Ezra argues for lower physicians’ salary in exchange for subsidizing medical education:

Doctors, to some extent, work for the public good. Why shouldn’t the country subsidize their education — particularly if they go into high-need specialties or work in inadequately served areas — but lower their pay? Or at least allow for many more nurse practitioners?

(via over my med body!)

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  • KipEsquire

    And who exactly gets to decide which specialties are “high-need” and which areas are “inadequately served”?

    Hmm?

    Every advocate of central planning always — always — envisions himself as the central planner.

  • Anonymous

    I don’t think its an unrealistic proposition. Other professions have managed to objectively identify underserved or underfilled areas. The federal government, in the field of education, has officially designated “high-need” areas for teachers both geographically (inner cities, poor rural areas) as well as by position (high school math/science, special education, ESOL). I think an objective criteria (such as number of primary care providers per ten thousand people, or specialists within a certain mile radius) wouldn’t be that hard to create. No system would ever be 100% perfect, but it could be reliably accurate. Everyone knows Indian reservations, for example, are practically bleeding for doctors, as are places in Appalachia and border areas. As for specialties, dermatology is an impossible residency to get into while lots of ob/gyn and family practice spots go unfilled.

  • Brock Tice

    The National Health Service Corps does some of this already.

  • Anonymous

    Does the author not realize this already goes on to a certain extent?
    1) Medicare funds a tremendous number of the residency positions available in the US.
    2)Medical students can have medical school paid for completely if they agree to practice in underserved areas.
    3) The federal government already provides low interest loans to students who agree to pursue primary care after graduation.

  • Gasman

    How to lie with statistics.

    Start with 10 year old data as his graph on physician income does.
    Then remove the denominator. That is, physician income is compared among countries with differing economies.
    One needs to add a denominator, such as physician income as a multiple of median income, or perhaps median professional income. Though as capitalists, we might wish to base it on something like opportunity cost. That is, physician income as a multiple of what I would have made if I didn’t spend 10 years between college and career financially going into the hole.

    The authors graph does nicely demonstrate that the more socialist the country with respect to educational subsidy the salary does go down. As an undergraduate years ago I did business class where one of my projects was analyzing my future income costs. Had I stayed with engineering and entered my career in 1986 versus pursue medicine and enter my career in 1996 as I did eventually do, it would take until 2020 to reach the same financial position. The medical salary is quite a bit higher now than I would be making as an engineer, but the debt load (now paid) and interest, and time without income, all seriously cut into net lifetime earnings.

    Sure medicine pays a lot better than most jobs. But you have to compar medical salaries not to most jobs, but to jobs that people of that caliber would alternatively pursue. Physicain income needs to be where it is to attract highly qualified people away from alternative careers.

  • Anonymous

    “But you have to compar medical salaries not to most jobs, but to jobs that people of that caliber would alternatively pursue. Physicain income needs to be where it is to attract highly qualified people away from alternative careers.”

    How do you determine one’s “caliber”? While a physician may be extraordinarily gifted in the sciences and by all accounts an intelligent person, he/she may lack the traits necessary to succeed on the same level as those of similar intelligence and training in other fields. Besides, physicians are, after all, the highest paid profession.

  • Anonymous

    Oh geez, seriously. Anyone smart and driven enough to get through pre-med courses, med school and the rigors of a residency is clearly capable enough to earn the median income in any other professional discipline. I’m not even a doctor myself, but I can acknowledge that’s true. Wishful thinking to argue otherwise.

  • Anonymous

    The National Health Service Corps does some of this already.

    Not really.

    the NHSC is VERY competitive. They are severely underfunded. Only a small % of physician applicants who apply get accepted.

    Also, the funding pie for NHSC is split up amongst many health professionals including nurses and dentists.

    So its not really sufficient.

  • Anonymous

    Again someone is messing with statistics. Yes medicine is a highly paid (I don’t know if it is the highest paid) profession. At minimum though one has to consider a correction for years worked. Since physicians don’t start their careers until early to mid 30′s they loose a decade of earnings compared to college grads.
    Physicains will never match the income of the United Auto Workers who start work after just highschool, earn up to 90,000 per year, then have full retirement and health care.

    Physicians and lawyers are some of the few professions with no traditional employer and thus no employer sponsored benefits such as health care (ironically) or retirement.

    As far as the ‘caliber’ issue goes. It means that every last one of them worked their asses off. They would excell in any field they chose.

  • emac@post.com

    Soon to be M1 here, can someone please tell me if all these issues are expected to be problems by the time I would start to practice? My main concerns are the liability crisis/defensive medicine, managed care buracrecy, falling reimbursments, the threat of IMGs, and rising costs of medical school. Feel free to email me or reply here.

  • Anonymous

    “Doctors, to some extent, work for the public good.”

    This is so vague as to be completely useless. Don’t engineers, to some extent, work for the public good? What about garbage collectors? And the government already subsidizes many fields in education. This is done to promote knowledge and the pursuit of truth as worthy goals in and of themselves, not merely to ensure a pool of worker bees for the state.

    As far as medical schools go, tuition in state med schools is already heavily subsidized by state funds. Should this money come with strings attached? This is for the states to decide. But if the answer is yes, then there should be an explicit contract and none of this vague “this is your moral responsibility” bullshit. If states want to conscript physicians like the military does, let them try it. I don’t think they’re going to like the results.

    People who make these arguments also try to say that physicians are “public servants”. To view physicians as servants, public or otherwise, as opposed independent professionals is a grave mistake.

  • chuck

    M1,

    I wouldn’t even think of going into medicine. All of your concerns are huge and will only be worse. I have no faith that government can make any fundamental changes to improve things. Look at how the government has bungled social security reform, immigration reform, hurricane Katrina, the current tax code, etc… Health care is a thousand times more complex than those issues.

