how important is salary?

md007,

You seem simply to want to pick a fight, so I'll resist the urge to spiral this one down with insults.

The point of my post was simply to respond to "Staff's" assertion that the youth of medicine is in a "sad state" and care nothing about money simply because they (we I guess, although I don't consider myself youth) are CONCERNED about declining reimbursement.

As a whole (obviously excluding myself - you seem to have my motivations pegged based on a single post) my contention is that physicians DO put patient care above reimbursement. Please, I beg, name ONE other profession which has even seen their earning power not keep up with inflation, much less DROP year after year. I doubt very few teachers, nurses, policemen, etc, all of which provide for the public good, would continue to work in a job if they were told tomorrow they would get a pay CUT next year. Physicians continue to do the same job for less money year after year. Were physicians overpaid in the past? Perhaps. Are they appropriately compensated now? Probably, depending on the specialty. Will they at some point be underpaid in the future and lead to shortages in certain fields? Well, it has already happened in my opionion - which despite what you would suggest, ultimately DOES affect patient care and access to health care. There are some areas of my state where the closest OB/GYN is three hours away. It wasn't always the case and I can't help but blame at least SOME of that on the decreasing reimbursement coupled with the increasing cost of running a practice.

You can insult me all you want on an anonymous message board, but it doesn't change the fact that ignoring financial issues in medicine is not only appropriate, but necessary.

Oh, and by the way, I don't own even a part of a surgery center.

now now gentleman ... let's not fight ... although some may say i should be upset with someone trying to incite me with remarks directed directly at me ... no apologies need ... my feelings are not easily hurt

Earthdawg brings up points ... all of which have merrit ...

that being said, salaries and stark laws are not related and therefore really should not be discussed in the sam setting ... stark laws are in relation to the buisness of medicine (what you own or have relationships with ... MRI, PT/OT)

patient care and salaries/reimbursement it discussed together you really tread on thin ice ... understand there are a lot of physician practices that limit their patient practice based on your insurance ... i.e. will not take medicaid, or lesser insurances ... is this done in the patients best intrest? .... patients with treatable condition by any competent orthopaedic surgeon that are refered away because of insurance ...

insurance payments ... well that is a discussion unto itself ...

well i got to run ... another knee pain patient to see ...

now everyone play nice

I think my biggest problem is with the "gen Y" comment. I feel it is the older physicians who have sold out the younger ones by chosing to have PAs and NPs in their practices instead of hiring a new partner in order to keep their salary high. This has occurred in all fields and now these groups are saying "we don't need physician supervision because we have been doing it by ourselves for a while." Physicians are about to lose all primary care and soon I am sure other groups will start encroaching on surgery. The respect of the physician has steadily been decreasing and this cannot be blamed on those that are just now coming into the field.

Staff,

I am not trying to encite you. I don't know anything about you. You may work 27 hours a day, eat Ramon noodles for dinner and live in a cardboard box for all I know. My comments about "holier than thou" physicians were about older physicians in general who criticize younger physicians about caring about money (hence the phrase, "while not always the case") and not necessarily about you.

It is my understanding that STARK laws also apply to how much a hospital is allowed to offer a physician in relation to standard income. Even if a hospital has a tremendous need for a physician, they are not allowed to offer over 75th percentile or 90th percentile, etc without raising STARK violation concerns. IE, if the hospital pays an unreasonbly high salary, they are guilty of offering a "kick back" in return for the physician's cases, and are therefore in violation. I am far from an expert, but I believe it does apply at least for employed physicians.

In response to your assertion that refusal of patients with medicaid is not in the patient's best interest - of COURSE it is not in the patient's best interest. But with whom does the fault lie? Is it with the physician, who in some cases doesn't even break even after paying their overhead when seeing those cases, or with those in control of deciding how much to reimburse for those cases. I personally accept any patient coming through my door, refuse no medicaid, and see a large number of uninsured in my practice, but at some point, let's say medicaid cuts reimbursement to the point that they are 50% or even 25% of what they are now, then it will be impossible to continue to see those patients and even earn a living. Even fewer physicians will be able (or willing, whatever the case) to accept medicaid. Why is it always the "greedy physician" who is to blame and not the insurance companies or politicians. The amount of the total Medicare budget spent on physician reimbursement is about 5%. So even if Medicare decided that physicians should work for free, only 5% would be saved. So why do physician reimburesent rates for Medicare continue to fall? Because physicians have allowed it.

