Kevin, M.D. - Medical Weblog

Best and brightest? And here I thought that the physicians were not full of their own hubris. See the LA Times story on the "best and brightest" candy-drug store? Or the Central Coast healer who was doing no harm with a little early organ harvesting? Or perhaps the Boston anesthesiologist who fell asleep during an operation secondary to being high on his own supply? Best and brightest here, right?

No. What we get is a Yugo at the price of a Lexus with the accountability of a politician. Welcome to American allopathic medicine.
 

In a free society there is no one who decides what professional are to earn. It is frankly a silly question in the context of a free market. Each individual consumer decides if what he gets if worth what he paid, if not, he takes his trade elsewhere, the professional then earns whatever he happens to earn with that process.

Who is to lower physician salaries? Medicare? I already decided that I am worth more than they pay and stopped taking it. As long as I find customers who pay my fees, then I am obviously correct in my estimation that my services are worth more than that.
 

I think $10,000 per year more than PhD chemical engineers should suffice for doctors. Lawyers too.
 

Anon 5:24

Free market? You must be jesting if you post that in regards to the American allopathic medical system. There is no other profession domestically in which the supply of providers of service has been as strangled (as if constricted by a Rock Python)as American allopathic medicine. Discussing a "free market" in regards to medicine domestically is akin to discussing a plurality of parties during Baathist rule in Iraq.
 

But it is a weak python, haven't you noticed all the foreign docs. And a great many of the American born docs go to school overseas. Market forces are more powerful than governments, and like water running down hill, they find a way.
 

i think people shoudl be paid for the care they actually provide. if you are only checking blood pressures and prescribing cholesterol lowering medications to a group of mostly healthy patients. you probably arent doing enough to warrant a salary over 90,000$. if you are a busy orthopedic surgeon with an office that may see 50 or more patients a day and you are in the OR all the time. you certainly deserve a rewarding salary. Not every physician was designed the same way.
 

Anon 5:39

Interesting point. Still not enough providers (BTW). Let me ask you this, if these foreign trained providers are capable of passing Steps I-III of the USMLE and completing a residency then the basis of the restrictionist policies in place domestically is what (I can expound if needed)?
 

What exactly do they mean by salaries? Most private practice physicians aren't salaried; if they work for themselves, they take a draw on their receipts, but that is merely a device for short-term accounting; in the end your draw cannot exceed your receipts less practice expenses, including anyone employed who does get "salaried".

So the writers fail to appreciate that what we are really talking about is multitudes of small businesses, unless the intent was to discuss only those doctors working for Kaiser Permanente or the V.A. That I doubt.

When I take a week vacation, my pay goes down. If I hit a slow period, my pay goes down. My staff don't get laid off or furloughed, my rent isn't abated, the light bill still has to be paid. My malpractice insurer still has to be paid. I bear the risk and am the first to see the shortfall and am the last to be paid.

Now some genius thinks I should get paid less but I suppose still be willing to work just as hard or harder. I am not sure I agree. Maybe I will just stop accepting all those insurance plans run by companies and agencies who think themselves entitled to say what I should be paid and when I should be paid. Perhaps I ought to leave those organizations to deal directly with the people who are paying them for their services and sell my own services only to those who are the ones to use them. If some of those folks who think it is OK for their insurance companies to cut my pay decide to go elsewhere when I decide not to play by those rules, well, I could probably live with that. Spending less time fighting with third parties who don't think they owe me anything seems pretty good to me. Maybe I could do with fewer staff, and perhaps with a smaller office, and while I am at it, a lighter schedule. All the sudden, vacation is looking more attractive and less costly.

Well pay less. You only get what you pay for, if that. Bring it on. But don't cry when I ask you for your credit card and not your Medicare card.
 

The link refers to this weekend’s NY Times “Sending Back the Doctor’s Bill” opinion piece. The author, NY Times columnist Alex Berenson is clueless.
http://www.nytimes.com/2007/07/29/weekinreview/29berenson.html?_r=1&oref=slogin
A study published in his own paper has shown that physician salaries in the US have decreased around 7% over the past several years while the salaries of lawyers and other professionals in the US have actually increased approximately 7%, during the same time frame. These other professions require far less years of training and do not end up with such high educational debt as physicians.

