"The cost of business is killing doctors"

More primary care woes:

“The nationwide average income for family physicians is around $120,000, and none of the doctors in my practice were making $100,000. We make less, probably $20,000 to $25,000 a year less than the doctors in other states.”
According to a recent national study by the Center for Studying Health System Change, physicians’ net income from practicing medicine dropped about 7 percent between 1995 and 2003.

(via Medpundit)

Comments

Anonymous
I read the article last night and wondering when it would show up here. The following was an interesting figure:
“Udall said his medical liability insurance is $18,000 this year, compared to $16,000 last year.”
All hyperbole aside, most Americans wish that they could be “killed” making 75-80K per year.
Anonymous
Seriously. What’s the average income in these areas overall? That would give us a better idea if the physicians are adequately compensated.
Anonymous
“All hyperbole aside, most Americans wish that they could be “killed” making 75-80K per year.”
Most Americans don’t work 65-80 hours a week and take o/n call every 3-6 day. Trust me I used to be an Arizona internist.
Anonymous
Nor do most physicians.
Anonymous
The one thing that I can say about this article is that it at least presented a somewhat balanced view of the issues. Most of the MSM aticles only discuss the “woe is me, look at my insurance rates” part of the story while conveniently leaving out that the provider is still taking home at least 100K after all expenses. It is harder to engender sympathy and get people to give up their rights when the beneficiaries of the same are still making the money that they do.
Jeff Barson
A conversation I just had pops to mind.
Surface Skin Centers (http://www.surface-med.com)is starting a roll out in the South East with a beta site in TN. I was in Nashville where there was a physician being recruited to become a medical director and be trained in cosmetic proceedures.
Salaries came up and the doc expressed some skepticism that the offer ($140,000) would be enough to attract physicians.
As for myself I know physicians who would jump at the chance of taking home a salary of 140k, paid vacation, paid malpractice, no call, and no staffing or other headaches. Still seems like a sweet deal to me.
Every physician we have hired has found us. It’s true that the cost of business is killing doctors and it will continue. Single docs will go the way of the family farm. They just can not compete against corporations with resources.
Anonymous
“Single docs will go the way of the family farm. They just can not compete against corporations with resources.”
Those corporations have major down sides. I live in a university down where 90% of the health care providers belong to one of two large “clinic associations,” and frankly, service at both absolutely sucks. They know they’re the only game in town and they act accordingly. Not coincidentally, very few people in town have anything good to say about local health care, but unfortunately have few alternatives.
I would MUCH rather see independent physicians earn higher net incomes than watch health care go this route. I’m sure the independents work much harder for their money and treat their patients far better.
Anonymous
“Most of the MSM aticles only discuss the “woe is me, look at my insurance rates” part of the story while conveniently leaving out that the provider is still taking home at least 100K after all expenses.”
They also neglect to mention that malpractice insurance, on average is less than 5% of overhead.
Anonymous
The medmal rates aren’t killing them, but they aren’t helping, either. The biggest expense of most outpatient offices is staff: the people hired to answer phones, sit at the front desk, fetch files, file insurance claims and assist patients. Wages and benefits are the biggest cost. Office rent/mortgage, utilities, computer hardware and software, general business insurance, medmal insurance, office equipment, and office consumables collectively equal the staff component. What is left generally goes toward professional pay. “Profits” in the proper sense is only what is left over after all bills are paid and all non-owner professional staff have been paid under their agreements.
Some commenters have erroneously treated all revenues not paid to a professional as “profit”, completely forgetting that the practice goes nowhere without a doctor to work. Unless there is allotment for a reasonable minimum salary for the doctor–let’s say enough so that doctor doesn’t quit and move somewhere else–then all operating costs for the practice have not been counted. Some people think that doctors should be paid no more than schoolteachers or anyone else earning an “average” income. Of course this is ridiculous, since doctors bear substantially higher investment costs to be able to work as a professional than any average worker.
So reasonable pay has to be proportional to investment costs. When it isn’t, doctors look to work elsewhere.
Anonymous
“The biggest expense of most outpatient offices is staff: the people hired to answer phones, sit at the front desk, fetch files, file insurance claims and assist patients. Wages and benefits are the biggest cost.”
This is the same for all offices. I would think the distinction for physicians would be the high cost of equipment.
