[sunnyatlast]

Q: What is the sustainable growth rate?

A: Known as the SGR, the formula was created as part of a 1997 deficit reduction law designed to rein in federal health spending by linking physician payment to an economic growth target.

For the first few years after it was created, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut.

Every year since Congress has staved off the scheduled cuts. But each deferral just increased the size – and price tag – of the fix needed the next time.….

...Q: How is Congress going to pay for this?

A: That’s unclear. None of the committees have identified how to finance the doc fix, intentionally staying away from the thorny issue in order to build political momentum to pass the legislation. Other Medicare providers, such as hospitals, are concerned that Congress may reduce their Medicare payments to help finance a repeal of the SGR……"

Congress Is Poised To Change Medicare Payment Policy. What Does That Mean For Patients And Doctors? | Kaiser Health News

[CFrance]

Originally Posted by sunnyatlast

Q: What is the sustainable growth rate?

A: Known as the SGR, the formula was created as part of a 1997 deficit reduction law designed to rein in federal health spending by linking physician payment to an economic growth target.

For the first few years after it was created, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut.

Every year since Congress has staved off the scheduled cuts. But each deferral just increased the size – and price tag – of the fix needed the next time.….

...Q: How is Congress going to pay for this?

A: That’s unclear. None of the committees have identified how to finance the doc fix, intentionally staying away from the thorny issue in order to build political momentum to pass the legislation. Other Medicare providers, such as hospitals, are concerned that Congress may reduce their Medicare payments to help finance a repeal of the SGR……"

Congress Is Poised To Change Medicare Payment Policy. What Does That Mean For Patients And Doctors? | Kaiser Health News

But none of the cuts has taken place yet. And supposedly a fix is to be worked on this year. I wanted to know where exactly each cut was happening as of right now. Because people are saying that Medicare has been cutting payments to doctors for years, when they haven't. I'd like to see them back up their statements with facts. Yes, they are arguing over where the money will come from, but it hasn't effected the doctors yet that I know of.

[Suzi]

If doctors had a pay cut of nearly 5% in 2002 and have not received an increase since then, how would you expect them to stay in practice? Employees of the practice expect, at least, COLA yearly. How in the world would a physician practice stay alive? I can say for certain that renumeration and government interference is the main reason that physicians are leaving medicine in droves.

[asianthree]

Originally Posted by applesoffh

My ex just retired from the medical profession. Young people may no longer be as motivated to go into medicine because of the cost of medical school being so prohibitive. In addition, I read in the NY Times a number of years ago how medical schools themselves keep the number of admissions artifically low to limit the number of doctors they graduate. Ditto the number of residencies given out. Just because someone graduates medical school doesn't guarantee a residency. Assuming a successful residency in a specialty, the doctor can now go out and earn a living, if they can find a practice. Can't afford to start one alone. Unless the doctor lives in a big city, she/he may not find a job. If you go where doctors are needed in this country, it's difficult to make a living. If you have a specialty, you have a begtter chance of earning a decent living than if you are a family physician, general practioner or internist. Specialists command more $$$. If you ask why there are so many foreign-born doctors in general practice, that's one of the reasons. They are sought out because they carry much less debt than an American-trained physician. I learned an awful lot putting my ex through school. (as an aside, he still carries debt; I'm retired!)

We have a close friend who is still looking to get a residency he thinks if there is nothing within a year he career is done. Our two children as doctors came out of school with half million in debt, and we paid for the first 4 years of premed, and nope there was no basket weaving, lots of math and science, but he did many credits in Spanish cause you need the language.

[jblum315]

The United States has at least twice as many lawyers than doctors.
Why???

[perrjojo]

Originally Posted by CFrance

But none of the cuts has taken place yet. And supposedly a fix is to be worked on this year. I wanted to know where exactly each cut was happening as of right now. Because people are saying that Medicare has been cutting payments to doctors for years, when they haven't. I'd like to see them back up their statements with facts. Yes, they are arguing over where the money will come from, but it hasn't effected the doctors yet that I know of.

Not having a pay increase since 1997 is certainly the same as a pay cut. That is 17 years without a pay increase. Most employees would NOT tolerate not having a pay increase for 17 years. Add to the lack of pay increase the layers and layers of paperwork and increased need for office staff...well, there you go.

[blueash]

Originally Posted by Suzi

If doctors had a pay cut of nearly 5% in 2002 and have not received an increase since then, how would you expect them to stay in practice? Employees of the practice expect, at least, COLA yearly. How in the world would a physician practice stay alive? I can say for certain that renumeration and government interference is the main reason that physicians are leaving medicine in droves.

Well, as you are certain, what is the basis for your certainty? A single poll of a low percent of respondents is not certainty.

Do you really think a one time 5% reimbursement cut from one insurer would put a physician practice out of business? Were there a large number of physician bankruptcies in 2003? Do you have any data for your comment that physicians are actually leaving medicine in "droves" as opposed to retiring at the same rate they always have retired? Do you actually believe there has been no increase in insurance reimbursement since 2002? I am certain you are misunderstanding the available data.