Comparing physician salaries in different countries to draw the conclusion that US physicians are over compensated is not valid, without comparing cost of education, physician productivity, and the salaries of non-medical professional opportunities in the different countries.

Only approximately 10% of our country's entire health care expenditures go to physicians and nearly half of that goes back to society in the form of taxes (unless of course [jokingly] they work for a private-equity firm and pay a 15% tax rate on their earnings or 0% if the firm goes public -http://www.nytimes.com/2007/06/25/opinion/25mon1.html?ex=1340424000&en=ad3a05633c2cd98b&ei=5088&partner=rssnyt&emc=rss). So where does the other 90% of medical cost go? Perhaps Mr. Berenson should do some homework.

Over the past decade the uncompensated administrative burden placed on physician practices has ballooned. Further squeezing already discontented physicians to lower overall health care costs is very ill-advised. Do we really expect to attract the brightest most ambitious students to the field of medicine if they aren't reasonably rewarded for the years of training/sacrifices/stress and educational cost involved.

On occasion I will have a patient complain about a bill that they think is too high (usually when they have not met their insurer’s deductible). I explain to them that I get paid differing amounts for the same service depending on the insurance company. I then explain that the fee doesn’t simply go into my personal account but must cover my overhead expenses. Below is a copy of a letter I have provided to these patients.

Why is my medical bill so high?

Over the past few years several patients have asked this question. It is a very good question that needs to be answered in the context of our current health care system.
When I was growing up and went to my family doctor, my parents or I paid around $10 for a typical minor problem visit (in 1966). With inflation, that would be around $62 today (in 2006 dollars) (http://www.westegg.com/inflation). Today Medicare reimburses me approximately $33 to $45 for a similar patient visit. When I was a teenager the overhead costs of my physician’s medical practice were low. My family doctor did not make appointments and thus did not need a receptionist. When you were sick you simply went to his office and waited your turn to be seen. If it was a busy day with lots of patients, I sometimes waited several hours before I was seen. He did not employ nurses nor did he have a transcriptionist (typist) write his notes. He worked by himself, but did have a part-time bookkeeper. He called me back from the waiting room, evaluated me and usually jotted down a sentence or two and that was it. I paid cash at the conclusion of the visit. He did not deal with insurance companies so he had very few phone calls and paperwork to deal with. He did not have high malpractice costs and he worked from his home office.
Over the past few decades, things have changed radically. The overhead costs for a physician are astronomical compared to the good old days of my family doctor.
My overhead costs are many. I pay the equivalent of 5 full-time employees: 1 ¾ transcriptionists/receptionists, 1 office manager/receptionist and 2 ¼ registered nurses. I need a receptionist to make and change appointments, call and remind patients of their appointments, collect co-pays and to answer phone call questions. I need a transcriptionist to thoroughly document all that I do, as insurance companies periodically audit my work to see if my billing level is justified by the work I have performed. The transcriptionist also makes copies of patient records and types letters that I send to other doctors regarding their patients that I see. I need a manager to oversee the scheduling, billing, and other operational activities. My office manger spends much of her time tracking down payments owed to us from insurance companies and answering billing questions from patients. I need nurses to help with patient care. The nurses also answer phone questions, call patients with lab test results, deal with getting approval for medications from insurance companies, and engage in other patient care-related activities.
I have medical licensing fees and ever increasing medical malpractice fees, even though I have never been sued. Medical equipment and supply costs, and building, utility and additional insurance fees add to my overhead costs.
Dealing with insurance companies adds other costs, including payments to a billing service that electronically processes and mails my bills, that cost thousands of dollars a year. It is unfortunate that insurance companies do not pay my practice for the extra work and hassle factors they create for my patients and me. When dealing with insurance companies I am at the mercy of their fee schedule. I document what I do, and I accept what they pay. If I feel that they are cheating me, or my patient, I will write a letter of protest to contest any denial of payment. Some insurance companies pay better than others. Some insurance companies are sensitive to the high cost of providing medical care today and some are not. A given insurance company may pay well for some services but poorly for others. There is one health insurance that I no longer accept because it paid too little and caused too many aggravations.
All the costs of running my medical practice, including the services provided by the transcriptionists, receptionists, office manger and nurses are paid for from the fees I collect for the services that I provide. When a patient receives a bill from me, it is important that they understand that only a portion of the bill actually pays me for my time, the rest goes to cover my overhead expenses of practicing medicine in today’s complicated health care system.
Occasionally there is a patient who is uninsured, or underinsured, who does not have the financial means of making payment for the services I have provided. If you feel you are such a patient, please call us; explain your circumstances and we will work out a reduced payment plan that will help you.

