Kevin, M.D. - Medical Weblog

seriously.
if people could just organize around reforming CEO pay... trifling with doctors who make 100-150 a year doing primary care is silly. and the overpaid specialists, well i don't think they are overpaid, just relatively overpaid in a system that's collapsing because of disrespecting primary, preventive, medical-home-based health care
 

First thing is to accept that narcissists naturally believe that anyone who makes more than they do is overpaid, as they are certain that they are as smart and contribute as much and work as hard as anyone, and are more worthy than most.

The second thing is to accept that there are a lot of narcissists out there who of course think as much of their opinion as anything else of theirs and are glad to share it publically.

The third thing, and this is hard for some doctors most of who are altruists at heart and most of the others are frankly socialists, is to accept that if you tie your income to your ability to convince committee's, legislative bodies, the public at large--anyone other than a paying customer in need of your service--of your worth, then you will be undervalued.
 

Everytime I go into the OR justifies my salary and quite frankly makes me think I am grossly underpaid.
 

The same citizen who will express admiration at a successful businessman or lawyer or entertainer will heap scorn on a far less high-earning physician. Don't expect to understand that; it is irrational. And the same doctor, even if asked to deliver services after normal hours and at a moment's notice is thought to be less entitled to be paid than the plumber under the same circumstances. That too defies understanding, and is likewise irrational. And the phenomenon isn't simply the resentment over having to pay for something, like fixing the drain, versus wanting to pay for something, like a new computer or vacation. At some level, people think that medical care isn't something they should have to pay someone else to have, regardless of what it costs in materials, or training, or labor to provide. The fact that they are asked to pay--even if they believe they can't--just sets this irrational sense of entitlement on its unavoidable path to collide with reality. And reality wins.
 

Years ago, I worked briefly as an "employment consultant" in an agency. One evening I went to visit with the few people I had met at the Y in a running group. They wanted to know where I was working, and when I told them, one woman (a nurse) became incensed that I would hold such an immoral job, wherein people had to pay in order to get a job. I did not have the presence of mind to point out that I had to pay in order to get medical care.

Some people just aren't rational. Their world view is the only one they can accept.

And while you're talking about other groups of people who are overpaid, how about some of our politicians? And--I don't remember--did anyone mention the good folks in Hollywood?

Personally, I would rather pay to see someone who had worked hard to become the qualified, competent person I want in a physician. Or a plumber, auto mechanic. . . .
 

"The same citizen who will express admiration at a successful businessman or lawyer or entertainer will heap scorn on a far less high-earning physician."

Yes, this is true. I remember Johnny Cochran saying something to the effect that his clients liked to see him driving a Rolls-Royce. They knew they had the "best" working on their case. Many of my patients assume I drive a Mercedes, while in reality I drive a Honda after 14 years of subspeciality surgical practice. I hope this doesn't diminish their impression of me. I may be the "best" but I am probably compensated less than the "worst" who have higher complication rates, overutilize, and perform unnecessary surgery.
 

I remember one fellow who complained incessantly about my fees, and would openly complain if I was 30 seconds late--yes 30 seconds--expressed overt disappointment to discover that I was driving a cheaper pickup truck than his rather than the Euro luxury car that he expected.

And he was in a Medicare HMO and paid a 5 dollar copayment.

The rational immediate response is to just ignore such people and hope they go away--I don't need to be everyones' doctor to make a living. The problem is that we live in what was once a constitutional republic but has become a democracy where the public's desires, no mater how unjust and irrational have the potential to get translated into law--without regard to the liberty rights of the minority.
 

What we have are a number of paradoxes or nonsequiturs in all of this.
I hear about patients who bitterly complain to my office staff about "doctors", maybe me in particular, that they can't be seen immediately whenever they want, then they come back to my office all smiles, complimenting me, saying, "Boy I don't know how you can work like this, I could never do it."

Some of the complaining I hear as a bystander in various settings, and it seems that you hear people talking about doctors everywhere you go, has more than a hint of distortion in the way stories are told, and if you listen to enough (you don't have to try hard because these people are usually talking loudly) there really is a lot of frustration about being ill, having some disease, treatable or not. So it isn't necessarily so much about the doctor himself, but more about him as the messenger of misfortune.
 

I don't believe everybody is angry at doctors.
If anything, I think a lot more people are angry at CEOs. If you work you get no raise and many of your friends are layed off because the business is doing bad and the stock price is going down while your CEO gets a 20% raise - this surely will make lots of people angry.
Being a doctor is still probably one of the most respected occupations. The only reason some people on this board appear angry is because of constant complaints from you guys about not getting paid enough. But it is hardly an indication of overall sentiment.
 

If there were 700,000 rappers or football players living the high life, you can be damn sure that I'd be upset. More BS spin brought to you by Kevin MD.
 

Doubt any perceived anger has so much to do with a personal grudge against the physician as with the system in which you work.

Last December I scheduled a physical with my PCP for Feb. 8. Got in early, everything went fine. Had to schedule an additional test per his instructions. Contacted his nurse, again per his instructions; she knew nothing about it and did not bother hiding her annoyance at being bothered. Contacted the pharmacy two days later about a prescription, which again per the PCP was being called in the same day as the physical. They had not received it. Called the nurse, who again did not bother hiding her annoyance. Sorry, but what am I supposed to do?

BTW, I received the bill for my Feb. 8 appointment on March 29. Would have been happy to pay on the day of the visit had a bill been proffered... instead, I have to wait for 7 weeks to receive an essentially incomprehensible statement of codes and charges from people I never met and have no idea what they did for me.

Not angry at the doctor at all. But all these hoops you have to jump through would test Job's patience. I suppose if the general populace gets upset at reports of high physician salaries, it may be because they sense a whole lot of expensive bureaucracy that should not be necessary, and the complexity of the system makes it impossible to tell who's to blame.
 