    I am 42 years old and I still enjoy it as a career and have resigned myself to the fact that my path is set. It is too late for me to jump ship, although I am exporing opportunities to decrease patient care hours even at the expense of less income. I am in a high risk specialty and have had to endure 4 lawsuits that take years until exoneration. I have some brilliant and smart children but I will not offer much encouragement towards a career in medicine.

  • Elliott

    Chuck,

    If you could choose any career for your children then what would it be? The only condition I would put on this question is that you get to choose the career and not their level of success.

    It’s hard for me to think of a career that offers greater opportunity for a comfortable life knowing nothing else about their interests or aptitudes.

  • Anonymous

    “I wouldn’t even think of going into medicine. All of your concerns are huge and will only be worse.”

    I am also in a high risk specialty, Emergency Medicine. I cannot leave because I currently support several family members, though I have cut my hours over the years. For me it is the Liability crisis. If I worked in a Pizzeria and I needed to earn a few extra bucks, I could just “pick up some overtime”. In Emergency Medicine I have to think that every extra patient I see could be a lawsuit so I can’t do extra shifts. What’s remarkable to me is that in the past 3 months TWO of my colleagues quit to go into other fields. One is leaving medicine Entirely for an Office Job. She had only been a doc for 3 years. She got tired of the liability, and the fact that it’s gotten so busy she can’t PEE when she wants to and doesn’t get a lunch break, like the rest of the world.

  • ismd

    “It’s hard for me to think of a career that offers greater opportunity for a comfortable life knowing nothing else about their interests or aptitudes.”

    Elliott,

    Comfortable life as in financial security and “raking in the riches”? If that’s what you meant, then the decent (NOT rich) salary I get from busting my hump caring for patients sure as hell isn’t worth it anymore. I’m in a pulmonary/critical care practice, and between the level of stress in caring for increasingly sick and complex patients, increasing numbers of times I have to come into the hospiotal after hours, the increasing number of difficult to deal with families, the stress of thinking that every patient you see may sue you (or to be threatened with lawsuits by families), the decreasing level of reimbursement, the increasing costs of overhead (not just malpractice) and with knowing that this incompetent Congress and Presidency can’t (or won’t) fix our healthcare woes, I’m looking to get the hell out of this profession. To continue this job means I’ll be looking at an earlier grave. I’m 54 years old now, and while some may consider it too late to get out, I’m doing this to protect my sanity and my health. Comfortable life, Elliott? Not really.

  • Anonymous

    “Oh geez, seriously. Anyone smart and driven enough to get through pre-med courses, med school and the rigors of a residency is clearly capable enough to earn the median income in any other professional discipline. I’m not even a doctor myself, but I can acknowledge that’s true.”

    At the median, perhaps. But in that case, why leave medicine since that’s the highest median of professions by nearly $50,000. A number that more than compensate for any additional schooling years.

    “Physicains will never match the income of the United Auto Workers who start work after just highschool, earn up to 90,000 per year, then have full retirement and health care.”

    How many UAW members earn $90K per year? That certainly is not the median. Don’t just make up stats.

    “As far as the ‘caliber’ issue goes. It means that every last one of them worked their asses off.”

    EVERY one of them?

  • Anonymous

    “EVERY one of them?”
    Why yes but since you are “not a doctor” I am sure you know better than us. Here is what it takes
    1: 4 years undergrad
    2: MCAT
    3: Good enough scores in 1 and 2 to get accepted to med school
    4: 4 years of med school
    5: three step USMLE exams
    6: 3-7 years of residency/fellowship which means 3-7 years of not sleeping every third or fourth night.
    7: Board certification exam

    Please show me someone who “skates” through that.

  • Anonymous

    Elliot,

    Expose yourself. Who or what are you? Are you a physician? I don’t think so because you don’t know what the hell you are talking about. Give me your cell phone number. Lets make sure you are working a minimum 60 hour week. When not working or trying to sleep lets call and interrupt you every thirty minutes. I will give you a lenience of three uninterrupted hours per night, but not the same three hours each night. We will do it for a month and see if you still think it is “comfortable”

  • Anonymous

    You guys don’t know Doc Elliot? He’s a Skank lawyer Sodomite! Don’t drop the soap in the shower, Doc Elliot’s here!

  • Anonymous

    ” Give me your cell phone number. Lets make sure you are working a minimum 60 hour week. When not working or trying to sleep lets call and interrupt you every thirty minutes. I will give you a lenience of three uninterrupted hours per night, but not the same three hours each night. We will do it for a month and see if you still think it is “comfortable””

    Damn, you podiatrists are busy! I wonder how I manage to run into so many doctors on the ski slopes who are staying at their condo for a couple of weeks?

  • Anonymous

    Ok, lets make a deal. We will quit whining when you all quit whining as to why your doctor won’t prescribe a Z-pack over the phone, or about the wait in the ER or office, or the hurrried service you get, or how much it costs, or over why obese, chain smoking 85 y/o grandma died.

    BTW, podiatrists aren’t MD’s. They are on the ski slopes eh? I wouldn’t know, I am too busy to go. Maybe podiatry is the profession for Elliot’s kids.

  • Anonymous

    ” Didn’t anyone explain to you what being a Doc. was all about? Why do you act so put out about all this.”

    No, it’s changed. We do alot of tests to cover our tired, reamed out sphincters and then, when some of these additional tests cause bad outcomes, instead of stating the reason we had to do the test in the first place was the lawyer sodomites, the AMA comes out and whines about “patient safety”, instead of fucking the lawyers the way they fuck us, so every one buys into the mentality that medical errors are due to “butchered surgeries”, when most of them are due to bad outcomes. I’ll order an extra un-needed CT scan tonight, just for you, anon 12:04 pm. And if the patient reacts to the IV dye, consider yourself at fault.

  • ismd

    Anon 12:04,

    “Did you just see it as an aesy way to make money? But, now that reality has set in you realize that money isn’t so easy to make after all. Stop having your temper tantrums!”

