“I am in the risk business. I don’t play blackjack, I don’t shoot craps, and I don’t play poker. Simply put, gambling is my vocation, not my avocation.”

Every time I see a patient, I’m playing blackjack, shooting craps, playing poker.
Every additional patient is a risk. “Is this the patient who’s going to sue me? What do I need to do to cover my ass with this one?

“I take the risk for free.”

No, you get paid regardless of the quality of your treatment. Your salary will be paid. You expend no money in advance of getting paid.

You go to work every day knowing that so long as they don’t fire you, and you may even have a contract governing those terms, that paycheck will be there at the end of the week.

You don’t worry about paying staff, the light bill, a plumbing leak, etc.

The plaintiff’s attorney does not “bill” for what he thinks he is worth. Most plaintiff cannot finance a major case against an insurance company on an hourly basis. I would expect were it you or your who were facing millions in medical bills because of someone else’s negligence that you would be utilizing a contingency fee arrangement as well.

Do you have risks? Certainly. We all have risks. But your risks are akin to those of the insurance defense lawyer, not the plaintiff’s lawyer.

CJD – You ignore the fact that many docs, including ER docs, are not salaried employees, but do their own billing. They may not have to lay out cash in advance (with the exception of their training, malpractice premiums, etc) but they still have bad debt, uncollectables, and so forth. And when the patient who didn’t pay last time shows up again, you can’t turn them away.

Forgive my assumption mbu. Rich, I don’t know where the assumption comes from. Probably because in the byzantine world of hospital billing us patients never know who is being paid for what or what their relationship is. Particularly if we only see the physician in the hospital.

But even as independent contractors, you can sign up for programs that guarantee reimbursement. Sure, you may have to fight over how much (and indeed sometimes even utilize the legal system yourselves to get paid), but you can be assured a good living from that reimbursement.

mbu, evidently you didn’t read the article in full. In fact, as the author points out it is not a case of “What is most annoying is the perception that bad outcome = negligence = someone must be responsible.” That perception exists only among physicians.

You, like the many anonymous’ on here, assume that’s the case without any actual statistics or facts. I would venture to say that you have no clue how many people get paid as a result of med mal claims.

But you’re right, maybe a universal health care and no-fault system would be a better way.

“You constanly rail that doctors don’t care about patients and just want to protect themselves. (and you are somehow the caped superhero of justice) Nothing could be further from the truth. The sad thing is that patients who are legitimately hurt by the medical system get little compensation short of the highly publicised big “paydays”. “

Incidentally, the first sentence is incorrect. Completely and utterly wrong, with no basis in fact. Lawyers do a service for their clients, but are not superheros.

As to who gets paid, while I appreciate that you seem to care, the legislation the physician groups back don’t seem to meet the goals you espouse.

So if an attorney in Florida loses three cases, do they yank his license?

MBU, you’re enlightening me. Please continue. I am actually interested in the economics of your practice. What kind of contract do you sign with the hospital? How do you get reimbursed and at what rate? I do appreciate the coding games you have to play to get reimbursed, it’s why I don’t do insurance defense work. I’ve seen the class actions filed by physicians against health insurers. That’s why it is so odd to me that you believe everything they tell you on the other side and you’re so willing to go to bat for them.

How does that perception get propagated? Read the LA Times articles I linked in an earlier thread. Big plaintiff verdicts sell papers. Defense verdicts and settlements don’t. It’s kind of like shark attacks. A few happen close to each other and Florida has an epidemic which lasts all summer until the next big story comes around. They may have had 10x as many the previous year, but all the sudden it’s an epidemic!

Doctors and the AMA also promote that perception. All based on anecdotes of course. They do excellent work on behalf of insurers and pharmaceutical companies – have you read the HEALTH Act? Who do you think that benefits?

Do you think the tort reform movement is a new one? Since the 50s companies and insurers have been seeking to limit their liability. It’s PR, nothing more, nothing less. It makes financial sense for them. Who do you think funds websites like Overlawyered? Do you think the attorneys that run that site do it for free? That the firms and think tanks they work for allow them to spend those billable hours for no compensation?

You and I can talk no fault all day long, but because the insurers aren’t behind it, it’s not going to happen. Why do you think damage caps is the only proposal that ever gets anywhere? But hey, next time I see a group of physicians marching on their state capitol in favor of MORE people getting compensated, I’ll gladly pull over and join.

CJD,
Emergency Department contracts are wide and varied, I couldn’t cover all the variations. Some EM physicians are salaried employees by some private and government hospitals, teaching institutions, and stand alone HMO’s such as Kaiser.

