Why would a neurosurgeon quit brain surgery to do hair transplants?

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A neurosurgeon quits brain surgery to do hair transplants

“‘Basically I was working over 100 hours a week just to pay a malpractice premium (of) about $135,000 a year,’ he says.

He was reimbursed between 25 and 40 percent of his surgical fees, and his income had already plummeted 60 percent.

Now, Dr. Ballon says he’s operating on the same place, but he just doesn’t go as deep. And he had the same operation himself.” (via Common Good)

Comments

Anonymous
Does it really need to be said that Dr. Balloon (or more likely the editors of this piece) are shameless liars. How much time a neurosurgeon works is up to him. There are certainly ways to structure his life so that he works fewer hours and I can guarantee he was NOT working 100 hours per week every week. The reimbursement rate means nothing unless we know what his rates were relative to the value he delivered. My lab only gets 10% of their rate for most tests, but for historical reasons, their “published rate” is a fiction like the “rack rate” for a hotel room. Finally, I’d love to know if Dr. Balloon thinks that giving people hair transplants if as good for their health as doing medically necessary brain surgery?
Anonymous
Posted as a comment without further comment:
http://www.aapsonline.org/newsletters/apr97.htm
Digging Your Own Well. I am meeting more and more doctors who, like me, have chosen to replace their medical income entrepreneurially in order to practice medicine on their terms, without regard for the stranglehold of managed care. I believe I can most effectively battle managed care’s erosion of my income and autonomy by becoming financially independent [by selling Amway]. I practice neurosurgery as a hobby.
Jonathan Ballon, M.D., New Britain, CT
Anonymous
You’re right.
How much time a neurosurgeon works is up to him.
He chose to work a day job with minimal malpractice worries, as opposed to a neurosurgery job with constant malpractice worries.
You’d love to know what the neurosurgeon thinks about hair transplants versus neurosurgery?
I’m sure he’d say the brain surgery is more medically important.
The link was a Philly TV staion I assume that’s where he practices.
Maybe if Pennsylvania enacted some serious tort reform there would be one more neurosurgeon in the area.
In any event, he made the decision that his life would be better if he did not operate on people with brain tumors and brain injuries.
It’s a free country. Slavery was outlawed.
As I say as well to people when I decline to do high-risk work that I used to do…….call the trial bar and find a lawyer to do the work. As long as people would rather sue doctors than have doctors, they will get their wish.
Anonymous
The point is that Ballon and the above anonymous are whiners who care more about money than their patients. It has nothing to do with malpractice. They certainly have the right to structure their lives however they want to, but what they want is the right to commit torts with no consequences. They want the right to make money without any responsibility. Study after study shows that malpractice does not contribute more than 2% to healthcare costs. These people are willing to lie to get what they want. Go sell Amway, but stop whining.
alois
You are mistaken. 2% to health care is quite different than 2% of salary.
unless 125,000 dollars is only 2% of a neurosurgeon’s income then I would agree, but becuase it is a much higher percentage- it is fair for a physician to do what they will and abandon medicine.
I am in med school and am already thinking of my future role in medicine only as a side job. This makes me sad, but at the rate we physicians are being pushed around by theh law folk’ it doesn’t suprise me.
Anonymous
Well, Dr. Ballon hasn’t abandoned medicine. My guess is you need an M.D. to do the hair transplants he does. Also, he has a current license in Connecticut (#024266). He does have some malpractice awards against him as well. Finally, to anonymous who won’t do high-risk procedures; most malpractice is about low-risk procedures that go wrong. Look it up if you don’t believe me.
Anonymous
The bogus 2% number doesn’t include the mammoth costs of defensive medicine which are much greater than the cost of malpractice insurance. This “study” apparently doesn’t include the full cost of malpractice insurance anyway.
Anonymous
No, I don’t want to have the right to commit torts without consequences.
Should I commit a tort, I want to be liable for unlimited economic damages, and noneconomic damages up to half a million. Just like my neighboring states.
You think the doctors whould have unlimited liability, whatever a jury can be convinced to award? What’s that life worth?
What’s that neurosurgeon worth when you get head trauma and the surgeon isn’t there?