    No, actually, it never was about an easy way to make money, despite the public’s continued misperception about our salaries and motivation. It’s everything else that goes with the job that’s getting tiresome. And there’s no way I’m gonna stop having temper tantrums, as you so fondly call them, not when my profession is being raped and pillaged by lawyers, the government and an uncaring public. There’s one thing you fail to realize – healthcare in this country is going down the tubes, and it’s citizens like yourselves, who don’t have a freaking clue as to what we go through on a daily basis, who are enabling the impending disasters in healthcare delivery. Yet when it’s your insurance company who denies your medicine or your procedure or your MRI, it’s US you whine to, and expect us to fix the problem. You know what? It ISN’T my problem, but yours, because it’s YOUR insurance plan that you never bothered to understand.

    If you think we’re merely whining about our salaries, you’re wrong. However, I do have a right to “whine”, as you put it, when the profession I used to love goes down the tubes and you guys think it’s all our fault. I’m entitiled to “whine” when I work in the only profession in this country NOT allowed to increase prices to compensate for increasing overhead. I’m entitled to whine when I get threatened with lawsuits by difficult to deal with families who want me to override their 98 year old family member’s living will which says “do nothing”. I’m entitled to “whine” when patients call with bullshit complaints they’ve had for months, and demand immediate office visits, or worse, call with these same chronic complaints in the middle of the night. I can whine when insurance companies deny reimbursements on a whim, or lose the claim my office submitted for the fifth time.

    I’m no longer seeing Medicaid patients because I lose money every time I do, and that doesn’t make me a money grubber or a dishonorable public servant, as some of the public would believe. I soon won’t be seeing Medicare Patients with Medicaid secondary insurance because, in my state, I don’t get paid the 20% Medicare allows. Medicine is a business, not a charity, and while I don’t like cutting back on patients, it’s a financial reality. If I don’t make money, then I’m not in business.

    “How terrible that the world is so unfair to you.”

    Actually, when the system finally melts down, it’s the world who’ll be very much unfair to you. But I know YOU won’t whine about it.

  • Elliott

    What career should the intelligent, ambitiuous child of today pursue then? That was my question and I haven’t heard any answers yet.

  • Anonymous

    I was so freaking stupid that I didn’t listen to my father. He said I should become an orthodontist and that I was wasting my time in med school and residency. Damn he was right! Also if you are not loaded with ambition or brilliance my neighbors the fire chief, police chief, chiropractor, general contractor, dentist, lawyer, restaurant owner, school principal are all financially on par or ahead of me in mid forties with much less opportunity cost.

    If you are particularly brilliant or ambitious invent something or program something people want to use, write something people want to read, raise a business and offer a service people want to pay for. Thinking of possibilities isn’t rocket science Elliot. Or become one of those.

  • Anonymous

    Oh, I forgot airline pilot — nice hours, professional wage with union benefits.

  • Anonymous

    Run a company that runs seminars that teaches professionals how to avoid the Sodomites. Call it the “Lawyer Avoidance seminar”. In reality, I think a travelling seminar entitled “risk reduction in medicine” would make alot of money.

  • Anonymous

    My wife’s family is in the Bakery Business. They have to work long hours, but it’s rewarding, and it’s unlikely anybody will sue you for a bad cake. They all seem happy. My wife often says she should leave her Heme-Onc practice and go back to work in the Bakery.

  • Anonymous

    That Elliot guy sure like to spew about how physicians are the highest paid profession. I have already pointed out to the re-named CJD that this is false according to his own Department of Labor Stats.

    Check out the recent US news report for another take one it.

    Or just compare me to my sibs:

    Me: 11 years of education post highschool- family practice doctor – Best year $140,000

    Brother #1: 4 years of ed. post HS – geophysicist – Best year $250,000

    Brother #2: Nuclear instrumentation electronics – 4 yr. degree – Current salary $160,000

  • Anonymous

    ” despite the public’s continued misperception about our salaries and motivation.”

    Maybe the public wouldn’t be so confused if they didn’t have to listen to all of you whine about how much you don’t make all the time.

    ” I have already pointed out to the re-named CJD that this is false according to his own Department of Labor Stats.”

    You did? When? The stats were supplied by Dr. Rangel originally, who apparently hasn’t received the memo that they were false.

    “Oh, I forgot airline pilot — nice hours, professional wage with union benefits.”

    This makes me chuckle. Ask an airline pilot at Continental, American, etc. how secure they think their jobs are.

    “Also if you are not loaded with ambition or brilliance my neighbors the fire chief, police chief, chiropractor, general contractor, dentist, lawyer, restaurant owner, school principal are all financially on par or ahead of me in mid forties with much less opportunity cost.”

    Sounds like you need a money management seminar more than a risk avoidance. Because you have clearly squandered some cash.

  • Anonymous

    You talk about the decline of medicine in America as though you haven’t played a part in that decline.

    Why is it that you suppose there are all these problems? You blame the attorneys and the patients or the ins. companies….Never once, taking any of the blame for it yourselves.

    How can you ramble on about defensive this test and defensive that procedure and referring this patient to 4 different specialist and at the same claim non-responsibility for what is happening.

    You give up patients because their ins. doesn’t pay you enough. Maybe the ins. companies aren’t as dumb as you think. I’m sure they know you are just, covering your ass, by all this unnecessary testing ,that you expect them to gladly pick up the tab for.

    It is an endless cycle with you being the “first in line” culprits.

    You are the one’s driving up medical care costs, and you are NOT doing it for the good of your patients. Your doing it for your own good and having the nerve to blame it on everyone else.

    Such arrogance!

  • Anonymous

    “You are the one’s driving up medical care costs, and you are NOT doing it for the good of your patients. Your doing it for your own good and having the nerve to blame it on everyone else.

    Such arrogance!”

    Such stupidity.

  • Anirban

    “Why is it that you suppose there are all these problems? You blame the attorneys and the patients or the ins. companies….Never once, taking any of the blame for it yourselves.”

    If truth hurts its easy to find the easy scapegoat –the physician . Albert Kamu once said if truth dazzles your eyes ,it is better to settle for the colourful illusion of dawn. Works for you.

