Should Cardiologists Lead the Way in Health Reform?

Here is an opinion piece from today's Journal of the American College of Cardiology, in which the authors claim that cardiologists should mobilize and provide leadership in health reform. The authors refer several times to preserving cardiologists' compensation as a primary goal of reform efforts. They suggest that efforts to maintain their current compensation levels should be presented as a form of "professionalism."

Given that the average starting salary of a cardiologist in the US is $442K, to make salary preservation an explicit goal of health reform is... rather crass. I have seen a similar argument made in the pages of an American College of Radiology newsletter. Radiologist salaries top $380K annually. These salaries compare to starting salaries in primary care of around $140K. It's no wonder that 75% of all US physicians today are specialists. For decades, primary care has been getting the short straw in the US health system.

Health reform is not about how much a specialist gets paid. It's about getting more and better care to patients. I'm afraid that mobilizing specialist physicians to preserve their incomes is not going to bring about better patient care. I would dare to say that it will achieve exactly the opposite.

FDA Oversight of Medical Devices

I have a tight schedule today, so I am using my blog to footnote an interesting resource.  Srihari's blog on FDA review of medical devices is good, and his post yesterday was excellent. In it, he summarizes a presentation by Elias Mallis, the Chief of Cardiac Electrophysiology and Monitoring Branch (CEMB) at the Division of Cardiovascular Devices in the FDA.


Take a look at it!

Do All Doctors Hate Practicing Medicine?

A New York Times blog post and its accompanying article today make some interesting points about the attitudes of doctors on practicing medicine in today's health system, including their feelings about the coming changes in health reform. But the blog post and article miss perhaps the most interesting point of all: the kind of medicine a doctor practices may have the strongest influence of all on their attitudes about the practice of medicine.

In the US, a whopping 75% of physicians are specialists while only 25% practice primary care. Why this imbalance? I'm not sure how many people know this: in the US, a primary care doc makes about $140K to start and a radiologist makes about $340K to start. Medical school graduates in the US flock to higher paying specialties and there is no doubt that projected income is a major factor in their decisions. In 2009, just 10% of Harvard Medical School graduating class of 165 went into primary care. By contrast, Tufts graduated 17% and UMass graduated 39% into primary care. These are scary numbers, especially those at institutions that are supposed to be on the leading edge of medical education.

Which kind of doctor is happier with the current system and the prospects of health reform? This question has to be explored, and the answers may not be what you'd expect. At least on the changes coming in health reform, my hunch is that many primary care doctors are more likely than their specialist counterparts to be supportive. Primary care doctors should especially like increases in their authority to control global payment under accountable care organizations and medical home intiatives. Health reform, if done right, could reduce the gap between primary care pay and specialist pay.

Changes like these will probably make a radiologist seethe, but they could cause a primary care doctor to celebrate. Primary care doctors may have legitimate gripes today, but they could soon see changes they will like.