Wednesday, June 13, 2007


Two colleagues who are Cardiologists have decided within a few months of each other to abandon private practice. They both cited the same reason: dwindling reimbursement. One had just moved his office to a new site and after a month had had enough! He said that insurers just wouldn’t pay and office costs had gotten out of control. He said the whole thing was a mess.

The other was the first attending I ever had as an intern in residency (about eight years ago). As far as I am concerned, he is synonymous with my hospital. He’s an older doc who is very honest and smart. As such, he refuses to perform what Happyman calls the “trifecta” of ECHO, stress test and holter on every person that walks through the door. This left him the option of seeing, as he puts it “100 patients a day”. He is now joining a practice at a hospital across town.

So the message appears to be that if you are a smart clinical cardiologist, and you decide that a patient doesn’t need a bunch of expensive tests, you will actually LOSE money. If you are not clinically skilled, or if you just need to make more money, then doing a bunch of unnecessary tests becomes NECESSARY to stay afloat.

Obviously, if you put in an extra three years of fellowship in Cardiology, I think you are entitled to more money. I think you deserve it, primarily because of the liability factor. As an internist, if I’m not sure about something, I can just defer to you and then in court I can plead “Hey, I accepted that I wasn’t sure what was going on, so I appropriately called a Cardiologist.” So the buck stops with the specialist.

But I don’t think the extra money should ONLY come from unnecessary tests. That just encourages fraud and waste. And drives intelligent specialists to merge with hospitals to reduce costs and overhead. So then the HOSPITAL can foist unnecessary tests on the public.

I am doing the “reverse commute” soon, leaving the hospital for private practice. I’ll let all of you know whether I fall on my face or not.

Soon, I will return to the “BLANK MD” product line which so angers me.


Anonymous said...
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Anonymous said...

I was an office manager in a cardiologist's office for 4.5 years. What you say goes on is absolutely true. You've nailed it. Cardiology patients take longer to see/evaluate, which decreases the number of patients seen per day. So the cardiologist gets equipment that will allow in-office testing for higher reimbursement opportunities. Then every single patient walking in the door who 1) has insurance and 2) has at least one indication for the test will inevitably be signed up for it.

It's just wrong.

Mike said...

The truth is, I don't even blame the Cardiologists. The system is stacked aainst them, and every other specialist who spent an extra 2, 3 or 4 years of fellowship training to increase their value and better their lives.

Unless the system is reworked to reward thought as well as tests, then we'll continue to have the same problems with primary care reimbursement.

туры в барселоне said...

The chap is definitely just, and there is no doubt.

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