    “How can you ramble on about defensive this test and defensive that procedure and referring this patient to 4 different specialist and at the same claim non-responsibility for what is happening.”

    The same way you ramble about how many people were ‘killed maimed butchered poisoned’ by those unscrupulous physicians, pretend to be the friend of the little guy ,ramble day in day out in TV like publicity whores and whine about how people see you in low light , ramble in front of the judge and jury and still lose 80% of the cases .Your rambling stops only if your mouth is stuffed with money,
    but starts again for the next court room drama. You are in the extraordinary league of ramblers. What is so big deal about it? I don’t remember you took responsibility for anything anywhere .I just forgot you are self-proclaimed successors of Jefferson

    “You give up patients because their ins. doesn’t pay you enough”

    The same way you don’t do business with someone, if not economically sustainable .Applies to every walk of life.

    “It is an endless cycle with you being the “first in line” culprits”

    Even if it is true, Do you ever consider yourself the 3rd or 4th or the nth in line of culprits. Anyway when did you take responsibility for anything?

    “You are the one’s driving up medical care costs, and you are NOT doing it for the good of your patients. You’re doing it for your own good and having the nerve to blame it on everyone else.”

    I think no one had the chutzpah to say that they are doing this ‘for the good of their patients’. They are doing this to cover their ass, the whole truth and nothing but the truth. Take off all these overburdening bureaucracy, legislature, ‘sue happy lawyers and let the free market prevail. Medicine will again be worth pursuing. The hoops of regulation and fee-cutting that are here were never proposed by physicians themselves.

  • Anonymous

    “Why is it that you suppose there are all these problems? You blame the attorneys and the patients or the ins. companies….Never once, taking any of the blame for it yourselves.”

    And what specific part of the downfall of American healthcare are docs responsible for? We didn’t ask for declining reimbursements, increasing malpractice rates, and certainly we didn’t cause the plague of bloodsucking lawyers who sue first and ask questions later. What part of all of this don’t you get?

  • Anonymous

    “What career should the intelligent, ambitiuous child of today pursue then? That was my question and I haven’t heard any answers yet.”

    Law…. just don’t look in the mirror they may not like what they see.

  • Anonymous

    ” Your pissed at the Lawyers so your attack is to take it out on your patients?..Talk about misplaced anger!!”

    Sure beats reality testing. Go ahead, sate your outrage. Hammer on that exclamation point.
    Who exactly is attacking patients here? Seems more like a shrill, irrational straw-man attack than a reasoned and intelligent argument. The OP is about
    trading lower compensation of doctors for free education.

  • ismd

    “I guess the good news for you is…One day when you have offended enough of them, you won’t have any left to worry about a lawsuit….I’m sorry but you seem really immature with this pseudo way of fighting back. Your pissed at the Lawyers so your attack is to take it out on your patients?..Talk about misplaced anger!!”

    Like you don’t have misplaced anger? Don’t you realize that we’re fighting the lawyers?Look at all the attempts at tort reform on borth the state and federal levels. They all get shot down by lawyer controlled legislative bodies. And if we dared to go out on strike to try to improve conditions for you, the patient, we’d get blamed for problems, not anyone else. What the hell would you have us do? As a member of the public and a citizen of this country, YOU should also fight the trial attorney establishment, and get rid of the lawsuit culture in this country. Until then, if you need medical care, we’re going to practice defensive medicine. After all, you could be the one in a whatever patient who swears “You know that I’d never sue ya, doc”, and then turn around and do exactly that. Sorry if we’re not so trusting, but all it takes is one experience in a malpractice suit to turn us into defensive players.

    But don’t forget – you always have the right to refuse a recommended test – yep, even ones we’re doing to cover our butts, while at the same time trying to help you. Just don’t sue me or my colleagues over a test you refused to get that you should have had to make that real longshot diagnosis.

  • Anonymous

    “If truth hurts its easy to find the easy scapegoat –the physician.”

    Ahh, the irony of a physician saying this.

    “Don’t you realize that we’re fighting the lawyers?Look at all the attempts at tort reform on borth the state and federal levels.”

    Talk about misplaced. Tort reform won’t hurt lawyers. Just patients. And the really funny thing is there isn’t any evidence it will make physicians any money. So really, you’re fighting patients on behalf of your insurance companies.

    ” And if we dared to go out on strike to try to improve conditions for you, the patient, we’d get blamed for problems, not anyone else.”

    Physicians staged walkouts all over the country, and no one blamed them. Seriously, the truth will set you free.

    “As a member of the public and a citizen of this country, YOU should also fight the trial attorney establishment, and get rid of the lawsuit culture in this country.”

    Why should people help your insurer make more money? It won’t lower their costs any. It won’t bring any more docs to their neighborhood. The only thing it will do is cost them if they’re on the wrong end of one of your screwups. Or under the knife when one of your colleagues is drunk. What’s in it for the patients?

    ” Sorry if we’re not so trusting, but all it takes is one experience in a malpractice suit to turn us into defensive players.”

    Even though you have no idea if it does you any good?

    ” Take off all these overburdening bureaucracy, legislature, ‘sue happy lawyers and let the free market prevail. Medicine will again be worth pursuing. The hoops of regulation and fee-cutting that are here were never proposed by physicians themselves. “

    You can. You just don’t want the risks entailed. Don’t blame others for your cowardice and poor financial planning.

  • Anonymous

    “Physicians staged walkouts all over the country, and no one blamed them. Seriously, the truth will set you free”

    Yo CJDlite those walkouts did not result in loss of emergency care in critical situations. Hoy many times do you have to be told we CAN’T strike (except employee docs). Have you ever heard of patient abandonment?

    Just for you since you seem to need a little law refresher and
    since you need a little “truth” dose yourself:

    “as independent businesses, physician practices are not permitted to band together in a conventional labor union or participate in group boycotts; strikes and job actions are the province of labor unions.”

  • Anonymous

    “Tort reform won’t hurt lawyers. Just patients.”

