This comes right back around to how doctors are paid with our fee for service arrangement.  These folks have families and bills to pay like the rest of us and if you put yourself in their shoes you might be feeling a bit of the same with going into an “unknown” area of compensation.  Algorithms are complicated today to determine everything related to healthcare. 

Some of most innovative areas of healthcare research and treatment though are coming from these same fields, cardiology and oncology and we need them to administer the treatment plans for cancer for one, and we need the cardiologist to work with us and development better lifestyles and imagetreatments for our hearts.  Oncologists have to pay upfront for the chemotherapy medications they keep on hand and sometimes there’s issues with compensation, many have even gone the route of paying out of pocket on some of expenses to take care of patients.  I chat with a physician who used to practice oncology and he gave it up a few years ago due to lack of compensation and turned himself into a family practice doctor.  He cited compensation and time and money for his reason to change so the trend is there and now he struggles with joining numerous HMOs for compensation and realizes he gets the “cherry picked” patients from the insurance companies but he did the math and found out that’s where he could do the best.  He’s not heartless by any means here and feels bad that he had to make these decisions as it wears on the patient/physician relationship, but it was just a matter of the system and the way he gets paid.  I do have to say this is the first time that I have heard any one physician be as descriptive, a good thing in a way as he is telling it like it is.

The “cherry picked” patients don’t take up as much of his time and he can see more this way.  The problem though is where does this leave everyone else as all doctors can’t rely on “cherry picked” patients by any means and provide good health care. 

The role of the cardiologist is changing rapidly too with technology as we have medical devices coming on the scene that help him/her and you the patient bring together treatment plans along with lifestyle.  We need those folks too, again as mentioned some of the most innovative technologies are being introduced and practiced in both fields. 

Both fields also have issues with health insurance reimbursements, I hear this first hand all the time, so we can’t ignore that fact and pretend it doesn’t exist, although at my Town Hall meeting this week, insurance reimbursement and issues were left wide out on the table with not much more said than “we are working on it” so I can’t even reiterate any potential solutions from what I heard. 

Granted, primary care needs money and are far underpaid in many areas, and they have taken their hit for the last few years and are the gateway to the specialists, but what do they do when the specialists are not there?   This is a big job to tackle and one issue rolls over into another area, so to put bandaids out there to fix one area and not do the other is futile too.  It all comes down to money and if the physicians were assured of income, well I bet we wouldn’t be having this conversation.   Technology can help in some areas, but the overall package of compensation needs a major overhaul so the doctors can figure out how they can pay their bills before we have the same thing with bankruptcies affecting doctors like what is happening to patients right now.  BD

Aug. 28 (Bloomberg) -- An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a backlash that’s undermining the president’s health-care overhaul.

While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a “tooth and nail” fight against a separate initiative to boost the pay of family doctors, and cut fees for cardiologists and oncologists. The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care, from pacemakers to chemotherapy.

“A fair number of cardiologists are looking at the accounting and saying ‘we can’t afford it,’” Bove said in a telephone interview.

Some oncologists in rural areas may stop offering chemotherapy in the office, forcing patients to travel to more- distant hospitals, said Allen S. Lichter, 63, CEO of the 27,000- member American Society of Clinical Oncology in Alexandria, Virginia.

If the proposal stands, “the bottom line is I’m going to close the office,” he said. “This is impossible for me to survive. If my partners and I don’t get a salary and run it for free, maybe then we can survive.”

Average total compensation for family doctors ranged from $150,763 to $204,370 a year, according to a 2008 survey by Modern Healthcare magazine. Cardiologists fetched from $332,900 to $561,875. Radiation oncologists, cancer doctors who specialize in radiation therapy, earned $357,000 to $463,293.


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