This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge?
Most kids who get cancer or ESRD end up on Medicaid. Which does not even cover the cost of the high priced cancer drugs.
So the net income to the academic institution is a small amount or a loss.
This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge?
Most kids who get cancer or ESRD end up on Medicaid. Which does not even cover the cost of the high priced cancer drugs.
So the net income to the academic institution is a small amount or a loss.
Makes sense, from a payer mix standpoint. Would be interested to see the actual p/l of these centers specifically though.
This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge?
Which does not even cover the cost of the high priced cancer drugs.
There’s also the inherent underpayment for all Peds services (thanks AAP!).
From what I have been hearing, it’s the Senate bill that matters most at this point. If it’s not in the Senate version of the bill, then it’s unlikely to become law.
I’m not a doc (just a lurker, mostly on the Senate tax bill thread and reading the blog generally) but funny enough my son is a Ewing’s sarcoma survivor (doing well, thanks to pediatric oncologists at our local and excellent children’s hospital). And I study/teach a bit of public policy for a living.
Many kids go on Katie Beckett Medicaid, even if a parent has employer-sponsored health insurance. Without Katie Beckett, pediatric cancer cases would blow the risk pools at many small employers.
Also, many cancer/blood disorder centers do a lot of sickle cell cases, which are often Medicaid.
In addition, as noted, the drugs are often (essentially) first generation. Doxorubicin, cyclophosphamide, etc.
But I will say the fellows are fantastic. Underpaid. Lifesaving. Wonderful. Thanks to any and all of y’all who have done that work.
PSLF will affect many, many people – not just MDs, JDs, etc. Peace Corps. Anyone who gets an MPA/MPP to work in the public sector. Other people who could make a lot trading municipal debt, etc. in the private sector. There will be a lot of lobbying on this bill.
You have a few factors at play for low compensation for pediatric sub-specialists. First, you’re employed by the local children’s hospital. How many locations in the country have more than one children’s hospital within a reasonable commuting distance? Thus, monopsony buying power on the part of the local children’s hospital.
Second, a pediatrician matches into a relatively uncompetitive and poorly paid field, then takes more years of training in a sub-specialty for what sometimes is even lower pay.
A possible third factor may be gender discrimination. Relatively more women enter pediatrics and peds tends to be underpaid. This might be correlation, it might be causation, but the “macho”, more prominently male surgical specialties tend to be higher paid and the specialties that have relatively more female docs tend to be less well paid. (One notable outlier is dermatology, but it may be the exception that proves the rule.)
Finally, we have payer mix, as discussed above.
None of this suggests that the work of pediatric sub-specialists isn’t important or shouldn’t be better compensated, but here we are.
Re grandfathering… anyone read the actual bill? (I will not)
I’m imagining the MS4 who has been living high on the debt hog who is about to get burned…
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