    And, just how , genius, does tort reform not hurt lawyers? Geez, it would only seriously cut down how much money the sodomites make, while still giving the injured patient ALL of their economic damages, and, yes, even more money – the cash the sodomite didn’t extort for their work. And, the patient gets the money faster.
    DOH!

  • Anirban

    “Tort reform won’t hurt lawyers. Just patients.”

    The number of lawyers in this country has increased at a rate which far exceeds population growth, they need a steady flow of cases to survive . it is rather a wishful thinking that it doesn’t affect lawyers. Look at Texas , how they moved out of Med-Mal and now pursue the patent claims.

    “Physicians staged walkouts all over the country, and no one blamed them”

    I don’t think that any kind of industrial action was ever seen in good light by the lay people. Look at the recent New York transportation strike, how many of them came out in its favor. What basically a strike does is playing hardball with consumers as hostage. So if overused, cuts a sorry figure of a physician, almost like a lawyer.

    “Or under the knife when one of your colleagues is drunk.”

    Then I would love to see that colleague in jail stripes, not some phony civil action.

    “Even though you have no idea if it does you any good?”

    What good it does to us? Or, to any defendant as such ? Win or lose its still a lose-lose game, unless I can collect my expenses.

    “You just don’t want the risks entailed. Don’t blame others for your cowardice and poor financial planning.”

    What could be more risky than what it is already? Where do you actually see the cowardice , if they are coward to lose money to your pocket, then I don’t actually blame them.

  • Anonymous

    “Yo CJDlite those walkouts did not result in loss of emergency care in critical situations.”

    So you did walkout, contrary to the other posters’ statement.

    “as independent businesses, physician practices are not permitted to band together in a conventional labor union or participate in group boycotts; strikes and job actions are the province of labor unions.”

    Why do you need to strike to negotiate better contracts with the insurers? Perhaps you should hire better lawyers.

  • Anonymous

    ” it is rather a wishful thinking that it doesn’t affect lawyers. Look at Texas , how they moved out of Med-Mal and now pursue the patent claims.”

    Only someone whose sole knowledge of the law comes from Overlawyered would think this statement is correct. Good lawyers, and most med mal lawyers are very good, will always have plenty of work. They just won’t be representing individuals. Tell me, when you’re on the wrong end of that catastrophic injury, do you think those lawyers in those 50 story buildings in downtown Houston who bill $400/hour to their corporate clients are going to take on your case? Patent claims? What are yo talking about?

    “I don’t think that any kind of industrial action was ever seen in good light by the lay people.”

    This may surprise you, but you could be wrong.

    “Then I would love to see that colleague in jail stripes, not some phony civil action.”

    You wouldn’t think it was so phony if it was you who was unable to work and facing mounting medical bills. Of course, no one ever thinks it could be them.

    “Where do you actually see the cowardice , if they are coward to lose money to your pocket, then I don’t actually blame them.”

    We’re talking about the fear of leaving the insurers reimbursement cradle. You’re not reading what’s being written.

  • Anonymous

    Anon 11:22,

    “We’re talking about the fear of leaving the insurers reimbursement cradle. You’re not reading what’s being written.”

    It’s clear that you’re not reading what the docs here are saying. They are leaving insurers in slow but increasingly steady numbers. “Cradle”? Oh, please – what a so full of shit statement.

  • Anonymous

    “It’s clear that you’re not reading what the docs here are saying. They are leaving insurers in slow but increasingly steady numbers. “Cradle”? Oh, please – what a so full of shit statement.”

    Actually, it’s rather clear that I am.

    What would you define a system that guaranteed you were paid, even if you didn’t like the amount? An amount you can negotiate if you choose. Your only fear is the insurers will go insolvent. And that doesn’t happen very often with health insurers.

    Most businesses don’t have customers that financially secure. So yes, that’s quite a cradle.

  • Anonymous

    - I cannot negotiate the reimbursement rates with any carrier. Very very few physician groups can, if any.

    - The real “cradle” in medicine is a salaried position- getting paid a fixed, predictable amount no matter how many or how few patients you treat.

    - The other “cradle” is the concierge doctors who don’t take insurance at all, but are guaranteed an up-front flat fee from their patients. Problem is, only a very small percentage of the patient population can afford this type of service and therefore only a small percentage of physicians can do it.

    Your comments are incredibly ignorant, and betray the fact that you probably have no expertise at all in this arena.

  • Anonymous

    “- I cannot negotiate the reimbursement rates with any carrier. Very very few physician groups can, if any.”

    Do the carriers not compete for you? Can you not pick one but not the other based on price?

    And again, unlike other businesses, your customer, the insurer is the most secure source of payment out there short of the govt., which can print its own money.

    Your ignorance of the strength of your own position is surprising.

  • Anirban

    “Most med mal lawyers are very good, will always have plenty of work. They just won’t be representing individuals”

    What is the benchmark for a good lawyer? Losing 80% of the cases on trial? Can you please explain?

    “Tell me, when you’re on the wrong end of that catastrophic injury, do you think those lawyers in those 50 story buildings in downtown Houston who bill $400/hour to their corporate clients are going to take on your case?”

    See free market operates. Anybody who choose to be a trial lawyer, well know that their client can’t pay the hourly rates, and so the contingency system. Corporate lawyers are assured that their hourly rates are paid up. You are not some ‘holier than thou’ to represent the little guy because the fact is that no other business model would have worked for you and you would have no clients in an overlawyered country.

    “You wouldn’t think it was so phony if it was you who was unable to work and facing mounting medical bills”

    Most of the criminal defendants are not worth a penny (forget O.J) .How the plaintiffs are taken care of in these cases?

    “We’re talking about the fear of leaving the insurers reimbursement cradle. You’re not reading what’s being written”.

    I think Anon 2:00 PM has shed his share of light.