Sincerely,



Perhaps I should send Alex Berenson a copy of this letter.
 

Phd Chemical Engineers make about 70K in my neck of the woods. If you think physicians are only worth 10K more than that then you have no understanding of the amount of training required to train a physician to reasonable standards. All that training for only 10K extra?

Dude, you can get a Phd in three years. The minimum for training a physician is seven, I will have eight, and some specialists put in twelve years. (A Phd is a post-graduate degree. Board certification is a post-post-graduate "degree.")

I guarantee that I work a lot harder than any doctoral student and at this point in my training have a lot more responsibility. Let's see..managing the Intensive Care Unit at night versus sitting around in a Dungeons and Dragons t-shirt, eating cheetos and typing my thesis...uh...no contest.

As for limiting salaries, why just do it for doctors? The problem is that you are trying to wall the medical profession from the rest of the economy, essentially hoping to make physicians your chattel slaves.
 

"Dealing with insurance companies adds other costs, including payments to a billing service that electronically processes and mails my bills, that cost thousands of dollars a year. "

Most of your overhead costs appear to be the result of complying with insurer regulations. So why continue to accept their money? Why not go to a cash practice?
 

"If you think physicians are only worth 10K more than that then you have no understanding of the amount of training required to train a physician to reasonable standards. All that training for only 10K extra?"

Physicians are worth whatever they, and the parties paying them, value themselves at. No one is limiting their pay but themselves.
 

Bottom line: If you ask a doctor if he's paid too much, the answer is no. If you ask a non-doctor, the answer is yes.

This Alex Berenson moron fails to read Medical Economics. They said 1/3 of healthcare dollars spent in this country goes to bloated, error-prone CLAIMS PROCESSING!!! Thats right.. ONE THIRD!!

But doctors salaries are the real problem.

Please. Talk about just believing what you want to believe.
 

you may compare yourself to a phd chemist and compare salaries, but the truth is that you are doing a job and you have an outcome. you may see n number of people with n number of problems. those problems may or may not be helped. you are going to make a certain impact on the sickness in the population... if you make a big impact, you will earn alot of money.. ive seen orthopedists earn more than 1 million a year... on the other hand ive seen some internists who run around... say they are working hard.... do all sorts of elaborate writeups... but really dont impact the general health of their patients to that degree. some do . some dont. look at the total contribution of your talents. not the fact that you work n number of hours. really. i think a phd chemist shoudl be able to make a contibution of more than 70K a year if he/she is good.
 

3 years for a PhD vs. 7 for an MD? And it took you 8 years? Oh wait. I see the obfuscation. You are throwing in residency after the MD. Let us make it comparable. Two years for a MS degree, 4 for the PhD (the norm), 1 for the post-doc and then after these 7 years of training... peanuts as an assistant prof. This X years of schooling = justification for extortion is nonsense and you should know it. The only reason allopathic medicine is the highest paid profession in this country (median figures) is because of Flexner and the Rock Python stranglehold that existing providers have over the supply. If we magically shut down 50% of the existing auto mechanics schools, require that the rest of them be coupled to large ME research departments and then make it so that only these new mechanics can practice... their after expense compensation rates would go through the roof.
 

Whoa, buddy. You do not have to get an MS before a Phd. Some do, some don't. But you do have to get board certified to be hired for anything other than spending your life in an urgent care. So that is four years of medical school plus from three to seven years of residency (not to mention a fellowship for the sub-specialties) which, compared to slumming around campus in a ratty Grateful Dead t-shirt is like comparing a month in the county lock-up to hard time at the state penitentary.

Additionally, an engineer with an advanced degree is not doomed to academics but can move right into industry where he will indeed make more money than an engineer with a BS.