Anonymous
Some people think that doctors should be paid no more than schoolteachers or anyone else earning an “average” income. Of course this is ridiculous, since doctors bear substantially higher investment costs to be able to work as a professional than any average worker.”
What specifically are you referencing when discussing “investment costs?” Regardless of the answer, there is no legal statute that equates X dollars of investment cost with Y dollars of requisite compensation. The compensation will be what the market bears (regardless of the regulation placed on the market).
“So reasonable pay has to be proportional to investment costs. When it isn’t, doctors look to work elsewhere.”
With all of the “malpractice crisis” states and providers fleeing because of being killed by only making high five to low six figures (after expense compensation)… where are they all going?
Anonymous
I say to all the Americans that think MD’s are still overpaid, spoiled and rich: continue to let the marketplace sort it out, but don’t complain when it results in no one wanting to be doctors anymore. Remember–you get what you pay for.
Anonymous
“…results in no one wanting to be doctors anymore…”
It will remove the people from the field whose primary motivation is financial and social status (the New Jersey Medical Association crowd – recall their emails).
Those that go into medicine with a primary motivation of wishing to heal the injured will continue to go into the field regardless of the level of financial compensation.
Anonymous
“Those that go into medicine with a primary motivation of wishing to heal the injured will continue to go into the field regardless of the level of financial compensation.”
There are not enough people in this category to fill the need we have for doctors.
I dont agree that we should lower docs income to 50k just so we can weed out the “greedy” people.
Docs should get paid more than other professionals. 100k is about the lower limit. Any lower than that, and instead of being docs, people will go into law or dentistry.
Dentists already average higher salary than primary care doctors, and they have 3 years less training.
You people already claim we have a huge doctor shortage, and your response to this is to lower wages? How the hell would that solve the shortage? It would make the doc shortage a hell of a lot worse.
Anonymous
I am not one that wishes to artificially lower the compensation rates of doctors. The best and the brightest should be able to make a great living. However, current salaries are based on the existing artificially limited supply system. Thusly, even the most bottom of the barrel malpractitioner can command a king’s ransom. Comparatively lower salaries in other first world countries has not stopped people from entering the medical field.
“Docs should get paid more than other professionals. 100k is about the lower limit. Any lower than that, and instead of being docs, people will go into law or dentistry.“
Should get paid more than other professionals? Hardly. They should get paid based upon their skills and in accordance with the maket bears. They should not get paid more based on a system that allows for only a limited number of providers to be trained such that compensation rates are based upon limited or non-existent competition. The doctors that are skillfull at their craft should have no problems with opening admissions and increasing seats at medical schools such that all qualified applicants are allowed a position.
Anonymous
“You people already claim we have a huge doctor shortage, and your response to this is to lower wages?”
Who is claiming that? Do medical schools have empty seats available?
“Docs should get paid more than other professionals. 100k is about the lower limit. “
Because. . . .?
Anonymous
“Nor do most physicians”
Based on what do you say that…..Oh yeah you don’t know what the hell you are talking about.
Anonymous
The shortage is in the contexts of meeting existing demand for healthcare services and in terms of having a sufficient number of providers to engender competition amongst them in the healthcare market (for the New York/Boston red herring individual – read my response to your last post in this regard). The shortage is not in relation to the number of applicants for existing medical school slots. These were restricted according to the recommendations of the Flexner Report.
Anonymous
>>”This is the same for all offices. I would think the distinction for physicians would be the high cost of equipment.”
Not necessarily true. Support staff requirements will vary significantly depending on the type of practice. Better trained people cost more, obviously. Specialty medical equipment can be very expensive, true, but in primary care the basics are not that bad. Staff is the biggest category, and has become bigger since medical offices now have billing personnel to handle insurance claims and chase payments. Dumping that back onto the patient and having a smaller, less-costly staff is a possibility, but there is a lot of resistance and resentment when doctors stop taking patients insurance cards and force them out of plan.
Of course, when forced, doctors will do this.
>>”What specifically are you referencing when discussing “investment costs?”
Education costs, both principal and interest, practice purchase costs, and the opportunity costs of income not earned during years of lengthy training. There is a large requirement to make up for lost time and money: home savings, children’s college funds, retirement savings, payment for business investment to start or buy into a practice, and paying off the school loans,. All this needs to be done in a compressed time period.
