Point by point:

1. do not care to comment at this time.

2. Physicians are just looking for ANY type of relief and ANY ally. The legislation could have better fundamental changes, but I don’t think that will happen until the system has completely collapsed.

3. This I guess where you and I will continue to live in different universes. I base my reality upon my reality. It is not perception. I do not have to look further than the lawsuits brought against me or my partners, or the every day realities of the environment in which I work.

4. C’mon. Rain is wet and snow is cold and there are more lawyers involved in the legislative process than physicians. No, I do not know specifically how many or how few are plaintif lawyers.

5. I may lament outrageous jury awards, but I have never been obsessed on this blog, or otherwise, on what lawyers make. If you are curious, and you are, and want to know what I make, it is not a hidden secret. Goggle EM physician salaries and you will find lots of different surveys and data bases. I just briefly looked at them and they are in the ballpark. Some are older and from teaching institutions so add 10% if you want.

I am proud that it has been estimated that the average EM physician provides 138,000$ ANNUALLY of Emtala, or charity related care, based on the only detailed study analysis I am aware of. Google Annals of Emergency Medicine emtala for the link. That was in 2002. Anecdotaly, I know that continues to rise.

We shoulder a lot of medical malpractice risk to provide that “free care”. Every patient is at risk of a complete collapse of emergency medical care.

Thanks for bantering.

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.

You and I both know that one cannot spend as much time as you and Walter do writing, speaking, touring on behalf of corporate America and still receive the salary of a partner in a large law firm unless there is a benefit to the client or the firm.

In the case of the firm you worked for, that is a who’s who list of US business. It’s nothing to be ashamed of. You shouldn’t hide from being a zealous representative of your clients. You do a good job – as an attorney, if not a public servant dedicated to the truth.

Your “think tanks” are simply more of the same. The same criticisms that you apply to groups like Public Citizen apply to your own employer now.

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.

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 really benefits from damage caps? They make you no guarantee that they will reduce your rates, or that if they do, that they will stay low for any period. Who do you think benefits from the legislation in Congress?

“I think most doctors would opt for a no-fault system.”

I think the evidence says otherwise. The AMA certainly isn’t pushing it. Doctors aren’t holding press conferences to push no-fault legislation. No one is telling horror stories of doctors running out of town or going bankrupt to get no fault legislation enacted.

Even assuming you’re right on what plaintiff’s attorney’s are going for, its rarity would seem to gut your case. How many truly devastating injuries are there? And of those, how many are related to negligence? As the original article indicates, these guys assess the likelihood of winning because it is their uncompensated time that is lost when they lose. They don’t take dogs to trial. Especially in med mal when the chances of winning are already so low anyway. No matter how persecuted you guys feel, in large part people still revere their physicians. Especially in rural areas.

I note your comment on defensive medicine. Have you ever considered that your practice of defensive medicine is based more on a perception of fear than a reality?

As for who makes the laws, you better check the makeup of your legislature. You’ll find very few practicing lawyers anymore, and those that you will find are generally corporate lawyers. There are few lawyers who represent individuals in your state and national legislatures.

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?

And some docs are compensated on a capitated basis if they are under contract to an HMO.

But the majority of those in private practice receive a small portion of their revenue from patients via copays. The bulk is from third party payors.

When the carrier or the uninsured fail to pay the doc takes it in the shorts. Best case scenario is a 30 day float. Worst case can be 6 months or longer, particularly where Medicaid/Medicare is concerned.

And as for the uninsured, well that is why collection agencies were invented.

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.