On the other hand, in my field of engineering (I was a structural engineer before I became a doctor) the Professional Engineering Registration is what separates the men from the boys and the doctoral degree is not much use.

I will have eight years of post-college training. A gastroenterologist needs four+three+three or ten years total of "hard time.

I was a graduate student for about a year (engineering) before I got a real job and in no way did I work a tenth as hard as I do now, here in my third year of residency or even when I was in medical school. Graduate school is just an extension of college with most of the goofiness and the slack schedule punctuated by brief periods of furious activity.

But comparing writing a thesis and pulling a couple of all nighters to four years of Q4 call and 12-hour shifts is ludicrous. Have your graduate students shadow me for a couple of days and I will have them crying for their mothers.

I repeat, there is a huge difference between training as a resident, being responsible for medical decisions that can injure or kill living people and working on some hokey research project that nobody cares about.

Medicine is a high paying career because to be a decent physician requires a tremendous investment in human capital. If you think that any old Joe Schmoe will make a good doctor and that the only reason the entry barriers are so high is to protect salaries then I suggest you don't know the difference between a good doctor and a bad one.
 

You mean,, we have the best and the brightest working in medicine right now?

We are more f***ed than I imagined!
 

Here's a question for the physicians - is the length of medical school necessary, and does residency have to be such a miserable experience for you to learn the necessary skills to be physicians?
 

As a third year medical student who has been learning fact after fact about disease process everyday of my life for three years solid (M1 summer I worked in clinic), I am amazed at how much I don't know when I spend time in the clinics with patients. Knowledge in medicine comes through grueling experience, unfortunately. I must admit I did not think it would be this hard to be competent until I started this experience.
 

"We are more f***ed than I imagined!"

And it's only going to get worse as the primary care shortage continues, as there are less neurosurgeons willing to take on your brain tumor, as the number of docs delivering babies decreases, as the number of endocrinologists to manage your diabetes goes to near zero - yep- we sure are all f****d.
 

Well, the reason we currently don't have the best and brightest in medicine is because physician salaries are already too low.
 

Where are the best and brightest going, then? Because you're the highest paid profession by nearly $50K.
 

The best and brightest will go into business and other professions where there are no price controls, where educational costs are far lower, training time far shorter and less stressful, and where talent and hard work are justly rewarded. How about corporate law, tax law, investment banking, and a plethora of other business opportunities. You make the mistake of looking only at the average salary figures for the common professions. These do not include many other opportunities in the business world.
 

I can see why your graduate work was limited to one year. In most fields one does get an MS before a PhD and also does a post-doctorate. As far as board certified goes, take a visit to the PRCa. There are non-board certified providers aplenty that do more than urgent care. The original issue was time for completion of training. My seven year figure for doctorate work stands. As far as “Grateful Dead t-shirts” go. Give me a break. One wonders what side of campus you were hanging out on as it certainly does not appear to be the science side. Your second paragraph is actually correct. As far as your third paragraph goes, PE Registration is a requisite in the consulting world for civil engineers and has little to no utility for the other fields of engineering (the Safety Engineer certification, for example, was dropped by the PRCa). The PE registration for seismic and structural engineering are important for civil engineers but do not replace the doctorate. The PEs are only applying existing theory (as the PE examination tests for) while one actually has to come up with something new for the PhD. The underlying continuum mechanics theories were developed by doctors in engineering and mathematics and not by PEs. If one gets their PhD and then gets a PE… the time for training is increased given the work requirement prior to being able to be seated for the PE examination. Your next paragraph deals with your own work habits during your one year of graduate school and has dubious ubiquitous applicability. Your next paragraph is nothing more than typical rank allopathic arrogance and speculation. The following paragraph was more of the same. All of the billions that go into real research funding (not the clinical case study resume padding where whining of patients and relying on them is put forth as science) from private and public sources shows that somebody actually does care about the research work being done. It is just amazing how all of the knowledge developed through basic science research (not post hoc ergo propter hoc junk science clinical causation) and the tools developed through engineering (yes, engineers design the tools that you use) are given short shrift when it comes to the ego of the allopaths. How about this. Why don’t you eschew any tool or bit of knowledge that wasn’t first generated by some allopath. As far as responsibility goes… give me a break. Pick any state that you wish and I will show you a broken disciplinary system in which a multitude of excuses is used not to discipline the providers. From excuses such as “bad outcomes” to blaming the patient there exists no degree of responsibility that an allopath will not shirk and be allowed to shirk. As far as your last paragraph goes… did you pass the engineering economics section on the EIT examination? Allopaths get paid what they do because they tightly control and restrict the supply of those that can provide the service in question. That is the only reason they command their after-expense income levels.
 

