Follow the money.

First, I am an employed doc. On salary. Have been my entire career. I'm 7 years out from residency, 11 from med school and I have about 3 more years of paying off my loans (which will be ~20 years ahead of schedule, since I consolidated them). Financially, I could NOT enter private practice out of training. I needed to support my family and I needed the financial security of a paycheck, not the uneasiness of running my own practice.

But I care about my AR, my write-offs, my billings. Why? Because I understand that I need to make bank in order for my employer to continue my services, for my staff to get paid. And I am covering my expenses, which makes the hospital happy and keeps the practice in business.

But there is a lot of shit in the air, to be blunt. The RVUs suck. The AMA and older leadership should be ashamed at how we've allowed coding and documentation to wag the dog. It has killed the most important part of medicine, the family doc/internist. They have gotten the shaft completely.

It also has, in some ways, hurt patients. Let me give you an example from my field. Hysterectomy. Fairly common surgical procedure for us, our practice does several every week. Abdominal hysterectomy is still the most common way of doing this in the US, although that is shifting. Vaginal hysterectomies are relatively rare in the US, although studies show it is the method with the lowest complication rate and the cheapest.

Why?

Vag hysts are difficult to do compared to other forms. They are a pain in the ass for the surgeon (and, I suppose, the patient too). But...they are also reimbursed at a lower rate. One of my partners and I were going over reimbursements of surgeries from various companies. Vag hysts are consistently paid about $150-200 less than abdominal or laparoscopic hysts. So even though I struggle more, I get paid less. I can see how some docs say "Fuck it".

Just one example in one field. ACOG and AAGL are all up in arms about increasing the rates of minimally invasive surgery. You know, PAYING us more for the medical care you want to encourage and less for the others may get you further than the hand wringing currently going on.

And yes, office visits that require, you know, actual thought need to be much better reimbursed.