JB, your ignorance of the political lobbying system is sad. Who do you think funds those “crisis maps”? Who do you think writes the legislation you are advocating for? Who do you think puts together the “statistics” you spew? Do you have any clue?

You know where the seed money for all those “Citizens Against Lawsuit Abuse” groups came from? Tobacco industry. You know who their primary lawyer is? Philip Howard, Director of “Common Good”, who puts out all the “health courts” propaganda.

And you accuse me of myopia.

I only point to your screwing of the injured because in my state that’s the only time I’ve ever seen doctors en masse at my state capitol, and only when it’s before Congress have I seen that many doctors at the US Capitol. Let me know another issue where you guys have accomplished anything. How’s that reimbursement method change going?

CJD,

I have been in practice for fifteen years and been involved in advocacy for our profession. I have never seen or heard of any kind of assistance for our cause organized and payed by liability carriers. Please provide some examples.

“Tort reform” is only one part of advocacy. It shows how myopic you really are on the overall topic.

JB

Only you can do that. So the question is, if all of you can find the time march on every state capitol to make your insurers more money via tort “reform”, why can you not show that level of organization to put money in your own pockets? Where is the reimbursement “crisis map” from the AMA? Where are the PR stunts like “disappearing docs” ads to scare patients on this issue?

Is the only time you guys can accomplish anything is when your liability carriers pay for and organize it?

How big was the group? I’m talking about consolidating physicians into 3-5 groups per million people in a city. If the majority of docs worked together they would have the bargaining power to raise their payments.

That is because staff salaries are determined by the labor market of free people bargining for themselves and you aren’t taking control of compesation. Actually you set your own fees and can increase them–but you aren’t getting paid your fee. You are in the position of taking whatever is given you–or leaving it.

Regarding large groups–if that were a fix, it would be fixed as PCP’s have flocked to group and institution practice. I was a partener that owned our own HMO. PCP’s did no better–that HMO had to compete with the other insurance companies.

Physicians cannot form unions or discuss their prices with each other. The only way to get a large number of physicians working together is by their employment at Health care corporations or in very large physician groups.

Once this happens, primary care docs will be able to demand a reasonable fee from insurance companies and get it.

#1 patients don’t all pay. we get screwed all the time on this.

#2 free care that is mandatory at the hospital.

#3 telephone calls, refill requests, records requests, all are not reimbursed expenses on our time

#4 expenses are fixed and variable. if one brings in 150k a year his expenses are going to higher as a percentage than someone who brings in 800k.

#5 there isn’t a visit that you can do in 15 minutes that pays 100 bucks medicare/ medicaid/ pvt insurance is around 60 bucks for 15 minutes.

#6 My expense ratio is around 60-65 percent. so using the login of 4 visits an hour at 60 bucks, including 10 percent no-pay, but expenses on the whole number is…144k, pretty close to average.

#7 biggest problem is that we don’t get an increase in our fees but staff salaries have to increase. healthcare for my employees increase. supplies increase in cost. etc..

The fact is, this is an internal matter. We have done it to ourselves. It was physicians who crafted the RVS and individual physicians who one by one make the choice to accept it. You want the public to care? Reject medicare and all other RVS based compensation schemes and soon they will care when a critical mass of docs–each acting on his own convictions–do so. Most of you will never do that because only individualists who value freedom over money will have the guts to do so and judging by all the calls for more laws and mandates on this and other medical blog sites you are basically mostly collectivists and statists.

If you did go through with it and got the public’s attention, you might not like the response given the low stock of respect for personal autonomy and responsibility overall in the culture now.

Atlas isn’t shrugging–he is wallowing in self pity.

To set the record straight on the financial analysis above. It completely fails to recognize:

The 15 minute visits that turn into 30 minute visits for reasons that are essentially non-reimubursable.

The expense of collecting the fee which is ever increasing.

The denied payments for all sorts of reasons–some of which are petty.

The unpaid services for all the patients whom you choose to give charity care to, or end up giving it to involuntarily, because it turns out that the insurance on the record is canceled due to non-payment of premium or the company is insolvent, or the patient went into bankruptcy, or is just plain deadbeat and wrote a bad check.

No PCP sees 8 hours of patients in an 8 hour work day–in the best run clinic 1 1/2 hours are spent on unpaid activities such as Rx refills and forms and usually much more. More like 32 clinic visit hours a week in a 45-50 hour work week

And that is just the clinic. There is then the hosptial rounds and rotating call in the ER where you get your service loaded with all the uninsured indigents that come in on the ER and take 8-15 hours a week.

But it does no good to explain. Not 1 person in 40 is going to have the attention span to listen to even that much about someone elses problems.

Just act, buckle down and stop whining, or buy more tissue.