Could you save money going to a state medical school? Maybe, if you are lucky enough to qualify for in-state status somewhere that the tuition is still relatively cheap. There aren’t as many places like that any more, though.
>>” is no legal statute that equates X dollars of investment cost with Y dollars of requisite compensation”
Of course there isn’t. There is an imperfect market, though, and where there isn’t the possibility of recovering investment costs–as perceived by the potential investor, not the services buyer–few will want to invest, time, effort or money.
>>”With all of the “malpractice crisis” states and providers fleeing because of being killed by only making high five to low six figures (after expense compensation)… where are they all going?”
Where medmal is a practice market driver, they go where they can still afford to practice, that or they pare off practice services that add to the insurance bill but don’t cover their costs. Ergo, OB/GYNs drop OB and just practice GYN. Much cheaper for insurance that way. No one says they like it.
>>”It will remove the people from the field whose primary motivation is financial and social status (the New Jersey Medical Association crowd – recall their emails). “
You will only be left with sons and daughters of the wealthy with educational trust funds who don’t need to work to make a living. Problem is, there aren’t very many of those. For those doctors of more modest backgrounds, the practice has to justify itself, in work satisfaction and in return on investment. Why work as a slave for ten years to settle for an income typical of a worker with none of that investment? Doctors, like other people, aren’t that altruistic, and it is not reasonable to expect them to settle for that kind of compensation. Personal satisfaction doesn’t pay the bills or fund an old-age pension. Too many non-medical people indulge themselves in the fantasy belief that since medical care relieves suffering (sometimes) that it is unreasonable for the provider of that care to also expect a good living from that work (“Why isn’t the fact that you helped me satisfaction enough?”). That kind of thinking never seems to apply to practitioners of other professions that have high social utility.
>>”Those that go into medicine with a primary motivation of wishing to heal the injured will continue to go into the field regardless of the level of financial compensation.”
This is an immature and unrealistic view. Doctors choose medicine for many reasons, helping patients is one of many, but not the only nor necessarily the most important one. Some are attracted to particular disciplines the same way scientists are attracted to their disciplines. Some do enjoy the promise of prestige and income (poor calculation, though), and some choose because the work appears to offer greater social utility than other available occupations. You can’t and shouldn’t expect selfless altruism to be the motivator. That is a fantasy.
>>”Should get paid more than other professionals? Hardly. They should get paid based upon their skills and in accordance with the maket bears.”
Wishful thinking. If only we actually had a market to do the bearing. Good docs would demand cash at the counter and tell those expecting the big medical smorgasbord at Medicaid prices to take a walk. Be careful what you wish for.
Anonymous
“…results in no one wanting to be doctors anymore…”
It will remove the people from the field whose primary motivation is financial and social status (the New Jersey Medical Association crowd – recall their emails).”
What e-mails, you moron? Your statement is an out and out lie. I live in NJ and I’m a member of the Medical Society of NJ – geez, at least get the name right. There never were any e-mails of the kind that you refer to sent to members. Get your facts straight instead of propagating bullshit and lies on this site.
Anonymous
“Wishful thinking. If only we actually had a market to do the bearing. Good docs would demand cash at the counter and tell those expecting the big medical smorgasbord at Medicaid prices to take a walk. Be careful what you wish for.”
The above statement is so true. And it makes me wonder why you and your lobbying organizations spend so much time and money on things like malpractice insurance instead of things like working on how you are funded.
Anonymous
To the people who think that intelligent people will continue going into medicine if salaries keep falling: yes students are drawn to healthcare for reasons other than money, but they aren’t stupid and few people would agree to accrue massive debts, sacrifice years of earnings, and work more than their non-physician colleagues to make less money. Even if they enjoy practicing medicine, nobody wants to feel like they are getting a raw deal.
Anonymous
Read em and weep!
http://www.consumerwatchdog.org/healthcare/rp/1012.pdf
Do no harm? Yeah to the pocketbook and social status of the providers.
Anonymous
“To the people who think that intelligent people will continue going into medicine if salaries keep falling: yes students are drawn to healthcare for reasons other than money, but they aren’t stupid and few people would agree to accrue massive debts, sacrifice years of earnings, and work more than their non-physician colleagues to make less money. Even if they enjoy practicing medicine, nobody wants to feel like they are getting a raw deal.”
