Tuesday, March 23, 2010

Show Me the Money!!!!

Based on a recent survey by NASS, 24% of spine surgeons responded that if mandated reductions in Medicare reimbursements occur, they will no longer participate in the program. Additionally, more than one-third of those respondents would opt out of Medicare for two years, and privately contract with Medicare patients. So what does that mean? Does this mean the end of spinal care for Medicare eligible patients? In all likelihood, no. What it means is that on the surface there are 76% of spine surgeons that will either provide services or are undecided as to how they should react until there is more clarity as to what the government's plan is.

Dr. Baker was quoted as saying that "these findings are indicative of the fears resonating among physicians nationwide." TSB could hear the conversation;

Spine surgeons have just told Dr. Baker that they are not going to participate in Medicare

Dr. Baker: That's great!

Spine Surgeons: Are you listenin'?

Dr. Baker: Yes!

Spine Surgeons: That's what we're gonna do!

Dr. Baker: What can I do for you?

Spine Surgeons: It's very personal. Hell, it's our motto. Are you ready Ray?

Dr. Baker: I'm ready.

Spine Surgeons: We want to make sure you're ready Ray. Here it is: Show me the money. Oh-ho-ho. SHOW! ME! THE! MONEY! A-ha-ha Ray, doesn't it make you feel good to hear us say that! Say it with us one time Ray.

Being a surgeon in today's healthcare environment must be stressful. First there is an assault by the DOJ on their abilities to act as consultants, then, there is a contingent that are complaining that the reps are making too much money, of course the CEO's are truly underpaid, then, they want to own distributorships because by doing so they will drive down the cost of healthcare, and now in all likelihood the potential exists that they will be paid less for providing medical care for medicare patients. Maybe its time to stop worrying about everyone else and just focus on the task at hand. So what's the alternative? Some speculate that there will be an early exodus by some very talented surgeons because of what transpired today. If that's the case, TSB must ask the proverbial question; What are your going to do? Become a hedge fund manger? The government is putting in regulations on shorting. Go to work for Goldman Sachs? Maybe you can make millions packaging and selling sub-prime mortgages? Nope! Gold is the next thing. Open a laundromat? Become an artist? Become a salesrep? I mean snap out of it! Surgeons have one of the greatest and most noble professions that a person can have while at the same time earning a respectable living. And if you're not happy being a surgeon, then you were never intended to be one. So in the spirit of debate, maybe, just maybe, its time to hang up the spurs and ride off into the sunset, or move to Paris.

You know what TSB says; "I was a free man in Paris, I was unfettered and alive, there was nobody calling me up for favors and no ones future to decide. You know I'd go back there tomorrow but the work I've taken on stoking the star maker machinery behind the popular song."


  1. So because the position of the surgeon is noble: if one is upset at the pending increase in work (more patients, less doctors) and decrease in pay, then they should not have become a surgeon?

  2. You know TSB, when I read that NASS PR, I must say I thought the same thing. The 24% appear to have completely forgotten that a doctor's role in society is to treat the sick, regardless of their ability to pay. Our society does need to ensure that a doctor has the means to survive and raise a family, plus throw in a little extra so that the best and brightest among us choose to enter the profession. But just because times are tough and society can't afford to pitch in like it has in the past doesn't mean that doctors (especially surgeons) should be screaming that they're coming up short. (I'm guessing very few of them are living below the poverty line.) It makes one wonder if those 24% should even be entitled to practice medicine at all. Even with some cuts to their pay, they'll still live a pretty good lifestyle. And threatening to only selectively treat the patients out there isn't going to help challenge the new stereotype of specialists as greedy hired guns at all!

    Fortunately, it seems like 76% haven't forgotten their role. For my money, that's the better 76% of the profession. There's hope in the world after all.

  3. Questions for the readers (sorry to post here but I don't know where else to do it):

    Has anyone else heard rumors that Zimmer is going to abandon the distribution model and go back to a direct sales force? Thanks

  4. I’m curious who the 24% are? It’s time to down size and return the Bentley. Good one TSB!

  5. If we made EDUCATION more of a priority in our country and made sure more people could go to college, we would have no problem filling the ranks of surgeons with people who would feel it was a privilege at half the income.

  6. Bash the spine surgeons but it appears all specialties--even the primary care docs making a $150K a year--are saying the same thing. Didn't Mayo Clinic in Arizona's primary care division announce they are no longer accepting new Medicare patients due to a multimillion dollar loss on caring for these patients last year?