I agree with most of what you say. It IS sad that specialties and subspecialties are chosen with financial concerns in mind, but I believe that is a result of declining reimbursement across the board, rendering pediatrics and FP less desireable. Physicians, like other sectors of society, are human, and are driven by incentive. It is unrealistic to expect them to behave otherwise. Is it ideal? No. Are there exceptions? Yes, and you sound like one of them, but most physicians have at least one eye on the bottom line, and that doesn't make them any less devoted to patient care.

By the way, my last post should have ended with, "You can insult me all you want on an anonymous message board, but it doesn't change the fact that CONSIDERING financial issues in medicine is not only appropriate, but necessary."

So I have been reading this post for a while and decided to ask the simple question....does anyone really know just how much a successful orthopod takes home? How about an average orthopod?

I have only heard rumors....and trust me, if money was the #1 reason I was going into ortho, then I would feel awful stupid right about now....do the math people......not too many stock brokers are getting up at 430 am everyday to work a 16 hour day for 5 years at about $8/hour.....you gotta love it to do it.....

oh i love a good debate ...

first i would like to put out there that i am of the opinion (i know and everyone has one) tha money is always a factor in a practice ... i feel tha medicine in general has taken a huge hit ... now most of you in the forum are in madicine, so you come into it understanding that ... therefore your chioce of practice then should be based on what you feel best suites you ... the money side initially should not be as much a factor ... other specialties that do well are derm, radiology, anethesia (an great life style and income), cardiology .... question is will these ultimately make you proud of what you do .... or do you feel like trump working for the dollar ... this is a personal issue ....

second to give Doctor Sawbonz some information

there are diferent practice agreements (single specialty group, multi-specialty group, solo practice, hospitalist, academic) .... depending on location, specialty, and incentive the average is between 200-400 ... the thing that is hard to figure in is it will go up or down based on your practice payor mix, how hard you work, and the bonus structure with in your group .... i will speak for most practices (private) .... when you are going into a practice this is a system of determining your overhead (either on a percentage or flat fee) ..... your overead includes clinic/office space, malpractice, supplies, nurse, pa/np, secratary .... therefore depending on your practice these number may very ... i will put numbers on this .... my sports friends overhead ranges from $20-30,000/month on average .... he also has a nice office with all the trimmings ....

third to dr. eathdawg ... the enciting comment just comes because you put the "I will NOT apologize to "Staff" and others like him or her" ... that's all ... i got much love for you brother ...

stark laws ... hmmmm

The Stark statute applies only to physicians who refer Medicare and Medicaid patients for specific services ("designated health services," or DHS) to entities with which they (or an immediate family member) have a "financial relationship." The lists of designated health services and financial relationships addressed by the statute are extraordinarily broad. To ensure you're not violating Stark, you must evaluate any economic benefits you receive from entities to which you refer Medicare and Medicaid patients to determine whether they meet any of the almost 20 detailed and complicated "exceptions" described in the statute.

THE EXCEPTIONS
The almost 20 exceptions to the Stark statute address many different types of referrals, including the following:

- To other physicians in the group,
- For in-office ancillary services,
- Within prepaid health plans,
- To entities in which the physician is invested (including publicly traded entities, hospitals in Puerto Rico, rural providers and a hospital itself).

The statute also describes some other exceptions, such as when financial relationships include the following:

- Rental of office space and equipment,
- Bona fide employment relationships,
- Personal services arrangements,
- Physician recruitment.


i am not sure why you have problems recruiting a trama doc ... we are fortunate ... we have 7 in our group ...

as far as the reimbusement issue, that is anothere subject that we can speek at length about .... i would whole heartedly agree with the problems with reimbursement the system medicaid (state) and medicare (federal) ... we as physicians need to be more vocal ... the AAOS has been very vocal in the recent years .... more needs to be done ...

you all rock ... orthopods rule ... thanks for putting up with my statement against Gen Y ... i am Gen X ... may be i'm just jealous ... i didn't get my PS3 for christmas ... so now i am saving up (i am a lowly pedipod)