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Editor's Correspondence |

The Demise of the “Evil Specialists”: Class Warfare of Specialists vs Primary Care Physicians Fostered by Elimination of the Consultation Code

John A. Goldman, MD, MACR, CCD
JAMA Intern Med. 2013;173(12):1155. doi:10.1001/jamainternmed.2013.984.
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The article “Unintended Consequences of Eliminating Medicare Payments for Consultations” provides interesting insight into the planning of those who designed this insulting plan.1 The most cost-effective diagnosis is the correct diagnosis.2 I am a solo rheumatologist and find this entire concoction an insult to those of us who provide in-depth care to people with complex musculoskeletal problems.2 It is a program to encourage class warfare between the “evil specialists” and the downtrodden primary care physicians. This program was ill defined for those who are caring specialist physicians. Though none of the authors are practicing physicians, they should have also looked at this program through the eyes of the patients and those of us who care for them. Nothing has been calculated to measure the quality of care as a result of this coding change. I realize that this is beyond the scope of this article, but the real insult of this ill-conceived program needs to be carefully considered and not just through spending cost. You need a cost-benefit analysis. All that is offered is a cost analysis. The “complexity” section, which discussed more visits and higher codes and visit numbers, is not a substitute for quality care, and it could be that this program limited the patient's ability to access the sophisticated care of those who have the expertise—“the evil specialists.” This may have actually decreased the quality of health care of those who need specialists. It was a deliberate program to dumb down the care of patients and not designed in any way to improve their quality of care. It specifically endangers patients with complex medical problems and fosters medical class warfare. It is telling me that I as an evil specialist should not spend as much time evaluating patients. How does that improve their care? You need both specialists and primary care physicians to care for people. You do not need to vilify one group against the other. What I do now is still labeled by me as a consultation, I am just paid less! Medicare may be spending more but not to me.

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