  • Anonymous

    Anon 2:28, seriously, you need to stop embarassing yourself. I am NEVER guaranteed payment from an insurance company on any claim I submit. What ever gave you this idea? My claims are subject to rejections and denials (not to mention downcodings) all the time. Examples of this include prior-existing clauses, non-covered services, unmet deductibles, capitations, etc.

    As far as carriers competing for me- they don’t. I won’t waste my energy explaining this one though because it has nothing to do with your original point (which was also WRONG) that I can negotiate a rate with an insurance company “if I choose”.

    What exactly about my position is weak- the part where I say I cannot negotiate rates(even though I can’t) or that salaried/concierge positions are a cradle (even though they are)???

    If you want to talk about a guaranteed source of income, prepayment is the real pinnacle. You know, kind of like a retainer…

  • Anonymous

    The problem is CJDlite does not understand the system, even though he thinks he does since he pays insurance for himself and some employees. He has little understanding of the other side of the coin. He doesn’t understand that striking for us is an antitrust violation (not a one day walkout by some providers with clear emergency backup). He doesn’t understand that medicare pays what medicare pays. Insurance pay based on some percentage/multiple of medicare. If you are in a one doc field of practice in a small town you may have some power, but this is limited as the insurance may just tell the patient’s to now go to the next provider several towns over. The insurance company cares little how inconvenient/unsafe travel is to the patient.

  • Anonymous

    “What is the benchmark for a good lawyer? Losing 80% of the cases on trial? Can you please explain?”

    Do you really think the good ones lose 80% of their cases at trial? Tell me, what percentage of med mal cases do you think settle?

    ” You are not some ‘holier than thou’ to represent the little guy because the fact is that no other business model would have worked for you and you would have no clients in an overlawyered country.”

    Again, Anirban, the ignorance that comes from getting all your information from Overlawyered comes shining through.

    “Most of the criminal defendants are not worth a penny (forget O.J) .How the plaintiffs are taken care of in these cases?”

    Seriously, your lack of knowledge on this is painful. If you’re going to have such strong opinions, at least know what you’re talking about.

  • Anonymous

    “I am NEVER guaranteed payment from an insurance company on any claim I submit. What ever gave you this idea? My claims are subject to rejections and denials (not to mention downcodings) all the time. Examples of this include prior-existing clauses, non-covered services, unmet deductibles, capitations, etc.”

    I’ve been an insurance defense lawyer, I know the coding games. But be honest, what percentage of your claims get paid? 80? 90?

    “As far as carriers competing for me- they don’t. I won’t waste my energy explaining this one though because it has nothing to do with your original point (which was also WRONG) that I can negotiate a rate with an insurance company “if I choose”.”

    That statement is still correct. Nothing prevents you from doing so. But this goes back to how you, while you rage against the lack of a free market, are insulated from the downside.

    Physicians don’t compete for patients on the strength of their skills. Patients have no clue. Were you to do so, and were your actions and results more available to the public, perhaps we would all be better off. Quality physicians would be reimbursed higher because patients would demand their services more frequently and demand that their insurers include them in their plans. Thus giving you, presuming you were of some quality, more power.

    As it stands, the present system removes the financial incentive for a quality physician to perform at the top of his/her game.

  • Anirban

    “Do you really think the good ones lose 80% of their cases at trial”
    You told most of the med-mal lawyers are good ones . the cases are settled only if the cost of defending is more. This has created the incentive for ‘nuisance settlement ‘’cause the cost is scary down the line.

    “Again, Anirban, the ignorance that comes from getting all your information from Overlawyered comes shining through.”

    Cite your sources of legal knowledge? I’ll check out those also. ‘Overlawyered’ is just another catchy term.

    “Seriously, your lack of knowledge on this is painful.”

    So, how much a criminal defendant worth in most of the cases ?

  • Anonymous

    “As it stands, the present system removes the financial incentive for a quality physician to perform at the top of his/her game.”

    What kind of crap statement is that. If we aren’t at the “top of our game” we know you will be sticking your penis up our ass. Jesus some of your comments really show what a clueless idiot you are.

  • Anonymous

    Anon 10:23- you are correct, the majority of my claims do get paid by insurance eventually. But that really isn’t the point. I was responding to a poster (you?) who stated that insurance is the most secure system of payment out there, and that I am, quote, “guaranteed” payment. This is just not true. Even if I only get paid 80-90% of the time, a.) getting paid is then by definition NOT guaranteed and b.) it is nowhere near as secure a payment method as prepayment (retainers) are. This is a method that IS 100% guaranteed- you pay me up front, I bill against that as we go, and if you don’t pay up front I don’t treat you. This is the way the concierge system works, which is why I called it much more of a cradle. In all the retorts, I have yet to see anyone defend the original position of Anon 12:31.
    But yet, he/she fails to admit that they are wrong.

    And for the last time, I CANNOT choose to negotiate rates. Get that idea out of your head. It isn’t any issue of not choosing to, or not fighting to, its that I just plain can NOT.

  • Anirban

    “I’ve been an insurance defense lawyer, I know the coding games. But be honest, what percentage of your claims get paid? 80? 90?”

    How frequently as an insurance defense lawyer, you were reimbursed 80-90% of what you negotiated with the company? Tell honestly

    “What kind of crap statement is that. If we aren’t at the “top of our game” we know you will be sticking your penis up our ass”

    Threat of lawsuit can make your life hell but won’t make your practice safer for patients. The rate of frequency of committing malpractice is almost same in New Zealand, without a well organized tort-industry. Excellence comes through competition, in the realm of carrots and sticks. But if the parameter of excellence becomes the no. of patients you can churn out, quality must suffer. All the hoops and regulations that tried to circumvent the free markets in medicine, although well intentioned, have created unfortunate consequences. I think it’s true for a free market everywhere. We know physicians and nurses are in short supply, there is a cost for making one, and we have to poach regularly from third –world countries, to their peril. Still it remains insufficient for the burgeoning population. So definitely, rule makers were prioritizing on the volume. But I acknowledge the fact that the performance based incentives would work better for everybody.

