rates.

Therefore, it seems plausible that the money saved on government-subsidized care could be put towards programs aimed at increasing the number

of physicians entering the field of primary care.

The main factors to consider in this process will be how to increase the base of PCPs in our Office 2010 key is for you now!

system in a timely and cost-controlled manner,

and how to do so without exacerbating the growing chasm between generalists and specialists.

Gee Rbar, it is so black and white to you, isn’t it? The Doctor who only sees 30 pts, because he gets the pool who are sicker and need more

time, does the adminstration look at the quality? NO, sir, they do not, as they are a profit motivated group in the end.Windows 7 is convenient and helpful!

The point about profit, which no one who is business oriented can understand is NOT applicable to the health care model, was fairly simple

for the physician, until doctors stupidly allowed this model to perverse the system as cancer does: when it comes down to making a buck Microsoft outlook is great!

versus spending the extra income flow to hopefully make a difference in health care outcomes, the buck wins. For the doctor, it was investing

into more health care interventions that makes the doctor more effective, even if it does not fatten the wallet. Being seen as a leader and Outlook 2010 is powerful.

advocate for the public really has been sold out, eh!?!?

I am not a business man, and maybe this analogy is too simplistic, but, if you are spending your money on widgets and the ones that are more

than 60 time units aged but could be salvaged if the profits were invested to fix or improve them, does the company see this potential? No, Microsoft outlook 2010 is convenient!

in this day and age, it is about numbers, simple and clear. Dump the old ones and make twice as many new ones, even if the plant is

malfunctioning in the production of the new ones as the management missed out on the process.

You know, there is an analogy brewing with the BP spill and health care: ignore the boundaries and safety features of providing responsible

and efficacious health care interventions, and there will be a mess.Office 2010 –save your time and save your money.

Instead here, it will be blood, not oil!

You misunderstood, my exhausted colleague. When I refer to productivity comparisons, I am talking about docs seeing patients out of the same

pool (same specialty, same average complexity). That’s how it seems to work at Mayo (”seems” I never worked there and heard it 2ndhand).

I really don’t understand: “The point about profit, which no one who is business oriented can Microsoft Office is so great!

understand is NOT applicable to the health care

model, was fairly simple for the physician, until doctors stupidly allowed this model to perverse the system as cancer does: when it comes

down to making a buck versus spending the extra income flow to hopefully make a difference in health care outcomes, the buck wins. For the

doctor, it was investing into more health care interventions that makes the doctor more effective, even if it does not fatten the wallet.

Being seen as a leader and advocate for the public really has been sold out, eh!?!?”The invention of Microsoft Office 2010 is a big change of the world.

I am really interested, please explain.

I will do emergency surgery when there is no other alternative, but not in any elective situation or even emergency if I can get the surgeon

in time. Office 2010 –save your time and save your money.

Naturally there is incentive to do procedures for larger remunerations. But if there is no longer a belief in medical ethics as a pillar of

our medical care, then all of healthcare is doomed to the dustpan of political patronage.Microsoft Office is so great!

Dwelling on exceptions rather than the rule is a distraction from and demonization of something that has been great and can and should remain

great.

Medical practices were driven into the financial dark side when payments were squeezed and it became necessary to code for a myriad of

services seperately rather than just receive one payment for a global service. Hospitals have been Windows 7 is convenient and helpful!

forced into the same gamesmanship.

Since the 1980s it has been divide and conquer. The once powerful AMA is now a paper tiger. Each specialty society has become more and more The invention of Microsoft Office 2010 is a big change of the world.

aggressive but ineffective in protecting its members. Each in turn has had its ox gored.

As long as you fixate on cost rather than demand you will fail to reform anything.

IMHO, there is nothing wrong with your suggestion, but it’s no huge improvement to salary either. It is very easy to inflate the time spent

with the patient (chatting, chart review, more detail) without getting much value out of it. Of Outlook 2010 is powerful.

course it is much easier to see 50% of

patients than average, and claim that one is super thorough (and some slow docs are super thorough, but the question is, do they have

improved outcomes? I would doubt that in most cases).