When we start seeing chairs at the medical schools going unoccupied, we can start seeing evidence of the above-cited contention.
Anonymous
From the aforecited e-mails:
“Public opinion must be on our side so we cannot alienate our pts(i
would agree that it would it is a bad idea to allow pts to come to the
hospital for surgery without WARNING them that they will be cancelled or
have significant delays. But in the same light surgeons who have cancelled elective cases for that week SHOULD NOT RESCHEDULE) .We can significantly inconvenience them(which is NOT irresponsible) and direct their anger from this to help our cause. Educate them ,have them write letters, make phone calls , write letters to the editor of your local newspaper etc. MOST IMPORTANTLY, our pts must TRULY EXPERIENCE significant delays, inconvenience and INABILITY TO CHOOSE a physician to UNDERSTAND the
full impact of what this crisis is all about, and that down the line,
without reform, it will not simply be days or weeks but an an indefinite problem.”
Collusion? Do no harm?
Anonymous
I think you should all refuse all 3rd. party ins. Force them right out of business. Then you should all refuse to carry malpractice ins…If the bunch of you did it then there would be no lawsuits because the Lawyer’s aren’t going to spend all this time suing Doctors who have no ins.
But, plan for it first. get all your assets out of your name. Put it all in trust accounts for your grandkids or something.
If you have no malpractice ins. and no assets what can they take? A Lawyer doesn’t give a shit about your license to practice, he only cares about money.
Doing all this will also allow you to cut down significantly on your overhead, offering your patients better prices for OV’s.
Soon no pts. will carry any private health ins. because no doctors accept it. Get those ins companies and lawyers both off your backs.
Anonymous
“But, plan for it first. get all your assets out of your name. Put it all in trust accounts for your grandkids or something.”
How do you get retirement assets (IRA’s, 401k’s, defined benefit plans) out of your name?
Anonymous
When we start seeing chairs at the medical schools going unoccupied, we can start seeing evidence of the above-cited contention.
What about more subtle indicators, such as a decade-long steady decrease in the number of medical students choosing primary care. In 2005, only 70% of family practice residency positions were filled in the resident match day. This figure has been decreasing for the last 9 years to the point that match day is now known as “black Wednesday” among family practice program directors. I guess this wouldnt concern you, however, since you think the only indicator could be “seeing chairs at the medical schools going unoccupied” Med school apps will not fall if for no other reason than the fact that not all areas of medicine are in trouble. Interest in surgery, dermatology, and other various specialties is as strong as ever, but interest in some of the specialties we need most (ie primary care) is suffering and this cannot be denied.
Anonymous
I am not as overly concerned about this as I would be if chairs at the medical schools were going unfilled. If the interest in primary care is the problem that it is being made out to be, then one solution would be to have not only preferential acceptance of students into medical school that will go into the primary care fields but also make it a contractually binding term for admissions with a requisite number of years in primary care practice following the completion of residency with appropriate penalties such as no allowance for residency, civil breach of contract, etc. to provide some teeth.
Anonymous
I think they should do that. Only then we, the few remaining primary care physician, could write our own ticket. ))
Anonymous
>>”Yet, there is no gaurantee of high financial renumeration for any other field as there is for American allopathic medicine.”
I think that is the point of the OP. There isn’t a guarantee of a high salary for doctors either, allopathic or osteopathic. That is the problem, as much of the so-called market is controlled by insurance entities who underpay for outpatient primary care services. Dentistry, podiatry, and other medical professionals earn much more. Their incomes aren’t guaranteed either.
Anonymous
make it a contractually binding term for admissions with a requisite number of years in primary care practice following the completion of residency with appropriate penalties such as no allowance for residency, civil breach of contract, etc. to provide some teeth.
Surgeons, dermatologists, radiologists, etc. are not qualified to practice OBGYN, family medicine, or psychiatry. This would require additional years of residency training unless you wanted to see the number of malpractice cases skyrocket. Try telling a surgery resident with a wife and family to support in his eighth year of residency that even though he is 36 and has been out of college at least 12 years without receiving more than a pittance for his 80 hour work weeks that he needs to incur additional training so that he can delay earning a real paycheck even longer once he is finished.