I repeat, physicians make what they make because there is a relative scarcity of people with their skills in the work force. It may be a shortage of supply but it's not all from a conscious restriction of the supply pipeline. Not just anybody and his uncle can be a good physicians although I'm sure you could dumb-down the medical schools and post-graduate training and slap the "MD" label on anybody. But quality is going to be iffy to say the least. Now, whether people care about this or not is another story. Certainly everybody is happy to have some low-skilled FMG or PA provide health care to somebody else but if it's yer' Granny, you probably want a doctor who has gone through some training.

The daily potential for horrific mistakes made through ignorance, in my field in particular, is huge. It is not just monopolistic urges that make medical training so long and difficult but also a concern for quality. If you read my blog you will find that while I am not the biggest fan of the way doctors are trained, I have never suggested that we need to slash years out of the process.

I think many people see their doctor, see what he does, and think, hey, there's not that much to his job. But that's like our Emergency Department patients who think we're in the back smoking and joking while they sit in their beds waiting for something to happen. They just happen to be looking at the profession through a narrow window and only see a small fraction of the big picture.

On another note, I again challenge any of your graduate students to hang with me for a couple of days. Like I said, I was a graduate student myself and while it had it's moments, they were just moments. Generally, with the exception of some teachng hours, there were not a lot of times when I couldn't take it easy or get as much sleep as I wanted. It's kind of a free form job.

In the residency world, we are prisoners to the hospital in a way you can't imagine and I have worked on many occasions, on call for example, so sick that in any other profession they would have insisted I go home. In our world the nurse just asks if you want to take a fifteen minute break so she can give you a bolus of normal saline.

So don't give me this malarky about graduate school being the equivalent of residency. It is not. I have done both and there is no comparrison.
 

I can somewhat agree with the first sentence. We also must couple legal limitations in regards to scope of practice that exacerbate the scarcity problem. As far as the second sentence goes, I completely disagree. Flexner was implemented with the stated intent (one of many that were anti-competitive) for restricting the supply pipeline. Take a look at even the simple Wikipedia entry on Flexner (and yes we can debate it point by point if needed). The quality argument, given the current, system is dubious at best regarding restriction. If one were to accept the argument that the domestic allopathic training system at the medical school level needs to exist in its current form secondary to quality then there would be zero basis for allowing any foreign medical school graduate from a system that is not commensurate with ours to even be seated for the USMLE (much less have the opportunity to complete a residency). The actuality of the matter is that the enforced scarcity model practiced domestically has produced an extreme shortage of providers (while keeping their after-expense compensation rates high secondary to non-free market supply restrictions) thereby necessitating the importation of foreign graduates. This in turn obviates the quality basis for the enforced scarcity model at the medical school level. As I have asked before, do the Tijuana Technical Institutes of the world have large research (note PhD types doing that research that no one cares about as per your prior post) branches such as is required of domestic schools? Are the Tijuana Technical Institutes of the world not-for-profit institutions such as the domestic schools? The answer to both of these questions is no and yet students from these schools are allowed to be seated to take the USMLE (and oddly enough have to have a higher score to pass than domestic students) and given the opportunity to perform a residency. I still opt for opening up the domestic system and letting the USMLE and residency weed out those that can’t make the cut. In reading the news, the quality argument takes a bigger hit when one considers the almost daily reporting of providers that are subject to the façade of an enquiry when it comes to their negligence or gross incompetence. Yet these providers are allowed to continue their “practice” whereas quality would demand their removal from the provider ranks (see the dopey anesthesiologist from Boston who was getting high on his own supply or the pain management tools from California that were either getting high on their own supply or getting patients addicted through their non-quality prescribing practices – the former might get his license back and the others still have their licenses).