  7. no reason to worry. I'm certain that the government will force the medical community to accept all forms of care including Medicare. Right or wrong... for better or worse... that will be the next step in government take over.

  8. I am surprised that entrepreneurial types would have any problem with the amount of money that someone makes. If any of you had spent an extra 4 years in medical school, 6 years in residency and fellowship, and sacrificed time from your families, then you too would wish to be compensated for those sacrifices. As a sales rep, I am thankful and happy that they are able to make the income that they do, as it allows me the ability to make a very nice large six figure income, as well.

  9. Anonymous: You've missed the point. TSB does not have any problem with the amount of money that surgeons earn. Compensation should be commensurate with ability. TSB believes in unfettered markets. It's the constant whining. Before, you react, research the national figures on what the average spine surgeon earns, and I said earns. When you say, "sacrificed," understand that no one incarcerated or brainwashed them, hopefully, they chose this calling because of free will, regardless if they believed that they would provide social utility or become millionaires. So don't inundate our readers with the sob story of sacrificing for family. To blame others for the decline of the U.S. Healthcare system and not accept complicity is indicative of selfishness. We all have contributed to the challenges that we are facing, whether it is patients for not taking care of themselves, to hospitals being mismanaged, to companies pushing the limits on what they could charge, to physicians abusing the fee-for-market system, to insurance companies, to a lack of tort reform, and lastly to reps making a great living. So reflect on this idiom, "tighten your belt," everyone is being called upon to make a sacrifice. You'll survive or not you'll learn to speak Chinese.

  10. To Anonymous 10:26,

    We are thinking very entrepreneurial and capitalistic.

    First off, health care can't be 100% capitalistic, because as long as we don't leave people dying in the street or not care at all for the poor, the individual time and place of payment for a service and the need for the service are not commensurate with each other. Like national defense, there's an inherent socialism associated with the payment structure for it.

    But the backlash against high fees and overprovision of services is a normal part of the capitalistic process.

    Let's take the auto insurance industry for example. Say for instance a local body shop was doing too much and charging too much to the insurers for fixing cars, you'd expect the insurer to go find someone who can do the same work for less, in order to keep your premiums down. Right? (Unless of course, your car is in the shop right now, then who cares what it costs, right?)

    That's the process we're going through now. On one hand you have those currently profiting from the current system (i.e. the patients - currently with their car in the shop, the specialists who are the shop themselves, and the parts suppliers who have the shop as their number one customer), and then you have all of us who are none of the above, but are footing the bill for the whole thing. We expect those who are managing our money for this process (government and insurers) to put the screws to the above mentioned to make sure they are giving us our moneys' worth. We don't tolerate defense contractors billing the government $500 for unnecessary hammers, and we shouldn't tolerate it in healthcare either.

    We pay way too much for the healthcare system we have, and we have to start cutting back. And we have a much higher ratio of "expensive" specialists to "cheap" primary docs than most other industrialized nations. Some specialists will continue to deservedly make very high salaries. But we should expect them to earn it more, and not just with volume but with proficiency, expertise, and recognition and referral by their peers.

  11. And what would be wrong with "forcing" doctors to treat sick people?

    I'm sorry, you are actually quite beholden to society for allowing you the privilege to have your jobs - its about time you started ACTING like it.

    You have a responsibility and you took an oath - ACT like it.

    "no reason to worry. I'm certain that the government will force the medical community to accept all forms of care including Medicare. Right or wrong... for better or worse... that will be the next step in government take over."

  12. I wrote the "force" comment. I'm a rep. I'm not arguig either side. I'm just stating - what to me is obvious - that there will be no free will for doctor or patient. You will be directed to comply or be punished.

  13. If a quarter of the spine docs will bail on treating Medicare populations, do those potential patients go away and get untreated? Some perhaps survive with pain meds and make do. Most will likely get treated. Economics would say that the demand will remain the same, give or take early intervention Tx and the baby boomers moving into the Medicare population. Therefore the patients will either go completely untreated or the supply of services will grow to meet the demand in some manner. I find it hard to believe that some surgeon out there won't find a way to treat this population ni some manner that balances the need to make a living and the reimbursement system in place.

    Necessity is the mother of invention.

  14. TSB, You're tired of the whining? I'm tired of you whining about all the whining. The irony is that there tends to be a strong correlation between how guilty a surgeon is of all the things you find problematic and how much money that surgeon makes you and your ilk in the OR.

  15. You're not making me any money. Just like you, I earn my money without sham consulting agreements. Most non-industry professionals that read the blog think people like yourself are "thin skinned."