Probably most are similar to ours in which “our group” simply has an agreement to “work” or “operate” out of the hospital. They don’t pay us. If hospital administration is unhappy they can expel us with varying notification periods, some as short 30 days. The hospital holds most of the power. Talk about being bent over.

Practice economics are much like any self employed business. Fees we collect for service minus all overhead (staff, coding and billing, transcription services, accounting, malpractice insurance equals salary, which varies month to month depending on expenses and accounts recieved.

EM physicians and all other physicians that provide emergency back up services are confounded by EMTALA law that says anyone coming to an emergency room has to have their emergent medical condition “stabilized”. It is an unfunded mandate. There is no guarantee for payment. A good portion simply “eat and run”. For those patients it might cost us 50$ in overhead and practice costs to treat that patient for “free” (there is some element of cost shifting that hurts everyone involved)

“That’s why it is so odd to me that you believe everything they tell you on the other side and you’re so willing to go to bat for them.”

I don’t quite know what you are getting at here? By them, do you mean insurers? Who says we go to bat for them? Insurers are what has made practice miserable. Reimbusement in the medical field is not based upon market forces. The going rate for a plumber might be 70$/hr. If you don’t pay you don’t get your pipe fixed. What is the worth of recognizing someones MI, distinguishing it from an aortic dissection and other contraindications and administering a thrombolytic, defibrilating and resuscitating from their arrythmias, talking on the phone with their doctor, the cardiologist, the family who have called in from all over the country, and getting them alive to the ICU?? Medicare might be 200$ if you had the time to document everything. Medicaid might be 100$. The various HMOs that we have a contract with might pay a flat 125$ rate regardless of the severity of the problem. for the uninsured, illegal, or otherwise no-pay patient that little resuscitation may have cost us 50$(discussed above), not to mention the stress and heartache. The hospital might charge 5 grand, but that is all we are going to get from it.

I think some other doc has mused on this blog. “Why am I worth so little when I do my job right, and worth so much when something doesn’t go right”

I think most doctors would opt for a no-fault system. As it is, progress is stymied because no one wants everything “open to discovery” not matter how trivial. The legal system currently has it pinned into that corner. I have to say I am jealous of the lawyers. You make the laws and hold the power. We want to practice medicine and take care of patients.

“Big plaintiff verdicts sell papers. Defense verdicts and settlements don’t. It’s kind of like shark attacks.”

Shark attacks. I think you are making my point. Plaintiffs attorneys are going for the rare big payoff. That is the only thing worth the “practice risk” for them. It has destroyed the system and dramatically raised costs due to “defensive medicine” I have estimated my own defensive medicine costs to “the system” as 2-4 million dollars annually on a previous thread on this blog.

“No, you get paid regardless of the quality of your treatment. Your salary will be paid. “

I’m sorry but you’re an idiot and don’t know what you are talking about most of the time. Given your totally wrong posts about insurance issues and now this why should anyone take you seriously?

“Emergency Department contracts are wide and varied, I couldn’t cover all the variations. . . Probably most are similar to ours in which “our group” simply has an agreement to “work” or “operate” out of the hospital.”

Well, let me ask you this, then. When you enter into that agreement with the hospital, you must have some expectation of personal income. What is the average you would expect for someone in your situation. Feel free to give ranges based on location or other variables.

Who do you think funds websites like Overlawyered? Do you think the attorneys that run that site do it for free? That the firms and think tanks they work for allow them to spend those billable hours for no compensation?

I should know better than to respond to anonytrolls like CuriousJD whose other arguments have been thoroughly refuted by others, but Walter and I run Overlawyered out of our own pockets (and, to be fair, mostly Walter’s pocket). When I worked at a law firm, I didn’t get a penny or a single billable-hour credit for anything I wrote at Overlawyered. The only benefit I got out of it was attention from the national media and the pleasure of knowing that opposing class action attorneys were having heartburn monitoring the site in the hopes of catching me violating a protective order by talking about a pending case I was working on. And thinktanks don’t have billable hours.

I blog for the same reason other attorneys do: I enjoy it, I care about the subjects I write about, I want people to read my opinions, and I think it will help my career.

“CJD. You really are quite curious aren’t you? Your comments and perception of reality show that you live in a parallel universe.”

Mbu, is this you way of saying:

1. You don’t know the answers to my question about the HEALTH Act?

2. That I’m right about what legislation physicians are pushing?

3. You’ve never considered that the climate of fear may be based more on perception than reality.

4. That you didn’t realize how few practicing lawyers, especially who represent plaintiffs, are in state legislatures?

5. That you don’t want to share the economics behind your own practice for some strange reason, despite being obsessed with how much this or that lawyer makes?

I thought we were having an amicable discussion. Sorry to see you turned it personal.