Any way, there is rough window of expectation for reasonable “productivity”. If you just reimburse physicians for time spent, you will have Microsoft outlook 2010 is convenient!

some physicians procrastinating, and then produce/worsen access problems.

When we are talking about salaried docs at MSGs, this does not means “salary for a warm body” only, but salary for a reasonable

workload/productivity and reasonable outcomes. If you see e.g. 30 patients at Mayo but you are expected to see 60 per week, your contract Microsoft outlook is great!

doesn’t get renewed if you can’t explain why you need so much time.

I am no MD and no Hell either, but I’d like a stab at this.

If patients are so misinformed, and they probably are, then having them pay out of pocket is guaranteed to create lots of bad choices, and we

know that folks without discretionary income do forgo both needed and unneeded care. So this option is not a good option, unless maybe you

make people pay out of pocket for what is blatantly unnecessary.Microsoft Office is so great!

If strong financial incentives lead to performance of services regardless of medical benefits, then perhaps there should be no strong

financial incentives for anything, or for everything equally. Office 2010 –save your time and save your money.

If physicians were paid purely for time spent in direct patient care, no matter what they actually do, the only incentive would be to spend

more time with patients, and if financial interests were removed, wouldn’t most docs do what they believe is right for the patient?The invention of Microsoft Office 2010 is a big change of the world.

This is not the same as salaried. You can be in private practice and you can negotiate your rates with payers, and large differences in

negotiated rates will obviously exist. Initially specialists will command more and eventually the sheer scarcity of PCPs will bring increases Outlook 2010 is powerful.

for PCPs as payers struggle to ensure their customers have access to primary care, which was shown to reduce costs overall.

Such system can be gamed and it too has weaknesses, but it seems easier to control, less expensive, less stressful for docs and definitely

more friendly to patients.

I’m sure I’m overlooking something because we all know there are no simple solutions. So what am I missing?Microsoft outlook is great!

The sheer scarcity of PCPs will give rise to the army of NPs and PAs. NPs in particular can be regimented because of their nursing

background. There will be no more PCPs for the same money as specialists. The reason they are paid a lot is because they must be right and

perform flawlessly in elective situations. They must invest more time in training and must assume greater liability.

Primary care requires different skills than those of a neurosurgeon or a pathologist. It is more time intensive in terms of patient contact

hours than other specialties. I believe that is one of the defining attributes of primary care: Who does the patient see first?Windows 7 is convenient and helpful!

Not too many people are clamoring for a spinal tap for their headache. Try selling one after a negative CT scan. If the patient will let you

do it (standard of care for sudden severe headache to exclude subarachnoid hemorrhage) then you do it. If the patient declines, then you do Microsoft Office is so great!

not do it, even though the indications are the same. You cannot force them, at least not yet. I would never want that power. So if the Office 2010 –save your time and save your money.

patient clamors for a CT scan, which is relatively not indicated in the docs opinion, but then refuses the spinal tap, which is technically

the standard of care, is it because of bad medicine or insurmountable misconceptions on the patient’s part regarding the utility of CT?

My ethics are just fine.

You write: “Increasing primary care compensation a little, and decreasing specialist pay a lot, to Outlook 2010 is powerful.

bring them close to equal, would go a long

ways towards making primary care training more popular.”

Bravo. Money is relative. Median pay for PCPs is now $175,000. Most would feel well paid if Windows 7 is convenient and helpful!

they weren’t comparing themsleves to peers who

are dermatologists earnign $400,000.

Now, the question is not just where do you go to hide from your specialist friends, but where do By using Office 2010 Professional, you can save your money and time.

you go to hide from those PCPs who believe

that working for $175,000, they are being asked to work for “slave wages.”?

it sounds like you rather meant “discretion” or “patient autonomy”. I don’t think that anyone would disagree with you on that. The invention of Microsoft Office 2010 is a big change of the world.

