The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.
These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.
The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.
There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.
Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.
I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.
What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.
There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.
And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.
Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at clinicalneurologynews@elsevier.com.