Btw I have no problem with surgeons and other highly trained specialists making more than me as a psychiatrist- they deserve it! But you are correct to point out how misaligned Medicare and insurance payment structure can be. How confident would you feel after 10 min with your psychiatrist that they are able to adequately assess your presentation, make a tx recommendation, provide pt education and informed consent? Let alone coordinate with your PCP or therapist god forbid. Not gonna happen when we are chasing reimbursement in an environment where payment is going DOWN. Forget keeping up with inflation. Can anyone say “payment reform now please”?
Great piece Preston. Your ability to make the complicated and arcane understandable is quite a talent. I worked on commission and bonus and salary in the past. But even on salary you have to hit your RVU target to stay employed. Nothing wrong with that on the surface.
However- That specialties like primary care and psychiatry and other non “procedure” specialties are compensated on volume makes no sense. It leads to churning and the standard of care in psychiatry is moving toward 15 min visits (really 10 min).
Btw I have no problem with surgeons and other highly trained specialists making more than me as a psychiatrist- they deserve it! But you are correct to point out how misaligned Medicare and insurance payment structure can be. How confident would you feel after 10 min with your psychiatrist that they are able to adequately assess your presentation, make a tx recommendation, provide pt education and informed consent? Let alone coordinate with your PCP or therapist god forbid. Not gonna happen when we are chasing reimbursement in an environment where payment is going DOWN. Forget keeping up with inflation. Can anyone say “payment reform now please”?
Thanks so much for the additional perspective! Raising my hand for payment reform!
You always manage to bring clarity to the most complex financial issues! Thank you for your #thoughtleadership! Docs are paid largely on commission.
The RVU was well intentioned (isn’t everything), but it drives misaligned incentives.
Primary care in undervalued, relatively and actually.
Great piece Preston. Your ability to make the complicated and arcane understandable is quite a talent. I worked on commission and bonus and salary in the past. But even on salary you have to hit your RVU target to stay employed. Nothing wrong with that on the surface.
However- That specialties like primary care and psychiatry and other non “procedure” specialties are compensated on volume makes no sense. It leads to churning and the standard of care in psychiatry is moving toward 15 min visits (really 10 min).