I think a part of the reason that patients think doctors make so much money is the way that doctors submit claims to insurance companies. For instance, for a recent initial visit to a specialist, he sent in a claim to my insurer for $450, which I can see on my personal account with the insurer's website. The insurer doesn't say how much they paid out to this doctor, only that he has been paid. I think a lot of patients will assume that he got $450, though I know it was probably about $80-100, including my copay.

It is also confusing when an explanation of benefits letter comes from a hospital or other provider. There's the initial charge from the provider, which is a lot of money. Then a bunch of 'adjustments' and 'managed care credits', then suddenly a balance that ends up being the patient's copay.

To the average patient, it looks like doctors and hospitals are billing for a lot of money. It's confusing to figure out exactly how much the providers are actually getting in the end. I think this 'billing netherworld' is a source of some of the confusion and anger toward doctor salaries.
 

Given the average doctor's 4 years of undergrad (or more), 4 years of medical school and 3-6 years of residency, I think it's laughable that people think they're "overpaid". If you subtract the student loan payments, most starting doctors make squat.

A doctor from the Ukraine that I know (he refers to himself as a 'physician's assistant' because the doctor training is more equivalent to a PA than a MD) made $30/month in the Ukraine if he got paid at all. Almost everyone made more than he did because the government paid his salary.

The people that are whining about doctors' salaries are the same ones that think the government should be paying their checks.
 

One thing physicians forget is that most other industries are directly accountable to the consumer. You, by and large, are not, which accounts for some of the poor customer service habits you have.

Some of the alleged anger may be due to the helplessness many people feel since they are stuck with you in their insurance plan.
 

"If there were 700,000 rappers or football players living the high life, you can be damn sure that I'd be upset. More BS spin brought to you by Kevin MD."

Oh Lord - another BS comment from Elliott..
 

Agree with Greg P's thought of- "messenger of misfortune".
Indeed, the doctor who is paid to diagnose disease, is not entertaining or "saving a life" in as remarkable a way as a lawyer who saves a criminal from jail or punishment. Though this does not make it right. It is also unfortunate that the doctor has to sacrifice time, money and life to get to the point when they can diagnose correctly, treat and delay death which happens ultimately anyway. Medical professionals can't win for losing.
 

"Some of the alleged anger may be due to the helplessness many people feel since they are stuck with you in their insurance plan."

This is the wrong reason to see any health care provider, and the last reason I want you to see me. You do have choices. Understand that some HMO's pay doctors by capitation, which means they incentivize the physician to see you as little as possible and to keep visit time and overhead expenses to a minimum. Do you like to see a provider who is in essence paid not to see you? Many of the new Medicare plans work this way. They suck you in with a drug benefit and may not charge extra like traditional supplements do. I do not accept or participate in such plans. That does not mean that I do not see patients on those plans; they simply are paying out-of-pocket.
 

I have to agree that most people hold Doctor's in great respect. We are not mad at Doctors on the whole.

There are only a few doc's I have ever been angry at. Surprisingly, none of them are in my real life, and all of them visit this blog.

Either it is only the angry Doc's themself that comment here, or this board beings out the worst in them.
 

People hate doctors for much the same reason they hate lawyers--they are a necessary evil. Much of their necessity was self-created, however.
 

>>"There are only a few doc's I have ever been angry at. Surprisingly, none of them are in my real life, and all of them visit this blog.

Either it is only the angry Doc's themself that comment here, or this board beings out the worst in them."

You said a mouthful here. About yourself, it seems.

You need to get yourself a real life, not one lived on your browser. All you could have ever done as far as "meeting" or "knowing" anyone who writes on these pages is to read what they have written and disagreed with what was written. Doctors who write here aren't doing so to please you or to treat you. So they are no more doctors to you than ones you see on television talk shows.

The people I wonder the most about are the non-doctors who frequently read and post here. They seem like angry voyeurs eager to peer inside the backroom exchanges behind medical practice, mostly the stuff that doesn't make it into a patient encounter, and probably shouldn't.
And when the commentary confirms some doctors are as angry about bad patient behavior or frustrations of their practice as they are, out comes the non-medical voyeuristic lurker to shake his jowls and cry how bad those doctors really are, and how doctors really don't like their patients or medicine.

To those people, and there are quite a few of them skulking around here, all I can say is to grow up. Try to develop an understanding of others including your doctors as real people who have real likes and dislikes--and hates even--and who in the interest of benefitting someone else, perhaps even you, will try to set those feelings aside. That isn't so hard. It is all about getting a mature and adult grip on reality rather than the sad misperceptions of the personality-disordered.
 

I love it when doctors lecture others on manners.
 

>"I love it when doctors lecture others on manners."

Perhaps you have been on the receiving end of a few of those "lectures" yourself. If so, was it deserved?
And were you ever lectured by anyone else besodes doctors for your bad manners?
 

Yes it is wrong that footballers etc earn so much - and this does not automatically make me and all others who agree narcisist (response to a comment from someow qho probably has issues of his/her own). Anyway, I think people are concerned about the cost of health care and that the limited budget means that some people have to die because the main cost is going up (Doctor's wages). Doctors do a great job and work long hours, but increasing their wages takes money away from health care. This is worse when you think state educated Doctors (in the UK at least) leave to go the US and other places after the state paid for the education.
 

"because the main cost is going up (Doctor's wages)"

This is not the main cost, at least in the US, and it has been falling and eroded by inflation while productivity has risen for some time now.
 

People have always been free to live and die without doctors and still are. They are not a necessary evil. You may argue that they are evil but they are not necessary. It is an individual choice to gamble on the benefits vs risk of medical science vs natural course and, in the end, just as in the casino, all will lose to the house.