Anonymous
It is not something that one would implement midstream. That would be a bit barbaric. Start it with the incoming first year medical school students. The proposal is simple but has some real teeth. Instead of worrying about a med student who is admitted because they say that they have an interest in primary care, only to change that interest later, make it so they can’t ever obtain a residency.
Anonymous
These kinds of programs already exist.The U.S. Public Health Service sponsors a limited number of medical students under the uniformed services’ Health Professions Scholarship Program. Of course, nothing is preventing local communities from creating funds to pay for physicians to practice in their communities in exchange for paying off school loans or outright cash subsidy. That is a more realistic approach than trying to lock each and every medical student into terms of primary care service. Contracts of that nature, particularly if they are not tied to some significant monetary payment, are coercive in practice and really not true contracts, more like institutional extortion. If a medical student doesn’t want to work in primary care, he shouldn’t have to. We don’t make every law school graduate work legal aid.
Anonymous
People apparently forget that taxpayers are already subsidizing a large chunk of the medical training budget for physicians in training. There is nothing coercive about having the system set up in a manner such that only those that are interested in serving a targeted societal need are allowed into the medical schools. The practice of medicine is more than a vehicle to serve the needs of individual providers and providers in training.
Anonymous
>>”People apparently forget that taxpayers are already subsidizing a large chunk of the medical training budget for physicians in training. There is nothing coercive about having the system set up in a manner such that only those that are interested in serving a targeted societal need are allowed into the medical schools.”
The funds are not spent to the benefit of the residents in training exclusively. Housestaff provide care to Medicare beneficiaries without charges for their services (only attendings are permitted to do this) and are generally available far more hours during the workweek than attending staff generally are. As is, they are a terrific bargain for the government. But you would like to tie their service to still more duties. That is the typical mindset of the coercive, statist social engineer.
I think it is a plan that would blow up in their faces and would not work at all.
Anonymous
“If you have no malpractice ins. and no assets what can they take? A Lawyer doesn’t give a shit about your license to practice, he only cares about money.”
If you’re hiding all you assets to pay a judgment you owe, what does that show is most important to you?
Anonymous
“If you’re hiding all you assets to pay a judgment you owe, what does that show is most important to you?”
Only a lawyer what come up with hat kind of assinine statement
PS: who do you think comes up with the vehicles to hide money…lawyers.
Anonymous
“But you would like to tie their service to still more duties. That is the typical mindset of the coercive, statist social engineer.”
How is an enforced primary care preference as a requisite for medical school admissions placing any more duty on the part of the physician in training than that which is placed upon them currently?
Anonymous
“Only a lawyer what come up with hat kind of assinine statement”
Are you a lawyer – the original statement was yours.
Only a lawyer what come up with hat kind of assinine statement
“PS: who do you think comes up with the vehicles to hide money…lawyers.”
Lobbyists for people like you write those protections.
Anonymous
“Lobbyists for people like you write those protections.”
Ohhhhhhhh please. Go back to law school pal.
Anonymous
I’m a surgeon, and it costs me more to get my haircut than I charge a self-pay patient to see me in clinic. I’m fairly certain that my overhead costs (55% of revenue) are much larger than my hairdresser’s.
Anonymous
I think that we need a real life example to see if I am overpaid. I’m an OB/GYN. When I entered medical school I thought that I would do internal medicine. When I reached my clinical years I discovered that I hated it and much prefered working with my hands. I liked delivering babies and I like operating. So I’d be screwed if I signed a contract before medical school binding me to primary care. Perhaps we need contracts at the end of medical school where the debt is erased if you choose primary care.
So I came from a lower middle class family and I had to borrow my way through med school. When I graduated I owed $105,000. During my 4 residency that expanded to $150,000 as I chose forebarence on my loans as I made about $27,OOO/yr when I was a resident.
Over the past 12 years I have paid Sallie Mae (that -itch) $290,000 as such I made my last payment in May.
Now last yr, I made $250,000. $55,000 to the feds, $12,000 to the state, $4,000 in local and about $8000 or so to FICA, leaving me $171,000 take home.
Now I am in a group of 3 so one of us is always on, This means that I was working (yes sometimes lying in bed, but still on) for 2,920 hours last year, Thats 73 weeks of work for those who work 40 hrs per week. I took home pretax$85.62/hr or $ 58.56/hr net. Is that too much…. My lawyer charges a $125/hr when I talk to him….