  • DBR

    posted by Anonymous : 10:18 PM:
    “Do you really think the good ones lose 80% of their cases at trial? Tell me, what percentage of med mal cases do you think settle?”

    Fortunately, we don’t have to guess at these numbers. PIAA Claim Trend Analysis notes, on national average:

    29.7% of medical liability claims are settled in favor of the plaintiff.

    63.6% are dismissed, dropped or withdrawn in favor of the defendant (that’s the doctor or hospital. It costs an average of $15,000-$25,000 in defense costs for each of these claims, depending on what point in time they’re dropped, dismissed or withdrawn.

    5.5% are a verdict in favor of the defendant

    1.3% are a verdict in favor of the plaintiff

    So, of the 6.8% of claims which actually reach a courtroom, 80.88% (I think we can safety round that UP to 81%) are found in favor of the health care provider – i.e., a jury says there was no negligence and the provider isn’t liable for the plaintiff’s injuries or condition – and no money changes hands, except for defense costs.

    Do the “best” personal injury lawyers have a higher percentage of “wins” than the 19% average? Of course they do – I suspect they also have the highest percentage of settlements, since doctors and hospitals will be less likely to take a chance in court with a firm that has a strong track record of big courtroom verdicts. And I also suspect that the really “good” firms are far more selective about the cases they accept than those with less experience.

    It costs medical liability insurers an average of $85,000 to defend a doctor in court, regardless of negligence or LACK of negligence.

    Lots of money getting spent on defense costs and driving up the cost of insuring health care providers…

  • Anonymous

    “(that’s the doctor or hospital. It costs an average of $15,000-$25,000 in defense costs for each of these claims, depending on what point in time they’re dropped, dismissed or withdrawn.”

    Of course, let’s remember that the $15-25K includes such things as insurer building maintenance, executive salaries, etc. As does the $85,000 figure. All things which the insurer would have regardless.

  • Anonymous

    “Even if I only get paid 80-90% of the time, a.) getting paid is then by definition NOT guaranteed and b.) it is nowhere near as secure a payment method as prepayment (retainers) are.”

    The number of people who can afford to pay retainers is limited. In fact, the most frequent users of retainers are insurance companies, who don’t want firms to be able to file suit against them.

    I believe at one time AIG had 700,000 law firms employed.

    So let’s throw retainer out the window, because it simply isn’t an option for 90% of legal clients – at least individual legal clients.

  • Anonymous

    “the cases are settled only if the cost of defending is more. This has created the incentive for ‘nuisance settlement ‘’cause the cost is scary down the line.”

    Based on your vast experience in settling cases with insurers, can you tell me which ones roll over and pay on cases with poor liability?

    “So, how much a criminal defendant worth in most of the cases ?”

    Your question makes no sense. Are you asking what is the going rate to defend someone in a criminal case? If so, there is no set number – it depends on locale, type of crime, etc.

  • Anirban

    Your question makes no sense. Are you asking what is the going rate to defend someone in a criminal case? If so, there is no set number – it depends on locale, type of crime, etc.

    Are you the anonymous of post 10:18 PM, don’t think so. Read that up. What I said there are criminal charges for a drunk physician operating and screwing up, a better scale of justice than the phony civil action. And most of the criminal defendants can’t pay their victims anyway. No way it was about the cost of defending them .Frankly speaking we all are lost in this quagmire of anonymice. Please take up a name.

    Based on your vast experience in settling cases with insurers, can you tell me which ones roll over and pay on cases with poor liability?

    The post by DBR : 10:17 AM will educate you hopefully.

  • Anonymous

    “Of course, let’s remember that the $15-25K includes such things as insurer building maintenance, executive salaries, etc. As does the $85,000 figure. All things which the insurer would have regardless”

    I don’t think that was in the figure rather how much it costs to “defend” a suit. Perhaps DBR can enlighten us.

  • Anonymous

    “I don’t think that was in the figure rather how much it costs to “defend” a suit. Perhaps DBR can enlighten us.”

    Ever read those studies about what “tort costs” are that come out now and again? Did you know those include such things as building maintenance, salaries, etc? They also include payments for property damage when one insurer pays to fix your car when it’s hit even if you’re not in it. And the salary of the adjuster who reviews the claim. All things completely unrelated to any case which may or may not be filed.

    Anirban, your posts continue to make no sense whatsoever. You seem to be proposing we get rid of all insurance and just let . . . well, who knows. . . pick up the tab. And someone will have to pick up the tab.

    Why would these be any less deceptive?

  • Anonymous

    “Ever read those studies about what “tort costs” are that come out now and again….”

    Those studies….What studies? Give us more than an unsubstantiated statment. Words on a weblog mean little wihout a reference. Do you have a reference that specifically calls the “PIAA Claim Trend Analysis” number into question, let’s see it.

  • Anonymous

    I don’t think it is “in question”, I just don’t know what it covers. It is probably an accurate statement of whatever it includes.

    The primary study on tort costs is that by Tillinghast Towers Perrin – comes out every year, and each year it is touted loudly by those who would close the courtroom door to all but the wealthiest.

  • DBR

    “Of course, let’s remember that the $15-25K includes such things as insurer building maintenance, executive salaries, etc. As does the $85,000 figure. All things which the insurer would have regardless”

    Maybe I’m just particularly dense this morning, but I don’t understand the relevance of this….my earlier post referenced what medical liability insurers have to pay defense attorneys to defend the doctors they insure. How the defense firms USE the money they get paid is pretty much up to them – as is how the personal injury firms use the contingent fees THEY earn. EVERY business uses the money it earns to pay expenses and overhead….

    Someone asked how many cases are settled, etc, and in answering that question, I merely pointed out that a LOT of money is being spent by medical liability insurance companies to defend doctors in cases which are either dropped, dismissed or withdrawn, presumably because there was no clear evidence of physician negligence, and therefore, no case to pursue – i.e., no money to be made by the plaintiff or his/her attorney. The ONLY group which always gets paid in a medical liability cases is the defense attorneys, who are paid by the hour, as opposed to the plaintiffs’ attorneys, who, in most cases, are paid only if they WIN….

