Friday, March 30, 2007

Capped fees for doctors

Remove the financial incentive, and you get what's happening in Canada - perceived doctor shortages:
Now, we have a situation where the great doctor can only bill a maximum of $450,000 per year (minus overhead and taxes). When, prior to the cap, he was happy to work for "services rendered" and billed accordingly.

However, now his $1.3 million practice is cropped at $450,000 per year. So he has two choices - flee to the United States, make huge dollars for 10 years, return to Canada (maybe) and be the normal doctor again. Or, look at your cap, design a perfect 40-hour week, bill out to the maximum by September of each year and then enjoy a three-month holiday.

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Comments:
I though physicians supported caps - oh, wait, only caps on OTHER PEOPLE.
# posted by Anonymous Anonymous : 10:40 AM
 
Haha that is the most ridiculously stupid comment I have ever read! Good comeback! Apples to oranges my friend.
# posted by Anonymous Anonymous : 11:26 AM
 
You're right, it is apples to oranges. The physician can continue to earn income, albeit capped, for the rest of their life.

The victim of their negligence, however, only has the one shot at getting his economic damages and lost quality of life compensated for.

Good call on your part.
# posted by Anonymous Anonymous : 11:36 AM
 
11:36: You are obviously the victim of an educator's negligence. I wish I could get the lost quality of my life as a doc comepensated for.
# posted by Anonymous Anonymous : 12:35 PM
 
$450 K a year sounds good to me--but is that what is taken home or is that before costs? As an otolaryngologist in a heavily managed care market, if I billed $450 K I would recieve about $150K and then take out my overhead expenses from that...leaving me with about what my gardener makes. In fact, that's about what I really do make.
# posted by Anonymous Anonymous : 4:39 PM
 
The american physician right now is a well oiled machine. Market forces demand efficiency and patient satisfaction. Doing anything to the current system will get rid of the most efficient physicians on the planet. I did some time in England and on a typical OR day they would do two surgeries in the morning break for lunch for 2 hours and do one more case. That kind of schedule would be laughed at by 99% of the orthopedic surgeons in this country. In the U.S. I get close to double digits in the number of cases I do by lunch time. So I'm doing roughly the work of 5-6 British physicians and people want to take incentive away from the system. That will work great with the aging baby boomer population demanding such quality of life operations such as total hips and knees. Need a new hip? maybe next year, maybe never.
# posted by Anonymous Anonymous : 4:54 PM
 
You are spot-on Anon 4:54. The efficiency, particularly surgical and procedural efficiency, of the modern American physician is unparalleled. Gripe all you want, if you have the funds you can get it now. That is what the US populace demands; the situation can only become less efficient.
# posted by Anonymous Anonymous : 7:08 PM
 
This $450,000 is misinformation. You have to see the "minus overhead and taxes" to understand it. Right now in our community overhead approaches 60-70% for many physicians. Much of that overhead goes back to the community in the form of giving jobs to those who work for us, and the employment taxes for those employees.
Collectively, doctors are a major force in community employment, that generally is unrecognized.
So take that $450,000, subtract 65%, then subtract another 20% from that for taxes, and you see it's not really an astounding amount of money.
# posted by Blogger Greg P : 9:42 AM
 
While perhaps not "astounding", it probably still puts you in at least the top 3% of Americans in terms of income, and top 1% of the world.
# posted by Anonymous Anonymous : 1:44 PM
 
Kevin, once again, this is about Ontario and not all of Canada.

We have provinces (they are like your states, in case you didn't know) with distinct health care policies. Time and time again you point to how terrible things are in Canada and refer to some piece about Ontario.
# posted by Anonymous Anonymous : 2:09 PM
 
"While perhaps not "astounding", it probably still puts you in at least the top 3% of Americans in terms of income, and top 1% of the world."

The lowliest working Americans are already in the top 10% of the world; heck even many of the illegal non-Americans working here in the top 10%. Considering the many years (30) I spent in the bottom 1% of the world before I had a paying job, I guess it all averages out to me being about in the middle over a 30 year career. The only difference is I am in a higher tax bracket since my earnings are more concentrated, and I have less time to contribute to a retirement fund.
# posted by Anonymous Anonymous : 8:55 PM
 
Nationally averaged Canadian physician net earnings in 2005:

Dermatologists $240,000
Internists $$200,000
Ob/gyns $195,000
Pediatricians $160,000
Psychiatrists $160.000
GPs $155,000

source: http://www.nationalreviewofmedicine.com/issue/2006/10_15-30/3_PM_your_practice01_16.html

That's not bad at all. Why all the complaining??
# posted by Anonymous Anonymous : 11:17 AM
 
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