I care about my patients. I just don’t feel a need to put my head on the chopping block.
And again, you don’t understand. That neurosurgeon will never commit a neurosurgical tort again.
Much like the Code of Babylonia. Physisicans were threatened with having their hands chopped off, eyes taken out, etc., for “error” (read=less than perfect result), as a result when Herodotus went through Babylonia centuries later:
“They bring out their sick to the market-place, for they have no physicians; then those who pass by the sick person confer with him about the disease, to discover whether they have themselves been afflicted with the same disease as the sick person, or have seen others so afflicted; thus the passers-by confer with thim, and advise him to have recourse to the same treatment as that by which they escaped a similar disease, or as they have known to cure others. And they are not allowed to pass by a sick person in silence, without inquiring into the nature of his distemper”
How dare those Babylonian physicians leave medicine. My health is more important than their hand.
Anonymous
If he was a neurosurgeon in Pennsylvania, heck if he was a neurosurgeon ANYWHERE, he’ll have malpractice judgements against him.
Big deal.
That’s the whole idea, genius. He arranged his life to avoid being put in that position again. More and more trauma is being flown out in SE Pennsylvania because of lack of neurosurgery.
Curious JD
“Maybe if Pennsylvania enacted some serious tort reform there would be one more neurosurgeon in the area.”
Maybe if Pennsylvania would enact insurance reform there would be many more. Two PA insurers, including the state’s largest, PHICO, went under due to gross financial mismanagement which left the others to pick up the tab. Which they did by. . . .you guessed it, raising rates.
Alois, don’t believe the hype. Confirm the facts for yourself.
Anonymous
The old joke with a new wrinkle. How can you tell a lawyer is lying? His lips are moving. CJD has added to that. He’s lying when his fingers are moving across a keyboard.
But, nevertheless, if the insurance system is the problem, then YOU fix it. “Fix the insurance system” is ATLA-speak for doing nothing.
I’m sick and tired of this, as is this neurosurgeon obviously. As such, many doctors reorder their lives so they will not commit these “torts”. That’s good, isn’t it?
As it has been thousands of years ago, so still it is true, punish the doctors heavily for every bad outcome, you won’t have doctors.
Alois, believe the “hype”, as it’s your future. Nevertheless, despite his blatherings, overall the tort bar is losing the argument. There are states with good tort reform in place, just pick them and ignore the “hellholes”.
Anonymous
Actually, the neurosurgeon sounds like my wife’s OB/GYN, who quit OB and just does GYN with a lot of low-risk cosmetic work.
Again, concern about malpractice risk. I don’t blame him.
Anonymous
Also from that same Channel 10 in Philly:
http://www.nbc10.com/health/4537460/detail.html
Anonymous
Who is paying channel 10 to tout tort reform? Centers of excellence is the way to go with better outcomes where better equipped and more experienced staff do a greater number and more complicated procedures. This is why Chester County is losing neurosurgeons and NOT malpractice rates.
Anonymous
Do you have a link for this?
Outcome at Chester County-area hospitals versus elsewhere?
A decision to drop neurosurgical coverage in a county of 400,000+ because Philly or Wilmington can do it better?
Or did you just make it up on the spot?
I suppose that’s why southern Illinois lost their neurosurgeons as well……..centers of excellence in Chicago and St. Louis.
And my state as well, I guess…..they can always fly to Mayo. Vegas closed when the docs stopped because there was a center of excellence in……Flagstaff and Bakersfield as I recall, were the closest alternatives.
Anonymous
That’s simply a lie. Neurosurgery is available in Las Vegas.
alois
So is craps, its still gambling as far as i am concerned.
Anonymous
Also, if I’m ever in Southern Illinois in need of brain surgery, I can guarantee I will go to St. Louis or Chicago before letting the good folk in Carbondale operate and if my wife does anything different with my medical power of attorney (even if she has to promise to pay for the lifeflight out of pocket) then I will be very upset if I ever wake up. You can’t beat centers of excellence for better outcomes and it is amazing to me that people won’t drive 100 miles for scheduled surgery when they are dealing with their life.
