You are right except for one thing:

We don’t have to accept Medicare, Medicaid, or managed care contracts. I have made a firm commitment to providing my services in the context of privacy and economic freedom. When the market doesn’t support it or the law makes it illegal, I will leave medicine. So far, my patients love it. The ones that don’t, aren’t my patients–they go to someone who doesn’t have the professional pride to take risks for the sake of autonomy and optimal quality of care.

But I am not a big enough fool to feel entitled to make a living doing it my way. I keep my eye on options.

In fact I get less whining about 80$ cash visits now than I did about 20 dollar co-payments. In the latter case, people saw me as an extension of the insurance company which they had already paid, a utility to which they were entitled greedily squeezing a couple more dollars.

Now they see me as a professional with whom they have a private relationship charging a fee that is a reasonable rental of my 24 years of education and 20 years experience.

The reasons doctors make so little (for what they do) is that the government has gotten in the way. The gold instructors are free to charge what they want, but doctors aren’t. (Medicaid, Medicare, etc, effect the prices of things… greatly.)

So yeah, doctors are going to leave the profession, because they are smart, hard-working types (mostly) who could quit easily find another job that either pays more, takes less effort, or both.

If you are saying that it’s OK that they make less because of supply and demand, your own argument has just said it’s also OK for them to go find another job, so don’t complain whn they do.

Considering that most patients don’t even want to pay their copay, guess we’d end up with no docs at all.

If people will not pay it, you need to find something else to do.

OK. 25% of $300k is $75k. $75k for a CABG is reasonable, unfortunately Medicare reimburses only $1800!! I’ll take the $75k anyday.

“Facts are your friend.”

Actually, with jury based reimbursements, like the lawyers have, I would have to say jurors would be my best friend! Forget about the facts…

Don’t even assume every patient pays us. Docs get stiffed all the time. And let’s not forget the free care provided to patients in the hospital, which we’re required to provide. So, yeah, I’m gonna bitch about my lousy receipts.

Facts are your friend.