Brian’s Note: Readers may know that, on this site and on Replace The RUC, I re-published the article below by the Happy Hospitalist, a physician intimate with coding and its craziness. His explanations of the system’s inconsistencies are lucid and compelling, as are his descriptions of how adhering to this system is overwhelmingly burdensome. Those of you who have read it before may want to scroll down to the content that follows and responds to it.
Then, last week, I received a long complaint from an orthopedic surgeon who appeared knowledgeable about coding, and who defended the RUC’s approach. He claimed that, properly understood, specialists make approximately the same as primary care physicians on an hourly basis. I am by no means a coding expert, but I responded that, while his argument may have some merit, the facts remain that specialists have made increasingly more over time than generalists who see many more patients. I thought there was a logical flaw in his approach.