Curious JD
” Nevertheless, despite his blatherings, overall the tort bar is losing the argument. There are states with good tort reform in place, just pick them and ignore the “hellholes”.”
Of course, Anonymous neglects to mention that doctors AREN’T winning with tort reform. Rates aren’t going down. The best they can say is it “stabilized”. They certainly can’t say that “stabilization” will last for any period of time.
The other thing Anonymous can’t say is that “tort reform” will not prevent a crisis in that state next time the economy crashes. Because history has shown that it won’t.
Basically, all Anonymous can do is scare you. He knows nothing about which he speaks. He doesn’t know anything about his insurer, anything about the cases he complains of, basically anything at all. He’s merely a repeater of rumors he has heard.
He just has to hope he doesn’t end up like Frank Cornelius.
And if you’re going to be run off by empty horror stories, Alois, without doing any fact checking for yourself, perhaps you’re right about part time being the way for you.
Anonymous
Boy CJD you are a piece of work.
Do you understand the concept of past tense?
The trauma center closed. Past tense.
The center is open now, so yes, there is neurosurgery available in Vegas now.
Actually, even when the trauma center closed, there was still elective neurosurgery, just no trauma neurosurgery. The kind where you can’t wait to find your “center of excellence”.
And, as said before, the trauma center docs went back on assurances that the problem would be fixed, when a promise from lawyers and politicians is worth squat. When they got worthless tort reform they made the threat to do again what they had done, and this time were taken seriously.
Without a law degree, I just can’t possibly keep up with you when it comes to lying.
CJD when you have a car crash and there are pieces of your brain on the dashboard in Carbondale I do hope your wife holds you to your promise and drives you to St. Louis. Mayo’s even better, maybe you should drive there.
About now comes trotted out the stories of the states where tort reform was passed in the last election cycle and CJD says the rates haven’t gone down before the ink dries. The laws have to survive legal challenge and the cases in place have to be litigated first, actually the number of cases goes up acutely as they try to get cases in under the old rules.
I’ve worked at one of the “centers of excellence” alluded to as part of my training. Funny……they didn’t do trauma.
Can’t say as I blame them; it’s all hard work, lousy pay and constant lawsuits.
He has a law degree, I have a medical degree. Neither one confers expertise on insurance. To a med student, heck I’ll leave it to him to make his own decisions.
Anonymous
You are lying again. A life flight will get you to an urban hospital faster than an ambulance will get you to a rural one. Also, I am not cjd. Finally, in Chester County, there are 6 helicoptor outfits ready to do medevac vs. just 1 15 years ago. That increase in services probably has done more good for Chester County residents than the loss of neurosurgeons has done harm.
Curious JD
“When they got worthless tort reform they made the threat to do again what they had done, and this time were taken seriously.”
Again, you have no clue what the effects of either version are. You don’t know how many cases were affected, how many payouts would have been different, etc. You’re not a liar, you’re just delusional. Or wilfully ignorant.
“The laws have to survive legal challenge and the cases in place have to be litigated first, actually the number of cases goes up acutely as they try to get cases in under the old rules.”
They had tort reform in Missouri for over a decade (legal challenges definitely surmounted). Payouts went down, claims went down, and oh yeah, premiums went up. Next excuse?
Anonymous
yawn……
Again, same old.
The previous tort reform such as it was, just like Nevada, was watered-down by the trial bar, and the medical groups were saying it at the time. Hard caps, joint/several, limits on venue shopping. What the docs wanted was finally passed this year:
http://www.namic.org/advocatenews/050404sa06.asp
Republican Gov. Matt Blunt signed into law on March 28 legislation limiting personal lawsuits, keeping his biggest promise of last year’s campaign.
House Bill 393 changes medical malpractice laws by placing a $350,000 cap on non-economic damages, eliminates the provision allowing for multiple caps in most situations, and provides that joint and several liability will only apply if the defendant is more than 50 percent at fault. The bill also restricts venue shopping.
According to the Missouri Insurance Coalition (MIC), a NAMIC state advocacy partner, most provisions of HB 393 and SB 1 become effective on Aug. 28, 2005.