The hours associated with residency is a burden that your own profession has placed upon itself and does not support the argument of quality (e.g. a sleep deprived provider who is unable to think straight attempting to perform a procedure). If you are serious about letting others go through your rounds with you (and have the legal ability to make it happen), please respond and I might take you up on your offer.

By the way, have you decided to stop using any of knowledge or tools derived by those useless PhD types yet?
 

It takes a certain amount of knowledge and skill to function as a competent physician. Foreign medical graduates, except in a few cases, cannot just waltz on in and start practicing at whatever level they believe they are qualified to practice. Despite where they went to medical school, FMGs have to pass the USMLE Step 1 and Step 2 before they can accept a residency position for further training. Those coming in on an H1b visa also have to pass Step 3 before they can train and everyone has to pass it before they can get licensed.

Additionally, only certain countries credentialing can lead to equivalent credentialling in the United States in a particular specialty.

As to sleep deprivation, that's a given in residency. It takes a certain number of cases, for example, in Emergency Medicine before the typical resident is ready to practice as an attending. The exact number is somewhere between nothing and enough. Certainly a guy fresh out of medical school would be extremely dangerous if he stepped into an Emergency Room to practice on his own and it would be unethical to let the public suffer as he worked his way, unsupervised, through an ad hoc period of on-the-job-training.

As to whether two, three, four, or five years is enough that's a topic for debate. One is definitely too few and five might be a little excessive. But it's not just some sinister urge to monopolize health care that makes residency necessary.

I suspect you don't realize what is involved in medical training. It is not something that you can just pick up but requires some structure. And I reiterate that if you think it's comparable to graduate school, maybe you need to shadow a resident for a couple of days. I'm starting a run of four twelve-hour shifts in the ED tonight and I assure you that not only will the shifts stretch to fourteen hours as I try to tie things up but I will be running at full speed the whole time; the only way to train for my specialty which is extremely broad is to see a lot of different patients, enough where you can be confident of both never being surprised and of your procedural skills in one of the twenty or so common procedures that we are expected to do,in our sleep, with zero defects.

And my specialty has a relatively easy residency, at least as far as hours go.

I might as well say that graduate school is unnecessary, the Phd is worthless, and all research should be done by enthusiastic amateurs.
 

"I might as well say that graduate school is unnecessary, the Phd is worthless, and all research should be done by enthusiastic amateurs."

could not have been said better by criminallopath himself.
 

Perhaps you missed the section of my commentary dealing with FMGs having to take the USMLE. As far as years of schooling go... cut down medical school to two years and then have the residency. I know quite a bit about medical training. I just do not choose to fall on my knees and pray for salvation from that that go through it. The training is the cross that has been put upon the backs of new providers by those that have come before them. I would have some respect for the process if it actually produced providers whose enforced responsibility was commensurate with their status. Yet, we see every excuse in the book when it comes to responsibility and we see routine procedures (such as the cyst removal case in Northern California) get botched and yet the providers are allowed to continue to "practice." The responsibility claim sounds good but is little more than an empty claim. As far as shadowing you on your ER shift... again, is it a serious offer?

In closing, your own comments are those that indicated the nature of research that no one cares about. One would hope that you are using a special-MD only designed endoscope as using an engineer designed scope would be far below your self positioned lofty perch.
 

Civil engineer screws up, bridge collapses and tens of people may be dead. Provider screws up and kills one person. Thusly, secondary to the logic of some here, the civil engineer should be making many times the after-expense compensation of a physician.
 

what is this "best and brightest. BS"???. first most of the people who go to medical school are GOOD Students. but they dont have any clinical knowledge or vast understanding of medicine until they get to their 3rd year of school. when i was in high school... there were quite a few students who were high in our class. they did not all go into medicine. (4 of us did). in fact its not the best person from high school who does well in a medical program. usually its a very dedicated person who knows what he/she wants to do. as a previous post noted.. it takes years until you feel competant in a clinical setting. there are just so many variations in disease and the disease process. certainly physicians deserve to be well compensated... imagine your feeling being a patient and not understanding your condition or having high medical needs.. you want someone who is not only competant but also dedicated and able to help. we are looking for competant physicians.. it takes years of training to get people to the point that they can effectively treat some of the complicated disease processes that are out there. residency length is to make competant physicians.
 