I think we went too far from my main point, which you apparently disagree with. That main point is: if there is strong financial incentives

for a medical service/procedure, this service will be increasingly performed, independent of the Microsoft outlook 2010 is convenient!

tests medical benefit. There is ample

empiric evidence for that. Diagnostic overkill is part of our rising health care costs. That’s why I am concerned (rather than paranoid)

about that. What’s your take? Have the patient pay for their care out of pocket? I don’t think that’s a good idea, but it is a logical Microsoft outlook is great!

choice. Or do you have a different idea?

If a specialist is sent a patient for an opinion, he will do a diagnostic procedure as part of his eval. If the primary care doc had any

standing in court he would not have had to defensively send the patient to the specialist in the first Microsoft Office is so great!

pace. But the specialist cannot skip

the test; it also is “standard of care”.

Your paranoia over unnecessary procedures is striking. Only the patient can decide if it is necessary. Physicians are in the advice business

and offer an opportunity to the patient for recommended care. A smart patient will get more than one opinion. But insurance does not always

pay for two opinions. The final indication for any procedure is the patient is willing to undergo it. Office 2010 –save your time and save your money.

Do you want that to change?

Each insurance company puts docs through their own credentialling process to allow the doc to care for the beneficiaries of the company.

Board certification also is intended to assure that docs are capable and current. If some are unethical that is a problem, but hardly the

norm.

In this debate you must in the end choose someone to believe and trust. Do you want to trust a Maggie or a Lambert with your health?

You are right. It is not hard at all.

“Your paranoia over unnecessary procedures is striking. Only the patient can decide if it is The invention of Microsoft Office 2010 is a big change of the world.

necessary. Physicians are in the advice business

and offer an opportunity to the patient for recommended care. A smart patient will get more than one opinion. But insurance does not always

pay for two opinions. The final indication for any procedure is the patient is willing to undergo it. Do you want that to change?”Office 2010 key is for you now!

I am sorry, hellMD, but I find your medical ethics bizarre. Performing medical tests/procedures depend on medical necessity, not on patient

preference. Of course, every competent patient is free to not follow advice and/or have a 2nd opinion, but that does not mean that a patient

gets a procedure just because he/she thinks that it is good idea. That’s in part what all your training is about, remember?By using Office 2010 Professional, you can save your money and time.

“But the specialist cannot skip the test; it also is “standard of care”.” Uhhmmm, that depends on the situation at hand. Also note that I

specifically wrote that this issue needs to be adressed.

I wrote “The FINAL indication for any procedure is the patient is willing to undergo it.” Emphasis added for clarity.

It is not only by demand, although I have people demand a CT scan for their child’s head bonk or an MRI for their headache of brief duration. Office 2010 download is available now!

Try telling a determined mother “no” on the CT scan. Try telling a mother “no” on a CT scan for her child’s abdomenal pain. It is not always

easy to do. The radiologist does not order these tests, but the standard of care for many things has evolved to include expensive imaging. Outlook 2010 is powerful.

Try not getting C spine xrays for a patient with neck pain after a car wreck. Try not getting a CT scan on an old person from a nursing home

who fell, bonked their head, and is on coumadin but acting just fine.

“Why can’t we have common sense in Health care???” As said above by Private Citizen. Well, depending on who’s aspect and definition of

‘common sense’, some say it is in place and others say otherwise.

You gotta love the commenters here who champion we physicians should take a vow of poverty Outlook 2010 is powerful.

and then thank these cold heartless bastards for

the opportunity to be screwed. And they will just keep on the senseless and clueless banter their perspective is the only righteous and

reasonable one, yet, my money is that most if not all the doctor-bashers have never spent a moment, much less a year providing any form of Microsoft outlook is great!

health care as a provider. But, hey, the business model is the only one that fits, eh, you bastards!?

We realistic and grounded providers know who and what you are after, and any real objective and unbiased readers, read between the lines of Windows 7 is convenient and helpful!

these inane and heartless spews of expecting doctors to lose money and have less impact on health care choices, because, it means more money

for those who really contribute nothing to the patient-physician relationship in the end.