So, once again, let’s see what happens after the law goes into effect before passing judgment on it.
And if CJD/anon feels that it’s OK to gut medical services in rural areas, that’s their choice.
I guess they don’t live there.
And your excuse for neglecting to mention this little detail is……?
Look, this is getting sickening. If you like the status quo, if it’s OK with you that the neurosurgeon in question left the practice and certain counties closed trauma, then what’s your complaint.
You got what you wanted.
Curious JD
You seem to know lots of differences between tort reform laws, but you seem to have no clue about the effect.
Isn’t that what matters? I mean, if one version causes payouts to go down, claims to go down, etc., yet premiums still go up, how does that help you? How will a more restrictive version help you? That’s your problem, which you illustrate time and again. You’re well versed in the proposed fixes, but you’re totally ignorant as to how or if they work. Completely and totally ignorant. Yet despite not knowing anything about what the actual effect would be, you are quite comfortable asserting that one or the other may be “watered down.” What will be your excuse when this version doesn’t work? Or will you have forgotten your nonsense by then and be ready to start fresh?
Your deductive reasoning skills appear to be seriously lacking. It makes me wonder about your diagnostic skills as a physician.
Rural areas, places I’ve lived in nearly all my life, have ALWAYS had trouble keeping physicians. No tort reform proposal will change that. Ever. They can’t pay as well, and the need for specialists isn’t as great because of the lack of population. Your attempts to somehow tie this phenomenon to the alleged liability “crisis” are laughable.
Anonymous
Ooh, temper, temper.
I have no need to prove my medical bona fides to the likes of you.
Here’s the Texas data, where there has been a little less than two years since reform.
http://www.cga.ct.gov/2004/rpt/2004-R-0918.htm
Rates stabilized, the largest insurer lowered rates, insurers re-entering the market, and physicians returning to the state, especially high-risk specialties.
>>Rural areas, places I’ve lived in nearly all my life, have ALWAYS had trouble keeping physicians. No tort reform proposal will change that.
You entertain us with your profound insight that rural areas have a hard time recruiting physicians. Now that we’re starting to see more an more states with hard caps in place, the data is coming in.
Doctors seem to prefer practicing in states with caps, and the differential seems especially strong in rural areas. Data in Health Affairs seems to bear this out:
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.250v1
Anonymous
“Of course, Anonymous neglects to mention that doctors AREN’T winning with tort reform. Rates aren’t going down. The best they can say is it “stabilized”.”
You need to check your facts. In Texas since Prop 12 passed we’ve gone from annual 20-30% increases each year to actual decreases. I guess only in JD’s world do annual 30+% net decreases equal “stabilized”. Carriers are coming back to our state as well. This bodes well for competition and will pressure the rest to keep rates low.
Curious JD
Actually, in Texas you received decreases from 2 carriers. You received a 15% decrease from one carrier that had raised its rates over 140%. If that is to be considered a victory, perhaps we just have different standards. Anonymous #2, you’re correct though, I misspoke. I normally account for that by noting the following, as well as the fact that even with tort reform there is no guarantee that rates will stay low. I should have been more clear.
Does that reflect the effect of caps or an improving economic climate?
One could say caps, but Anonymous #1 already told us that you have to wait until the legal challenges are past and all the cases filed just before the caps went into affect to tell. You can’t have it both ways.
Also, the problem with the caps argument is that the nation’s largest med mal provider told the TX Dept. of Insurance that caps would only affect losses by at most 1%. They did this when they requested a 17% INCREASE after TX tort reform was enacted. The insurers themselves gut your argument.
One could say the economic climate, where interest rates are increasing, and the stock market is improving, and the reinsurance market is improving post 9/11. There, one would be almost certainly correct, and could simply look at history for proof. Incidentally, the reinsurance market loosening up may be the most important.
You have to ask yourself this – if the economy goes in the tank again, will my rates stay low? The historical evidence is no. You have no guarantee that they will for even another year, regardless of the economy. So what have you gained? Well, nothing. And if you or your famiy are ever the victim of med mal (I know Anonymous #1 is invincible, so I’m not talking to him) then you’ve almost certainly lost.
