While I enjoyed reading about the inner workings of why physicians get stiffed (“What Every Physician Should Know About the RUC,” February 2008), I cannot help but wonder who agreed to this scheme and why. What's worse, no one recognizes that physicians as a whole are being duped by a time-tested strategy of “divide and conquer.”

The article quotes Tom Scully, former administrator of the Centers for Medicare & Medicaid Services, who captures the essence of the process: “Essentially, we sit down with [RUC] every year and say, ‘Here's $43 billion and growing, how do you want to [divide it]? What's the relative value of weights between anesthesiologists, gastroenterologists, surgeons?’ and set the relative values at what the physician community thinks the relative payment should be.”

What do we expect is to happen? Our altruistic nature has really gotten the better of us when it comes to business sense. It's no wonder that subspecialists are laughing at us all the way to the bank while our patients are screaming at us about their $15 co-pays and droves of potential residents are flocking to the subspecialities.