Anonymous
The social engineers and doctor haters on this board are schizophrenics.
First, they claim we have a doctor shortage.
Their answer to that shortage is to cut wages to doctors.
Next, they want docs to be forced indentured servants in primary care. No other profession in the world operates that way, not one.
So on one hand, you’d think that means they think doctors are “special” right? If doctors are supposed to be indentured, doesnt that mean they have a great value to society? Apparently not, because in the same breath the schizos rail on and on about how all docs are greedy, arrogant, in the rpofession for the “wrong” reasons, etc.
But yet I dont hear them chastising anybody else for choosing a profession for the “wrong” reasons. They selectively apply it to doctors, implicitly stating that somehow doctors are “special” compared to other groups. But in teh same breath they deny it and declare all docs filthy animals just like common society.
So which is it guys? Are doctors special? Is their value to society so great, so important that it deserves special government regulation and artificial wage regulation as you suggest?
Or on the other hand, are docs just ordinary people with jobs just like everybody else? People whose jobs have no more implicit value than any other job? If thats the case, then why argue for govt control and wage regulation?
The schizos on this board are speaking with double forked tongue. From a govt perspective they treat docs as “special” but from a societal perspective they deny that doctors are special and instead are just ordinary people with jobs just like anybody else.
So which is it? Are doctors no more important than garbage men? If not, then why should the fed govt be involved at all in healthcare?
On the other hand, the schizos also want to hold doctors up as a “special” profession thats so valuable that federal control is required.
Anonymous
Doctors seem to be the only professionals in which everybody is so concerned about controlling their income.
I dont see the federal government considering any wage regulation for lawyers, social workers, teachers, engineers, accountants, CEOs, clerical workers, secretaries, construction workers, or anybody else.
Meanwhile, doctors are subject to federal govt wage fixing i.e. Medicare. Why dont we have a TeacherCare in which the fed govt dictates income for teachers? Why dont we have a LawyerCare where lawyer salaries are regulated by the fed?
Why are doctors so special, so important, that they must have their own federal wage control system?
Anonymous
“How is an enforced primary care preference as a requisite for medical school admissions placing any more duty on the part of the physician in training than that which is placed upon them currently?”
No other profession in hte USA operates that way. I dont see the fed govt requiring all teaching grads to work in underserved areas.
I dont see the fed imposign any rules forcing lawyers to work pro bono.
I dont see any regulations forcing CPA accountants to work for small businesses.
Apparently you believe doctors are “special” compared to these other professions.
Anonymous
“If the interest in primary care is the problem that it is being made out to be, then one solution would be to have not only preferential acceptance of students into medical school that will go into the primary care fields but also make it a contractually binding term for admissions with a requisite number of years in primary care practice following the completion of residency with appropriate penalties such as no allowance for residency, civil breach of contract, etc. to provide some teeth.”
Yet another argument that doctors are somehow “special” relative to other professionals. ARe you saying docs services are more valuable than a lawyer or an accountant? Otherwise why selectively apply it to docs?
P.S. There are already a shortage of docs willing to go into primary care. Making a new law forcing all med school grads to do primary care wont fix this problem, it just means the number of applicants will plummet. Then you’ll have to expand the system wide open to absolutely everybody, in order to fill all the slots.
You are a hypocrite. You want to open the floodgates, yet you also bitch about the current lack of quality in docs. Your response to the quality problem is to let EVERYBODY be a doc? What kind of sense does that make?
The only way you could justify an “opening the floodgates” philosophy is to claim that doctors are overtrained and that their training is overkill for what the job description requires. Is that what you are arguing?
Anonymous
As I have time this weekend, I will address the rest of your points (the majority of which you could address yourself if you actually read the posts to which the quoted comments were in response to).
“Yet another argument that doctors are somehow “special” relative to other professionals. Are you saying docs services are more valuable than a lawyer or an accountant? Otherwise why selectively apply it to docs?”
There is nothing special about the field of medicine except that it is the only field in which the existing service providers have created a stranglehold on the supply of production of new providers. Review the recommendations of the Flexner Report and your basic first year undergraduate economic texts to see what the effects are of supply side restrictions (go back and read the posts where we have discussed this topic previously as you don’t bother reading the responses and repost your same objections) are on costs for service for stagnant or increasing demand. The value of an allopathic physician has no more inherent value than that of the accountant or lawyer. Each serves a requisite and needed task specific function thereby creating temporal variances in relative value. The specific issue that I was providing an opinion on, in regards to your second question, was the commentary of another poster making a reference to the unfilled residency slots for primary care.