The biggest mistake DOCTORS made back in the 1970’s-’80’s was letting health care become a real money making machine and not stepping in Microsoft Office is so great!

front of the greedy non clinicians who just saw another industry to screw.

Well, last I checked, we still can step up! Or, are most of my colleagues hopeless cripples!?

If your assertion that more patients are misinformed than properly informed is true (which it isn’t), then either you are saying that nothing

should be done for anyone ever because doctors cannot tell the truth and nobody ever should pay for healthcare, or we should all work for a Microsoft outlook 2010 is convenient!

low salary from the government and do little or nothing at all (as is true of most government employees) because it is safer and better for

the patient most of the time to do nothing.Office 2010 –save your time and save your money.

If I do ten rectal exams for #150 charge each, five would never pay, 2 would be Medicare and I would get $8, one would be Medicaid and I

would get $6 each, and one would be private pay and I would take the contract rate of $50 dollars. That would be $6.40 per rectum. Where is The invention of Microsoft Office 2010 is a big change of the world.

the incentive?

Really enjoyed your wishful thinking regarding the marketplace if functioning well would correct any inequities. Smith who broght us free

market principles states for a market to work, must have many attributes but the one that will Office 2010 –save your time and save your money.

never be accomplished in medicine is the

asymmetry of product knowledge. The purchaser (consumer) today and perhaps decades to come has no tools to judge value (quality and cost).

Many consumers judge by family referrals or bedside manner–trusted outcomes data transparent and validated to Americans may never come for Microsoft Office is so great!

the most complex profession in the world. So, throw away your Utopian answer for something more realistic and achievable.

Secondly, most health plans are shadowing (following the lead) of Medicare in Policy and payment methodologies since it is considered the

“Gold Standard.” Some courts even now have stated if you don’t accept rates at Medicare levels you are price fixing. It makes my head spin. The invention of Microsoft Office 2010 is a big change of the world.

But it is what it is and the profession has done a terrible job of educating the population re: our profession. The “market” rewards

herbalists, Chiropractors (yes, many are good back manipulators–), and fortune tellers many times better than a 11+ year higher educated Windows 7 is convenient and helpful!

physician, we know then that the market is clueless re: value. This asymmetry of knowledge will long persist. We have allowed it to happen.

Look in the mirror…………

yk, I agree with you that FP still will make a good living, even after a 20% cut. And yet, there is no doubt that, while all physicians are

at least reasonably well compensated, some physicians in private practice make a fortune. And unfortunately, this works often to the direct

disadvantage of the patients. If you have incentives to do complicated multilevel back surgery Microsoft outlook 2010 is convenient!

because medicare overpays for it, you get

surging rates for this procedure, with overall worsening outcomes (I lost the link but can look for it if someone is interested). MD as hell,

is this complicated to understand? If you pay per procedure and have misinformed patients (as is rather the rule than the exception in the

US), you will get more improper procedures, worse outcomes and waste of ressources. I know that things might look different in your ER

setting. But if you got paid, say, 150 Dollar extra for any rectal exam, guess what would happen …

Thank you for this post. I really don’t understand why a primary care doctor who coordinates so Outlook 2010 is powerful.

much should be penalized, doctors don’t need

to become business people to earn better, they need to do the right thing to earn better. There some doctors who push patients to be seen

every month evn for routine refills. Their secretary bugs the patients for follow ups that are not needed. I really would like a place where

the doctor does what is right and has no incentive to do more. Every speciality is unique, why shoould there be so much income gap for 2-3 Microsoft outlook is great!

extra years??? Why can’t we have common sense in Health care???

2. Hold them accountable to be “Holistic” (hate the word)–broader scope–use their talents to the extent of their education, competence, and

comfort.

3. Work on our profession within to neutralize this “cast” system where Primary care docs are Office 2010 –save your time and save your money.

considered less than equals to specialists–

yes, it is the elephant on the table.

