Comments on: Health Care Policy & The Student Doctor: Gary LeRoy, MD

By: musicalmedicine

musicalmedicine — Fri, 26 Sep 2008 04:36:54 +0000

I completely agree with Inner Ninja. We need far more primary car physicians than we do specialists. I plan on going into a sub-specialty of surgery (otolaryngology, orthopedics, neurosurgery) because it has always been the most interesting and love being in an operating room. Although I love surgery I still feel that primary care physicians need to out number specialists several times; they also deserve a better salary than they are receiving now mainly because primary care is one of the few specialities that has the power to keep people healthy rather than just treat them while they’re sick.

By: Inner Ninja

Inner Ninja — Fri, 09 May 2008 23:25:28 +0000

a most excellent and encouraging interview. long live the family doctor whose heart is in the right place. dr. barbara starfield has been pointing out for years the value of health systems modeled around primary care, and interviews like this one help too. we need specialists, but we need more primary care docs. sometimes i'm glad i dropped six figures on med school. other times i wish i had simply become a ninja.

By: Anonymous

Anonymous — Fri, 09 May 2008 06:36:02 +0000

he may be right…but even if there is a 20% reduction in payment to “lifestyle specialties”..subspecializing is still the way to go. talk is cheap….they’ve been saying this for years and primary care still gets the shaft.

agree with his points though. all of our high priced specialty care is generally bogus and inefficient compared to capable and plentiful primary care. when will we get our act together?

By: Anon Cards Guy

Anon Cards Guy — Fri, 09 May 2008 04:15:56 +0000

With regards to new technology. New technologies are very expensive, and for example, the cardiac cath which is inherently expensive but provides a ton of useful info(real time visualization, pressures, flows, etc). CT Angio is here but CT angio is very expensive and if used as a screening tool will drive up costs. Newer technologies are not always to be used freely. Why scan asymptomatic patients when you can do a stress test if the patient’s condition deserves so? Stress tests are much cheaper than CT Angio. Also new technologies are sometimes a step in the algorithm. CT angio is regarded by some as one more step to the cath lab and this will only drive costs up. I speak of the cath lab because its the one example I’m more familiarized with, but my point is that new technologies while useful and novel are abused, and they are not always 100% necessary.

By: MOHS_01

MOHS_01 — Fri, 09 May 2008 03:52:21 +0000

Dr. Rack,

It is somewhat naive to believe that the competitiveness of obtaining a residency position has anything to do with reimbursement in practice. Free market philosophies simply do not apply to medicine in general; payment is based upon a mandated relative work value system. There is minimal negotiating power with third party insurers; in physician shortage areas where providers are able to negotiate more favorable fee schedules ALL providers benefit from the relative shortage. Dermatology income over has increased over the past decade due to a couple of factors — minimally invasive cosmetic procedures, increasing utilization of in office procedures, and an increase in work hours / patient volume. Simple math with today’s system — work longer, do more, collect more money.

NO ONE IN DIRECT PATIENT CARE IS GOING TO MAKE A TON OF MONEY WORKING 40 HOURS A WEEK. Not even dermatology.

By: BMD

BMD — Thu, 08 May 2008 23:42:36 +0000

Dermatology can be very susceptible to recession. More and more derm is now cosmetic and that part of derm can suffer quit a bit in tough economic times.
Biggest tragedy with surgery is the bundling of surgical fee so the surgeons dont get paid for follow ups anymore. That is sad. Primary care is stable yet underpaid for now but eventually will pick up!1.

By: Ron G

Ron G — Thu, 08 May 2008 14:09:53 +0000

i think the best field for the future is surgery. cant go wrong with it…a lot of hard work though!

http://yourwebmd.blogspot.com

By: LJ

LJ — Wed, 07 May 2008 19:25:21 +0000

Great interview, as someone who is considering primary care, it’s always refreshing to hear someone speak to the positives within the field.

By: Michael Rack, MD

Michael Rack, MD — Wed, 07 May 2008 16:37:51 +0000

“But, if you are thinking that this is a good specialty for you, because you will have a high income for a 40 hour work week or less, and can pay off your student loans rapidly, you could find out this is as much a bubble as the dot.com industry experienced”
I disagree with this statement by Dr. LeRoy. The lifestyle specialties like Derm maintain their income potential by limiting the number of residency slots. There will be no dermatology bubble. Another factor that protects Derm is that many dermatologists are able to get by without accepting Medicare and Medicaid. Some specialists (psychiatrists) often don’t accept insurance at all and aren’t dependent on government or commercial payors.

I do agree, however, that some specialties are vulnerable to technological innovation. This includes specialties dependent on only a few procedures: cardiology (catheterization), GI (colonoscopy/EGD) and sleep medicine (psg).