User talk:2600:1700:7670:1210:44F4:CDE3:66E7:A654

The "RUC" or Specialty Society Relative Update Committee was created by the AMA as a response to the 1989 Omnibus Budget Reconciliation Act mandating the use of Relative Value costs to determine physician reimbursement as encouraged by Dr Hsaio of Harvard who later disavowed the AMA application of this concept. The composition of this committee was entirely determined by the AMA, and heavily favored overcompensated specialties. Changed in 2012, this composition still has serious flaws: while orthopedics, thoracic surgery, gynecology and urology have permanent seats (as they should), medical subspecialties like rheumatology, pulmonology, endocrinology, gastroenterology and nephrology are relegated to sharing a rotating seat. AMA membership is approximately 225,000 physicians. There are nearly a million licensed physicians in the US, so fewer than one-quarter are AMA members. The American College of Physicians, representing internal medicine and medical subspecialties, has a membership of around 140,000, but has the same vote as the delegate from neuosurgery that represents some 3000 surgeons. The upshot of all of this is that primary care physician compensation has improved only very little, and the US is facing a dearth of primary care physicians. Primary physicians, because of poor compensation and mounting administrative duties imposed by medical insurers, often feel that they are becoming glorified referral clerks. A lot of lack of primary care access is being filled by nurse practitioners and physician assistants, who often give great care. They can do 75% of what a physician does, but they do not know which 75%. They tend to over prescribe, over refer and over test. This constellation of policies plays into the fact that the US has less access to care, but the care is much more expensive than in countries where primary care is much more robust (most of Western Europe). This extra expense does not necessarily come with better outcomes -- our statistics do not show globally more effective health care interventions. Len Nornak (talk) 14:52, 24 May 2020 (UTC)