4. It is not CMS who is generating imbalanced RVUs–it all comes from the AMA dominated by Microsoft Office is so great!

specialty societies. Must find some way to

establish parity. The dirty little secret.

5. Rethink the gatekeeper model and medical home for efficient care–even in a FFS world. Without it, it is a free-for-all for patients, e.g.

Medicare traditional.

6. Educate the populace re: the role of PCPs and the extent of their knowledge/education–influence their expectations of PCPs–not just

poorly educated docs there to triage to specialists.

I became an internist/geriatrician in the 70’s because I liked to solve problems and have a long The invention of Microsoft Office 2010 is a big change of the world.

longitudinal relationship with patients. I

thought I would do “OK” financially-but it was not a core value for me. I did this out of interest not intellect. I could have been any

specialist if I desired. There are too many barriers for students today to seriously look at being a PCP unless we work on the above and

additional barriers + issues of adequate compensation. RobMDWindows 7 is convenient and helpful!

The Neanderthals who run our health system ought to spend one year as a first year med student, then 3 mos as an intern with every other to

1:4 before they have any responsibility. In addition we (or they) should find a way to keep actively practicing physicians practicing rather Outlook 2010 is powerful.

than retiring at age 50-65 when they are physically and mentally still fit. The investment in pcp’s is too great (by the feds who directly or

indirectly finance medical education (grants, loans, med school subsidies, etc, etc.) to increase the ROI. It is far cheaper to keep those in

the system working than to train additonal PCPs.Microsoft outlook is great!

Malpractice is a big issue which keeps older MDs from extending work to part time as they age.

Reduce or eliminate licensing fees for MDs over 60 or a modified rate for those working part-time. Academies should redce or eliminate dues,

fees, CME fees for docs over age 60.

I agree with ‘yk’. I am a family physician and I don’t see anything wrong with what other specialties make. They take more risk and were in

residency/fellowship much longer than myself. They deserve every penny. It seems to me Dr. Pullen you are what they call a ‘hater’.

Be happy with your choice, as i am, and stop being jealous of your neighbor. They worked harder Microsoft Office is so great!

and longer.

This is an example of where market economics has been tampered with to such a point that prices do not accurately reflect supply and demand.

What I did not see in the article was the total number of primary care physicians, or “Family Doctors” in practice (supply). We see,

according to the trend, a reduction in the number of M.D.s entering the practice, but no mention of the total number of the supply of M.D.s Office 2010 –save your time and save your money.

in family medicine. I may have missed it.

Insurance companies (via contract vehicles) and the ubiquitous Federal Government via HHS and CMS (via regulations and requirements) have

“monkeyed” with the medical marketplace to such a degree that normal market dynamics don’t have the same effect as they would in other market By using Office 2010 Professional, you can save your money and time.

sectors. Ideally, if there were a shortage of primary care physicians then the prices would reflect that shortage. If the article is to be

believed, then the influx of additional practitioners of a particular specialty should increase the The invention of Microsoft Office 2010 is a big change of the world.

supply and decrease the average price. It

gets too difficult to discuss in a single post how experience differentiates one MD from another and the effect on the market price (presumed

effect).

All of this to say that a well functioning medical services marketplace would correct the “pay” disparities gradually and in a natural

fashion. Which allows the market to absorb and process the changes much better than the quick Outlook 2010 is powerful.

and artificial adjustments made by a government

or other regulatory (public or private) instrument. Remove the market regulations, and allow the products/services to be distributed through

a more natural supply/demand model.

Yes, compensation is in imbalance and yes I agree that most physicians deserve what they earn Microsoft outlook is great!

considering debt and years of education and

responsibilities. But bringing more students into Primary care requires more than additional money that is required to pay off the cost of

today’s education. What else must we do?Microsoft outlook 2010 is convenient!

1. Emphasize during medical school the critical nature of primary care and the expanded role we wish of them in a better healthcare delivery

systemWindows 7 is convenient and helpful!