Anonymous, your health affairs link is no good. I note that you continue to avoid the fact that you have no knowledge of the cases affected by tort reform. You know, there’s nothing wrong with admitting you don’t know what you’re talking about or that you haven’t done sufficient research to form an opinion.
Curious JD
Speaking of lack of sufficient research, your claims with regard to tort reform and the NUMBER of physicians are also weak.
First, the best you could do was state that the rate of INCREASE over a cherry picked period of time was slightly faster.
Second, despite the alleged “crisis”, Texas had increased the number of physicians every year since 1996.
You guys make it too easy sometimes. You know, when a claim sounds too good to be true, it probably is.
Anonymous
CuriousJD, not to get into a protracted argument over this point, but how can you assert that investment losses due to fluctuations in the market account for the increase in malpractice insurance rates when, in many/most states (from my understanding), companies are legally obligated to invest no more than a certain (comparatively miniscule) amount of their income from premiums collected from providers?
IIRC, this % was < 10%, yet you’re saying that this fraction of their overall financial pie being hypothetically squandered by way of bad investments is responsible for the exorbitant rate increases we’ve been seeing over the past decade? Color me skeptical.
Curious JD
No, I would never say that it was solely responsible for it. But a tanking stock market, which constricted investment income, coupled with a tightened reinsurance market, and historically low interest rates (bond investments) certainly played a major role.
But, I wouldn’t expect you to believe me on my word alone, so I will refer you to what is probably the most unbiased and comprehensive article on the subject, found in Medical Economics:
http://www.memag.com/memag/article/articleDetail.jsp?id=141338
I would also ask you to consider what the insurers and their lobbyists say. Again, I don’t expect you to believe me, but surely you can trust them, can’t you?
“We have not promised price reductions with tort reform.”
~Dennis Kelly, American Insurance Association spokesman, Chicago Tribune, January 3, 2005.
“There is no question that it is very rare that frivolous suits are brought against doctors. They are too expensive to bring.”
~Victor Schwartz, General Counsel of the American Tort Reform Association, Los Angeles Times, October 22, 2004.
“Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0%.”
~GE Medical Protective regulatory filing with Department of Insurance (TDI), October 30, 2003.
“I don’t like to hear insurance-company executives say it’s the tort system – it’s self inflicted.”
~Donald J. Zuk, chief executive of Scpie Holdings Inc., a leading malpractice insurer in California, Wall Street Journal, June 24, 2002.
“No responsible insurer can cut its rates after a [medical malpractice tort 'reform'] bill passes.”
~Bob White, President of First Professional Insurance Company, the largest medical malpractice insurer in Florida, talking about a proposed $250,000 cap in the January 29, 2003 Palm Beach Post.
“I don’t think we would argue that the premiums are likely to go down. We believe it will have the effect of reducing the increases in the future. And one of the reasons the premiums won’t go down is that even if noneconomic damages are capped, the losses for economic loss, medical expenses, for example, are still in this current environment escalating at, medical inflation is running in the double digits. I forget exactly what it was last year. So even if you were to cap noneconomic damages, the economic damages will still cause acceleration in the premiums. So it would not go down, I want to clarify if I misspoke and said I thought the premiums would go down.”
~Cliff Webster, representing the Washington State Medical Association & Chairman of the Washington Liability Reform Coalition, testifying before the Washington State Legislature, House Judiciary Committee, Feb. 21, 2003.
“Insurers never promised that tort reform would achieve specific premium savings…”
~From a press release published March 13, 2002, by the American Insurance Association (AIA).
“[M]any tort reform advocates do not contend that restricting litigation will lower insurance rates, and ‘I’ve never said that in 30 years.’”
~Victor Schwartz, General Counsel of the American Tort Reform Association, as paraphrased and quoted in “Tort Reforms Don’t Cut Liability Rates, Study Says,” published in Business Insurance July 19, 1999.
“We wouldn’t tell you or anyone that the reason to pass tort reform would be to reduce insurance rates.”
~Sherman Joyce, President of the American Tort Reform Association, as quoted in “Study Finds No Link Between Tort Reforms and Insurance Rates,” Liability Week, July 19, 1999.
