Pennies for Our Thoughts

Joshua K. Schaffzin
2018 Hospital Pediatrics  
When I tell people that I am a pediatric infectious diseases (PID) specialist (insert comment about hoping I'm not contagious; funny every time), I am often asked what exactly it is I do. It is a good question. A surgeon might describe a consultation as telling a patient, "I am going to take you to surgery." A gastroenterologist might say "I am going to scope you." In PID, we essentially tell patients, "I am going to think about you." Specialists such as those in PID, neurology, rheumatology,
more » ... gy, rheumatology, developmental pediatrics, hospital medicine, primary care, and many more are commonly referred to as "cognitive" specialists. These are physicians with additional training in a specific field of medicine who primarily provide evaluation and management (E&M) services to people with complex medical conditions that require a level of expertise that the referring physician is not trained to diagnose or qualified to treat. 1 This is not to say that "noncognitive" specialists do not think; of course they do. But procedures generate the most insurance reimbursement. Rather than being able to code for a procedure, cognitive specialists must rely on E&M codes, which do not reimburse as generously for the critical thinking involved in data gathering and analysis, patient management, communication, and decision-making. 2 This is not a new problem; it has been well described for decades. 3 Nonetheless, little has been done to remedy the disparity. In a recent study, it was found that revenue for physician time spent performing common procedures was more than triple that of cognitive service for a similar amount of time. 4 This issue is believed to contribute to ongoing dwindling numbers in cognitive specialties. 5 In addition, many traditionally cognitive specialties have taken on procedural responsibilities to help support their programs, such as point of care ultrasounds, sedation, and circumcisions. 6
doi:10.1542/hpeds.2018-0082 pmid:29946041 fatcat:syzozkpnvzglpb6osvxhddychy