Inflation=Physician Pay Cut

[CordMcNally]

I don’t disagree with this at all. It’s easy to not pay physicians more.

And maybe increasing the conversion factor wouldn’t get passed on to employed physicians anyway and the hospital administrators will simply get bigger bonuses. However in private practice it’s a big deal. If small increases would have even been half inflation, my partners and I would make up to 30% more money for the same work.

People (public and politicians) complain about fee for service because it incentivizes physicians to see more people and do more procedures, ie spend less time on each patient, but we’re making less money for the work we do every year. So it’s absolutely the natural progression to try to do more work in the same amount of time just to maintain income. I know everyone on this forum knows this, I guess I’m just venting. In 20 years, if the system exists like it does, and Medicare is still paying $35/wRVU, it’ll be hard to continue to do what a lot of us do.

I think you're 100% correct about it likely not flowing down to physicians if the conversion factor increased. If a physician or group has that money go directly into their bank account or if a compensation structure is based off collections then obviously it would be different but I would guess most physicians aren't in that scenario. 20 years would put me at 55 and I would hope I'm out of medicine unless I'm truly just working for esses & gees.

[ObgynMD]

This is why I appreciate WCI and this forum so much. I am an early career physician and I’m not blind. Between the EMR, the multi-level admin structure, RVU based reimbursement, insurance companies squeezing corporate hospital systems now…the future does not look rosy. I want to be FI so I have a chance to practice medicine my way. We all need to be FI or we will could be burnt to a crisp running the rat race.

Edited to add: we have a compensation adjustment. When I was hired, admin told me it’s pegged to inflation. Before COVID, it was 3%. For the last two years it has been 1%.

[CordMcNally]

Edited to add: we have a compensation adjustment. When I was hired, admin told me it’s pegged to inflation. Before COVID, it was 3%. For the last two years it has been 1%.

It sounds like the Fed is your admin. Try to downplay or even ignore inflation.

[Hoopoe]

Despite no conversion factor increases for inflation hourly compensation for emergency medicine has gone up significantly in the last few years. A portion of that has been increased efficiency (ie adding midlevel providers and more patients/MD provider/hr) but improved collections per patient is also a large driver of that. My hourly wage has gone up by 22% in the past 4 years since I was first hired in 2017. I suspect that this won't last but hope that at least salary holds on for a little bit. I'm in a private SDG group though, doubt salaried position would have increased this much.

[ENT Doc]

Despite no conversion factor increases for inflation hourly compensation for emergency medicine has gone up significantly in the last few years. A portion of that has been increased efficiency (ie adding midlevel providers and more patients/MD provider/hr) but improved collections per patient is also a large driver of that. My hourly wage has gone up by 22% in the past 4 years since I was first hired in 2017. I suspect that this won't last but hope that at least salary holds on for a little bit. I'm in a private SDG group though, doubt salaried position would have increased this much.

You have a hospital contract, right?

[Hoopoe]

You have a hospital contract, right?

Contract to allow us to work the ER. Stipend is negligible, mainly to cover some admin meetings. The rest is based on collections from patient care.

[wideopenspaces]

When I was at the university we got no cola ever. At the VA we get them yearly plus you get these step increases every 2 years that are like a bigger increase on top of that, like maybe 1.5%? And supposedly we will get like a 25k increase this year but that remains to be seen. Overall the VA does a much better job with compensation than the university.

[AR]

When I was at the university we got no cola ever. At the VA we get them yearly plus you get these step increases every 2 years that are like a bigger increase on top of that, like maybe 1.5%? And supposedly we will get like a 25k increase this year but that remains to be seen. Overall the VA does a much better job with compensation than the university.

In my experience, VA jobs are absolutely fantastic for the amount of work you are expected to do. I have a friend who does what I do. He makes about 35% of what I make (including value of benefits), but does about 20-25% of the work. So in a way he is getting paid more than I am. Of course in absolute terms there is no real way for him to make more than that within the VA system. So he moonlights outside the VA one day a week. He makes almost as much from moonlighting as he does from his full-time VA salary.

[ENT Doc]

Contract to allow us to work the ER. Stipend is negligible, mainly to cover some admin meetings. The rest is based on collections from patient care.

You use the PFS and in no way the OPPS payment system?

[FIREshrink]

This is of course true, however with Medicare part A premiums increasing 6% and part B premiums and deductibles increasing 15%, which the federal government is blaming partially on inflation/increased cost of care (and partially on increased utilization), the question remains where that money is going? I assure you there are plenty of high-earning administrators at hospitals and nursing facilities that are getting cost of living raises. The fact that conversion rates have remained stable for the past 20 years while Medicare premiums have risen and inflation totals something like 60%, is obscene.

Obviously we need a better lobby. Perhaps all these physician bloggers can divert some of their side-gig attention that way.

My admin jobs have not seen any pay increases any time recently, I make more per hour seeing patients.

Since I started almost two decades ago, the pay rate for one of my admin jobs went from $100 to $125 per hour.

[Sundance]

My admin jobs have not seen any pay increases any time recently, I make more per hour seeing patients.

Since I started almost two decades ago, the pay rate for one of my admin jobs went from $100 to $125 per hour.

Funny that you think the admin pay you get has anything to do with the type of annual raises your hospital administrators are getting.

[abds]

My admin jobs have not seen any pay increases any time recently, I make more per hour seeing patients.

Since I started almost two decades ago, the pay rate for one of my admin jobs went from $100 to $125 per hour.

Meanwhile the CEO at one of our hospitals (large system) makes $4.3M. There are 5 additional non-physician administrators who make 7 figures.

[pysibal]

I have been hassled about productivity before by an non-MD in administration.

I have so far successfully refrained from asking him how many RVUs he made last quarter, and following up by asking him to provide a single metric to justify his utility.

This RVU system is bogus in so many ways. So much value is not captured. I hear about hospitalists covering night call for patients admitted for elective surgeries (getting calls, but rarely something that generates a billable note), hospitalists required to work the transfer center for a full day (no notes/RVUs), subspecialist neurologists who spend 60-90 minutes with patients and order massive amounts of expensive labs and imaging (little RVU value, but feeds other aspect of hospital) who are then whined at about their "productivity."

[nephron]

The real problem with inflation is that doctors are so dependent on government reimbursement rates which are continually subject to deflation pressures from lawmakers that they will never be able to keep up. Any amount of inflation means higher salaries for secretaries, techs, and nursing staff while reimbursement rates are moving in the opposite direction. Our salary is completely dependent on the profit margin between costs and reimbursement rates.

[Cubicle]

There are Medicaid plans that have not given a single penny of increase for either E&M or procedures since 2016.

But yet multiple insurance request my charts every month for "Medicare Risk Adjustment" so they can get more money. When I demand payment they refuse.