[CFrance]

Originally Posted by perrjojo

Not having a pay increase since 1997 is certainly the same as a pay cut. That is 17 years without a pay increase. Most employees would NOT tolerate not having a pay increase for 17 years. Add to the lack of pay increase the layers and layers of paperwork and increased need for office staff...well, there you go.

The facts are that there has been one reimbursement cut to doctors from Medicare since 1997. And yet so many on this forum state the opposite without backing up their statement with fact.

Minimum wage has rarely received an increase either. Both should be taken care of-- but wait, many of you would call that Big Government.

[blueash]

Originally Posted by perrjojo

Not having a pay increase since 1997 is certainly the same as a pay cut. That is 17 years without a pay increase. Most employees would NOT tolerate not having a pay increase for 17 years. Add to the lack of pay increase the layers and layers of paperwork and increased need for office staff...well, there you go.

Your information that there has been no increase since 1997 is wrong.

I don't have a chart for 2007 to present.

[Mikeod]

Originally Posted by blueash

Your information that there has been no increase since 1997 is wrong.

I don't have a chart for 2007 to present.

What would be interesting would be a similar chart showing the year to year rise in utilities, wages, rents, insurance, supplies, etc. in the health care sector. If a rise in reimbursement rates is well below the rise in costs to provide the services, there is a problem.

[billethkid]

Originally Posted by Mikeod

What would be interesting would be a similar chart showing the year to year rise in utilities, wages, rents, insurance, supplies, etc. in the health care sector. If a rise in reimbursement rates is well below the rise in costs to provide the services, there is a problem.

Where is the base point?
There a reality the base being charged by doctors was significantly over stated in the first place knowing there would be varying approved levels of payments by differing insurance providers.

PAyment reductions or non increases are not an apples to apples comparison to wages or compensation that is paid without such variances.

[perrjojo]

Originally Posted by blueash

Your information that there has been no increase since 1997 is wrong.

I don't have a chart for 2007 to present.

I was only quoting another poster who said they have had no pay cuts since 1997.

[sunnyatlast]

Originally Posted by billethkid

Where is the base point?
There a reality the base being charged by doctors was significantly over stated in the first place knowing there would be varying approved levels of payments by differing insurance providers.

PAyment reductions or non increases are not an apples to apples comparison to wages or compensation that is paid without such variances.

Here are some numbers to consider, from some primary practice business-planning consultants:

“In the primary care groups we’ve worked with, the biggest factor that determines how much business they need to bring in is directly tied to the salary the physician wants,” says Andrew Creme, MBA, a consultant with MD Practice Consulting, Lake Mary, Florida. When discussing benchmarks, “it really depends a lot on the situation a practice is in,” he adds.

If you are new to practice, only take what you need to survive, then determine how long it will take for you to break even, Quattlebaum says.

The average income of a PCP, depending on the size of the patient panel, ranges from $120,000 to $180,000. Add in staffing costs, overhead, facility fees, and more, and a “bare-bones” practice would have to bring in $700,000 to $800,000 a year in business, Creme estimates.

On the low end of the physician salary scale, a practice should expect to generate $50,000 to $60,000 per month in revenue. Average salary requirements drive a need for $100,000 to $150,000 a month in revenue, whereas high-end salaries demand $250,000 to $300,000 of revenue each month. Those figures only finance smaller practices, perhaps with a single practitioner and one to two midlevel providers, Creme says.

Once doctor income has been set, most new primary care practices need to earmark about $250,000 in startup costs, then decide what they will need in average collections to estimate a total panel size needed. Panel size and average collections depend on the market and the payer mix for their area of practice……"

6 keys to profitability | Medical Economics

[Villages PL]

Originally Posted by Barefoot

I don't think that VPL is serious about doctors having "too much education".
I think he is just being controversial. But if he is serious, Barry, I want to be on your team too.

No, I figure with all their vast knowledge about health care (that most people give them credit for) why don't they a least live as long as the rest of us? It seems their education isn't doing them much good in that regard.

[dbussone]

Originally Posted by Villages PL

No, I figure with all their vast knowledge about health care (that most people give them credit for) why don't they a least live as long as the rest of us? It seems their education isn't doing them much good in that regard.

It appears you neglected to read/consider data provided by a previous poster. perhaps because it didn't support your position?


CONTENT/OBJECTIVES: No recent national studies have been published on age at death and causes of death for U.S. physicians, and previous studies have had sampling limitations. Physician morbidity and mortality are of interest for several reasons, including the fact that physicians' personal health habits may affect their patient counseling practices.
METHODS:
Data in this report are from the National Occupational Mortality Surveillance database and are derived from deaths occurring in 28 states between 1984 and 1995. Occupation is coded according to the U.S. Bureau of the Census classification system, and cause of death is coded according to the ninth revision of the International Classification of Diseases.
RESULTS:
Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6). The top ten causes of death for white male physicians were essentially the same as those of the general population, although they were more likely to die from cerebrovascular disease, accidents, and suicide, and less likely to die from chronic obstructive pulmonary disease, pneumonia/influenza, or liver disease than were other professional white men.
CONCLUSIONS:
These findings should help to erase the myth of the unhealthy doctor. At least for men, mortality outcomes suggest that physicians make healthy personal choices.