“There are already a shortage of docs willing to go into primary care. Making a new law forcing all med school grads to do primary care wont fix this problem, it just means the number of applicants will plummet. Then you’ll have to expand the system wide open to absolutely everybody, in order to fill all the slots.”
I never suggested the implementation of this practice for students already in medical school. The plan that I suggested would be implemented, perhaps on a temporary basis, until there are a sufficient number of providers to fill the primary care demand. There may be some that are interested in the surgical specialties that would choose not to apply. There are numerous qualified students, who are not currently granted admission, who would readily replace those that do not have an interest in primary care.
“You are a hypocrite. You want to open the floodgates, yet you also bitch about the current lack of quality in docs. Your response to the quality problem is to let EVERYBODY be a doc? What kind of sense does that make?”
Your lack of ability when it comes to reading comprehension does not make me a hypocrite. Go back and re-read my post. Please point out where I suggested that the medical schools should be open to everybody. My suggestion was to open admissions to all qualified students. The claim that the current system only allows the best and brightest to practice is mitigated by the fact that any student can attend a Tijuana Tech medical school, pass the boards and perform a residency to practice domestically. Coupling this with the fact that 25% of the provider base is foreign trained and has passed the boards and performed a residency only points to the conclusion that the small number of seats for incoming medical classes is an unnecessary artifact imposed by the acceptance and implementation of the suggestions of the Flexner Report. Not only does this manner of training force qualified American Citizens to move overseas for at least four years but it also drains the provider population from places in the world that can ill afford to loose them.
The current system does little to engender quality. One could, again, make the argument that the current training system is set up to only train the best and brightest (including the requisite coupling of medical training facilities with large research institutions). This argument is obviated by the fact that foreign trained students attending institutions that only in the best light would be deemed as conforming to American medical school standards are not only allowed to practice domestically but are able to pass the requirements to do so. The second issue is that with the restricted supply of providers, particularly in rural and urban areas, a provider with a hypothetical competency rate (use whatever hypothetical metric you choose) of 75% is better than no provider at all. Thusly, a quasi-competent provider is allowed to remain in practice as the other option is no healthcare at all. A Faustian bargain to be sure for the patient population.
Anonymous
I’ll say it again:
The USA ranks #5 in the world in doctor ratio per capita.
Thats #5 out of some 40 odd industrialized nations.
Relative to other nations, the USA has plenty of docs. Hell hte USA has a younger (i.e. healthier) population than most of the industrialized world yet we still rank near the top in terms of docs per capita.
Your ridiculous argument that the USA has some kind of dire doctor shortage is just flat out false.
Anonymous
Medical school is easy to get into these days… hell the acceptance rate is OVER 50%
Yet we have fools arguing that we should start taking people from the bottom half of the applicant pool?
Anonymous
Is there a better paid group in this country that whines even half as much as physicians about how much they make?
Anonymous
The value of an allopathic physician has no more inherent value than that of the accountant or lawyer.
I don’t know. Out of these three profession which one is more likely to save your life? If you were stranded on an island, which one of these three would you rather have with you?
Anonymous
“The USA ranks #5 in the world in doctor ratio per capita.”
Fifth in per capita number, first in after expense compensation and where in quality (we won’t discuss that one). Tell the people in the rural and urban areas of our country that have no healthcare services that the legion of saline bag stuffers for the vainglorious is indicative of a sufficient provider base.
Even the AMA, which for decades has been responsible either directly or indirectly for the provider shortage is finally starting to see the light on this issue. I can dig up the link for you.
If I was a betting man, I would think that you are a bit afeared of a little competition in the field.
Anonymous
“I don’t know. Out of these three profession which one is more likely to save your life? If you were stranded on an island, which one of these three would you rather have with you?”
It all depends. I would worry more about the allopathic provider doing absolutely nothing unless they received a check first.
If I was on an island, I would choose the person with the satellite phone, the boat or the McGyver-like survivalist skills.
Anonymous
I’d want the doctor on the island. We could float to shore on his inflated sense of self-worth!

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