There were many in my med school that were as dumb as rocks and somehow made it through. Some probably should not have made it through. I would hate to think that standards would be lowered.
 

By the end of my residency, I was able to estimate the hours that I had put into acquiring the skills that I was now setting out to sell. Counting medical school, it amounted to the amount of time that a state employee had put into the job in this state at after 20 years of full-time service, considering their vacations and sick-leave. And that doesn't count the pension they have been earning. Teachers in this state can retire in 20 years.

My health was damaged, I had missed my youth, and had put in nearly a lifetime of working hours crammed into a few years. I don't regret it--it was my decision, but I did it with the assumption that I would be living in a free society where I then rent that experience out at a fair rate. That is what someone is doing when they pay a fee--renting a little piece of that. I had to buy it.

Overpaid? My accountant with a bachelors degree charges more than I do.
 

Pay less but think you are going to get more and better? Sorry, but an hour is still an hour, and when you are talking highly skilled labor, that is not a reasonable expectation.

Those who post thinking that you will make the equivalent in capable physicians with shorter training on back-of-the-matchbook type schools are fooling themselves. That might work for training truck drivers or computer technicians--and even then, that is debatable--but it won't work for medical doctors. If the idea had any legs, for-profit "universities" would be clamoring for the chance to open medical schools. But they aren't, and those entities would be the best equipped to do an educational program on the stripped-down-ugly-but-works model. Sorry, medical school is long and expensive because there is a lot to teach and the environment requires much more than a bunch of cheap night school rental classrooms and some home study materials.
 

In the Soviet Union there were lots of doctors, they didn't earn a lot compared to others, and there was less training. But I don't recall service quality in that particular area of the economy being bad. As for your guys argument of doctor pay, I think there is some middle ground. I think some doctors are overpaid (dermatoligists, family doctors, psychiatrists, among others), and some are not - surgeons, if they are good surgeons, do require special skills which not everyone can be trained. And some, such as neurosurgeons also require highly above-average intelligence, which compounds the salary. So, I think some are overpaid, bevause of restricted supply but others at least fairly paid or even underpaid esp. given the training and hours involved.
 

I get the feeling that this blog is being read by disgruntled doctors who "get it' already, and a couple of uninformed intellectuals who just want to argue. Doctors cannot be compared to anyone else.
I am an OBGYN private practice. I take insurance plans because to not do so would cause economic ruin. There are 4 major plans in our area and they completely saturate the market. To not take one would mean 25% loss of market share. People are not able to foot the bill for a delivery or surgery out of network. Therefore one takes the plans. Let me inform you on something else.
RVU's- relative value units are how insurance companies look at our worth. It is an insidious system often arbitrary, but nonetheless, it is how they do it.
The avereage reimbursement from an insurance company for all doctors is $65 per RVU. For Medicare it is $55. Even worse for medicaid it is $45.
TMA the texas medical association has done research and found that the business model that would be most efficient and viable requires $75 per RVU. All insurance companies know this. The government knows this. Doctors need to know it, and so does the public. Today, one of my nurses complained because she had made an appt with an internal medicine doctor and then forgot. He sent her a bill for $25 for missing the appointment. She was mad at him. She thought that was unfair. I told her to expect more of the same as practices try to stay viable. I also reminded her that when he went to the ER at two in the morning to take care of her hypertensive crisis, that he couldn't charge any extra than if she had come into the hospital at 2 in the afternoon. Doctors should not accept any 3rd party service. They should go back to fee for service, and let the economy decide.
The current system makes all doctors earn the same money from an insurance company,medicare,medicaid, whether they are good or bad doctors.
Foreign trained doctors usually go to the less desirable residency programs that were not filled with US trained physicians. They are taken so as to fill the slots of the residency and create cheap labor for a hospital system. Supervision is a problem with that system. As a general rule they are not as well trained, have cultural issues, and ethics that often clashes with patients.
 

Physician should make as much as they need to make. They are simply too important for the community. Please don't play around with their salaries. they study hard, so pay them well