“Insurance was cheaper in the 1990s because insurance companies knew that they could take a doctor’s premium and invest it, and $50,000 would be worth $200,000 five years later when the claim came in. An insurance company today can’t do that.”
~Victor Schwartz, general counsel to the American Tort Reform Association, “Dose of Legality,” Honolulu Star-Bulletin, April 20, 2003.
“While MICRA was the legislature’s attempt at remedying the medical malpractice crisis in California in 1975, it did not substantially reduce the relative risk of medical malpractice insurance in California.”
~James Robertson, Assistant Vice President and Associate Actuary, SCIPIE Indemnity Company (California’s second largest medical malpractice insurer), in written testimony responding to a question from an administrative law jugdge who is overseeing a case in which SCIPIE has requested a 15.6 % rate hike. April 30, 2003.
Anonymous
God, JD, you post so much, I wonder when do you make money anymore ?
Curious JD
You know how it is with insurers. I file suit and they just roll over and pay millions. And if I file suit against a doctor? Multimillions.
Leaves me plenty of time to educate you.
Anonymous
“So what have you gained? Well, nothing. “
Well, nothing other than the two years of rate reductions as opposed to the almost certain continued 30% or more yearly increases if Prop 12 didn’t pass. So, yeah, I guess the $30,000 or so I’ve saved so far is “nothing” in JD lawyer-speak.
Anonymous
Tell you what – why don’t you give me $100,000. I’ll give you back $30,000 this year, but I reserve the right to take that $30,000 and more at any time whatsoever for any reason.
You however, regardless of what I do to you in the future, can only recover a set amount from me. An amount that is not indexed for inflation, and thus is less each year.
Good deal for you? Good deal for anyone but me?
Almost certain increases? How come? Do you even know why you had increases in the first place – not just what they told you, but have you looked at their historic profits?
The stock market and interest rates are improving and additional carriers are coming in to states with and without tort reform. So why did you have to gut the rights of the weakest members of our society to save a few dollars temporarily?
jballon
It’s true: I wasn’t working 100 hours EVERY week–just enough of them to feel the life being sucked out of me, and feel the strain on my relationships with my wife, my family and my friends. If you’ve never worked as a solo practice neurosurgeon covering 3 different hospitals (and their emergency rooms) in 3 different towns, you might want to try it sometime, Anonymous. Then, and only then, can you give me your patrononizing, sanctimonious advice about structuring my life, and call me a shameless liar. And how’s this for reimbursement rates being “relative to the value” delivered? I’ll guarantee (since you seem to like that term) that you’ve got collision insurance that will pay an auto body shop more to fix a dent in your car, than Medicare or most HMOs will pay a neurosurgeon to fix a dent in your skull. And the “rack rate” you so eloquently refer to is simply the “usual and customary” fee that I was paid when I began practice in 1987. That’s what my 60-75% reimbursement drop was based upon. So, you’re right: “How much time a neurosurgeon works is up to him.” This neurosurgeon wanted to pay his staff (including a Physician Assistant), his landlord, his transcription service, tons of monthly bills (at work and at home) and oh yes, a liability insurance company which was seriously threatening an 80% increase in premiums across the board–so I decided I’d better work my f—ing ass off.
Is doing hair transplants as good for people’s health as medically necessary (as opposed to medically unnecessary, I guess) brain surgery? For their psychological health and well-being, yeah. Do I miss neurosurgery? Absolutely–but I don’t miss the health care system. Have I had to make a huge ego adjustment to do what I’ve done? You better believe it–but I saved lives for 23 years, and now I’m saving my own.
Nursamedic
Wow, well said, JB!!
As a registered nurse who cared for Dr. Ballons post-operative patients for several years, and have tremendous respect for him both as a physician and as a person. I can sincerely tell you that nothing was more important to him than his patients and the surgeries that he performed for them. Having seen him at the hospital at all hours of the day and night, 100 hours a week is not a stretch at all. For him to leave neurosurgery altogether is not a decision he could have made easily…
JB…it took a while for the news to reach me…found you here by accident..hope all is well…drop me a line!!

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