    The cost of defending these physicians, who have been found to be “guilty” of nothing, is VERY high and raises both their own medical liability premiums as well as the premiums of every other doctor practicing in the state, as most carriers spread the risk across all insureds….

    By ALL means, cases against doctors who’ve committed legitimate malpractice should be pursued and the injured parties should be compensated – but if more than 60% of cases are dropped, dismissed or withdrawn, and 81% of doctors whose cases make it to the courtroom are found by juries NOT to have been negligent and each of those cases costs $85,000 to defend, doesn’t that give us a pretty good idea of why medical liability premiums are so high? Because the med-mal insurers have to pay defense costs in EVERY case….

  • Anonymous

    “my earlier post referenced what medical liability insurers have to pay defense attorneys to defend the doctors they insure. How the defense firms USE the money they get paid is pretty much up to them – as is how the personal injury firms use the contingent fees THEY earn. EVERY business uses the money it earns to pay expenses and overhead….”

    Not the defense firms’ overhead – the insurers’ overhead.

    ” I merely pointed out that a LOT of money is being spent by medical liability insurance companies to defend doctors in cases which are either dropped, dismissed or withdrawn, presumably because there was no clear evidence of physician negligence, and therefore, no case to pursue – i.e., no money to be made by the plaintiff or his/her attorney.”

    A “lot” relative to what? Regardless, though, some money is spent. So how do any of the tort reform proposals reduce that amount? If you wanted to reduce that amount, encourage doctors to submit to pre-suit discovery. Give them the ability to offer a deposition early in the process and get out if there is no liability. As you pointed out, it does the plaintiff no good to incur costs against people who ultimately aren’t liable, but how exactly are they supposed to find out who exactly was responsible for what without filing? Physicians aren’t exactly rushing to tell patients who screwed up when something does go wrong.

    ” and 81% of doctors whose cases make it to the courtroom are found by juries NOT to have been negligent and each of those cases costs $85,000 to defend, doesn’t that give us a pretty good idea of why medical liability premiums are so high?”

    Not at all. Medical liability premiums are high because the damages, which are primarily past and future medical bills, are high, and increasing at the rate of medical inflation. This is not money that goes in the victim’s pocket – it goes right back into the medical system. Either the health insurer takes it back through subrogation, or it is paid back to doctors in the form of future medicals.

    To simply say that defense costs are the reason premiums are high is silly, without accurate statistics as the percentage of operating revenue of insurers, knowledge of their investment income, etc.

    And it certainly doesn’t support any argument for caps.

  • Anirban

    “A “lot” relative to what? Regardless, though, some money is spent”

    “some money” relative to what ? if it takes a 25000 $ amount to get a case dropped it is a lot of money / case .

    “how do any of the tort reform proposals reduce that amount?”

    By disincentivizing the attorneys to take up these 60% bogus claims which would be dropped any way and fight 75% of the cases in court what they will lose, come rain or come shine.

    “how exactly are they supposed to find out who exactly was responsible for what without filing?”

    If they believe all the time that somebody must be responsible for something then may god ( now, attorneys) save them.

    “Physicians aren’t exactly rushing to tell patients who screwed up when something does go wrong”

    When did you see any defendant in any case rushing to tell the plaintiff, in this adversarial system?

    “This is not money that goes in the victim’s pocket – it goes right back into the medical system”

    That was the cost of future medical bills anyway; no way was it supposed to go to his/her pocket. If it goes to the medical system then they get it for providing a service to the victim. They are not getting it for free. What is your point here? Caps are for non-economic damages ,nothing to do with the medical bill.

  • Anonymous

    “By disincentivizing the attorneys to take up these 60% bogus claims which would be dropped any way and fight 75% of the cases in court what they will lose, come rain or come shine.”

    This will happen because. . . you say so? Based on your extensive experience with the law?

    “When did you see any defendant in any case rushing to tell the plaintiff, in this adversarial system?”

    They don’t become plaintiffs and defendants until much later.

    “That was the cost of future medical bills anyway; no way was it supposed to go to his/her pocket.”

    You miss the point. Who pays that cost is the question. We require the responsible party to pay. If you want the taxpayer to do so, then propose a single payer system and let the govt. pick up the damages.

    “Caps are for non-economic damages ,nothing to do with the medical bill.”

    Exactly! That’s why they won’t do anything with regard to liability insurance costs, the cost of healthcare overall, or defensive medicine.

    And that’s also why people with no economic damages other than medical bills, like children, the elderly, and stay at home mothers, get hurt the worst by noneconomic caps.

  • Anonymous

    “Exactly! That’s why they won’t do anything with regard to liability insurance costs, the cost of healthcare overall, or defensive medicine.”

    Where’s the proof regarding this statement about caps?

    “And that’s also why people with no economic damages other than medical bills, like children, the elderly, and stay at home mothers, get hurt the worst by noneconomic caps.”

    Says who? ATLA? The medical bills are paid, but not out of the noneconomic damages. Where’s the proof for that statement?

  • Anirban

    “This will happen because. . . you say so? Based on your extensive experience with the law?”

    Why won’t this happen based on your law experience.

    “Caps are for non-economic damages ,nothing to do with the medical bill.”

    Exactly! That’s why they won’t do anything with regard to liability insurance costs, the cost of healthcare overall, or defensive medicine.”

    Q name states starting with the letter k
    A Arkansas Texas…..uh……!
    Q No buddy I said starting with K….. for example Kentucky Kansas ………
    A Exactly! Connecticut
    Q forget it.

    Sounds like this.

    “And that’s also why people with no economic damages other than medical bills, like children, the elderly, and stay at home mothers, get hurt the worst by noneconomic caps”

    Did the caretakers for these dependent groups abandoned them after the tragedy
    Or they were planning to start a job following hospital discharge?
    Any sort of disability hurts. How these people are hurt the most is not clear .

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