The Top Ten Worst Paying Jobs For Doctors

Was surfing the net the other day and found this at Forbes.com. According to the medical search and consulting firm Merritt Hawkins & Associates' 2010 Review of Physician Recruiting Incentives, the ten worst paying specialties are:

Neurology ($282,000)
Obstetrics/Gynecology ($272,000)
Emergency Medicine ($247,000)
Endocrinologist ($219,000)
Psychiatry ($209,000)
Hospitalist ($208,000)
Family Practice with Obstetrics ($200,000)
Internal Medicine ($191,000)
Pediatrics ($180,000)
Family Practice ($175,000)

Now, I find it odd but not surprising, that half of the specialties on that list are currently experiencing shortages across the country. After all, how can you practice medicine, even medicine that’s your passion if it doesn’t pay even a living wage? (The figures above are gross income and don’t include the $60-100,000 a year malpractice insurance charges, clinical overhead, such as lab tests and new equipment, or the $140,000 in student loans the average medical student racks up.)

So how did we, as a nation and a society, end up paying the doctors we’re most in need of the least money? So little, in fact, that even the medical students across the country that have a passion for family or internal medicine end up in other specialties simply because they can’t afford to do anything else.

A lot of the problem comes directly from the AMA (American Medical Association) which sponsors a committee charged with deciding how much a doctor's time is worth in Relative Value Units (RVU’s). These RVU’s determine how much Medicare will pay a doctor for a procedure. They also determine, in a roundabout way, how much your insurance will pay, since insurance carries take their cue from Medicare when deciding how much to pay. Basically, the more difficult a procedure is, the more it’s worth. By their reckoning, intubating a patient is more valuable, monetarily at least, than face to face time with a patient in the office for a fifteen minute check-up even though the first takes much less time.

This system leaves physicians in primary care making half the money of specialists in a lot of cases. Not surprisingly, less money means less PCP’s, and we need those providers. Thanks to a not very well thought out new national healthcare plan, the demand for PCP’s is set to increase exponentially while the supply will only continue to decrease.

Something’s gonna have to give.

Electronic Medical Records

So… more from the I’m going to college this fall and why does it have to be so complicated front, I turned in my immunizations at Student Health Services today in hopes that it would cause them to take the hold off my registration so I can pick up the one last class I’ve been wanting before classes, you know, start.

Turns out that they did, indeed get it the first time I turned it in but there are not “enough” immunizations on it. Not enough meaning there is only one MMR recorded. Now, I know for a fact that I received my second MMR when I was twelve because a.) I remember getting it and b.) they let me attend high school which (at least around here) they won’t if you don’t have record of two MMR’s.

So, how could this have happened? Electronic medical records, the newest brilliant brainchild of the medical establishment. Now, I’ll admit, that when I first heard of the movement towards EMR’s I thought it sounded awesome. In theory, it should make records more accessible, care more coordinated and errors less likely.

The problem is that they only works if you use them and use them all the way and all the time. In my case and at the clinic I’m at they didn’t. They started using the EMR system and didn't transfer any of the older files over. So, despite the fact that I’ve been getting my medical care in the same place since I was three months old, when I ordered my complete medical record, the immunization records weren’t there. Not only that, all of my (and my oldest son’s) records weren’t even AT the main clinic location. I finally ended up having to go to the separate file storage area at the satellite clinic where my doctor practices and have them go through my medical record page by page to find the record I needed.

Imagine my frustration when it turned out that the record we found wasn’t even the complete record. It was missing my first MMR and heaven knows where the record of that shot lives now.

So, in short, there’s no centralized records. The computers, as efficient as they sounded, don’t talk, even within the same clinic system. I have all my labor and birth records at the (associated!) birthing center, all of my E.D. records at the E.D., a select few of my records at the central clinic office (still in hard copy), my records from after 2005 in the EMR computer system, and the rest of them at the satellite clinic where my doctor actually practices (also still in hard copy). A far cry from the “centralized records” that were promised when they switched over to the EMR.

How did this happen? How did everything get so spread out? And what does it say about the coordination of care that most patients receive?

I’m generally healthy, so the inability to find my records is really nothing more than a minor annoyance, but what if I had a chronic condition? I’m pretty sure that there’s no way my records would transfer seamlessly between my primary care provider (the proposed “medical home”) and the specialists I’m seeing or vice versa the way that the EMR‘s were supposed to facilitate. As a matter of fact, I’d be lucky if they ever got transferred at all.

The only “coordinated care” I’ve ever gotten from the EMR system is a repetitive list of medications that I haven’t been on since 2005. So much for innovations in coordinated care. There has got to be a better way.