Side Table: Who Really Decides What Doctors Get Paid? Inside the RUC

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🎯 Why Listen

Ever wonder who actually decides how much doctors earn for surgeries, visits, or procedures? This episode takes you inside the mysterious but powerful Relative Value Scale Update Committee (RUC) — the body that determines physician payments for Medicare and beyond. If you care about fairness in healthcare, innovation, or why a complex surgery can pay the same as a routine one, this conversation is for you.

👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

📌 Episode Overview

In this special “Side Table” edition, the Doctors Lounge digs into the RVU Update Committee (RUC) — the physician-led but AMA-controlled group that sets values for CPT codes, essentially determining how doctors get paid. The hosts explore:

• How the RUC works and who sits on it
• Why budget neutrality forces specialties to fight for value
• The unintended consequences of central planning, including stifling innovation
• The fairness debate between primary care and high-intensity procedural specialties
• Why physicians themselves are both defenders and critics of the system

💬 Notable Quotes

• “The RUC is essentially central planning — every doctor gets paid the same for the same code, no matter the experience.”
• “Becoming better at your procedure can actually punish you — the faster and safer you get, the less you’re paid.”
• “It’s a system that preserves order, but at the expense of innovation and sometimes fairness.”

📚 What You’ll Learn

• What the RUC is and how it shapes U.S. physician payment
• The mechanics of how CPT codes are valued
• Why Medicare’s budget neutrality keeps physician fees locked in zero-sum battles
• How new technologies like robotics and advanced ablation are undervalued
• Why primary care vs. specialty debates rarely get settled at the RUC table
• The pros and cons of a physician-run payment-setting system

⏱ The Episode (Timestamps)

• [00:00] What is the RUC and why it matters
• [02:00] The history: from “reasonable and customary” to RVUs
• [05:00] Who sits on the RUC and how they’re chosen
• [07:00] Central planning vs. innovation — robotic surgery as a case study
• [10:00] How physician surveys shape payment values
• [15:00] Specialty vs. primary care debates
• [20:00] Why new procedures often get undervalued
• [23:00] Should the RUC be reformed… or blown up?

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X