Most medical students understand that a good chuck of their day as practicing physicians will involve clicking through electronic health records and completing paperwork. But I do not think it is ever made clear how often we will interact with insurance companies. Of course, this will vary by specialty, but everyone entering medical practice should have a basic understanding of prior authorization.
I recently saw an Instagram post from Dr. Austin Chaing about the frustrations of prior authorization — a process wherein medical care will only be paid for if it has been pre-approved by the insurance company. There are a number of reasons insurance companies require preauthorization, including age, medical necessity, and availability of a generic. If a prior authorization is denied, a healthcare provider may file an appeal based on their assessment of the patient and the recommended treatment or medication.
Continue reading “The Frustration of Prior Authorization and What It Means For Burnout”
So you’re in medical school. And eventually you’ll be a resident. And then you’ll have to start paying back all those loans–the median debt level for medical school graduates is close to $200,000. But while you might make anywhere from $200,000 to more than $500,000 once you’re out of residency, your average salary while completing residency will be in the neighborhood of $51,000.
How is that salary determined? And why, if adjusted for inflation, has residency compensation not increased in four decades? The number of residency positions [and by extension residency salaries] is constrained by the 1997 Balanced Budget Act (BBA) which sets the level of Medicare financing for training residents at teaching hospitals. If the number of allopathic or osteopathic residents at a teaching hospital exceeds the cap set by the BBA, teaching hospitals will not receive additional funding, which come from two sources: Medicare indirect medical education (IME) and direct graduate medical education (DGME) reimbursement. Between IME and DGME payments, Medicare finances 90%–around $10 billion–of the funds teaching hospitals use to train and pay residents. A report from the Government Accountability Office (GAO) found that the two types of reimbursement are not equal–$3 billion are DGME payments and $7 billion are IME payments.
Continue reading “Makin’ Money: How Residents Are Paid”