I am also not sure what percentage of the people from the top 5% income bracket are physicians – my gut feel is it is very small.

I know some realtors who make six figure incomes in a year – and many other people (from plumbers to accountants) making six figure incomes through their small businesses. Doctors live a terrible life … late nights, profession that is becoming a bigger headache everyday … everybody and their mother, and uncle demanding a MIRACLE … remember a business minded physician would not have any reason explaining your problems once again to your mother-in-law right after they went over that same thing with your wife.

IF YOU DIVIDE the ACTUAL MONEY a PHYSICIAN TAKES HOME with ACTUAL HOURS they SPEND – no business minded person would become a physician. Having said that – as off now – there is pretty good certainity that every physician gets an income in six figures. I.e. if you are willing to work like a donkey there is money to be made in this profession – i.e. if you want a riskless profession then become a physician – but don’t assume it is easy money. You have to spend about 10yrs in medical education programs, and work pretty hard afterwards to make a decent living.

You could be a successful realtor and take 6% cut on couple of million dollar homes -OR- you could be a physician and deal with a 450LB patient who didn’t take a shower in 6 months! Again – there is no guarantee a realtor would make any money – where as a physician is pretty much guaranteed to make some money one way or the other.

Funny thing is nobody is complaining about the CEOs and other executives making meaningless amounts – especially when they run public companies -even worse companies like Freddie Mac and Fannie Mae which are semi-govt entities anyway.

I think Americans are suffiring from Schizophernia – one side of their personality wants physicians to be business people providing “customer service” like they would get in McDonalds – someone asking “You want fries with that?” – and then there is the other side of their personality/brain which wants the physicians to be the “Angels” in the hypothetical McDonalds asking “You want FREE fries with that?”

People are hating the "business mineded" private healthcare system. Earlier lot of people just died when they got really sick and whatever they have in assets passed on to their kids – now they die after they spend their last penny on healthcare – that is the only difference that a free market healthcare will get us.

Most people who talk on this forum and similar forums don't just get it … most (>85%) of medical dollars are spent on very very sick people (either because they are very very old or they are just sick younger people) … no "business minded" entity would want to treat these patients – insurance companies would not be interested in taking on these patients, private hospitals and business minded doctors would not be interested in seeing these patients. What we really need is many incarnations of Dr. Kavorkian to help these people die in dignity (instead of dying in debt) – that is the only solution – unless rest of the population somehow coughs up money for these people and put some kind of a framework for who gets the money and who doesn't. Right now — if there is a patient who is 99 yrs old and going to die anyway — the current healthcare system would still spend lot of money on that patient.

Now – what are the chances that he/she will be practicing medicine? Most people with good business sense have left practicing medicine on a day to day basis. It doesnt make sense to get phone calls on a Friday evening for a prescriptions and in the middle of the night about a patient who is pretending to be sick.

FYI – I am not a physician. I am an MBA from one of the top B-schools. I work closely with some physicians. I think here is only one reason why a good physician continues to practice medicine – because they actually enjoy doing what they do. If we start pissing off enough of those good ones – the only ones who will be left will be people with GOOD business skills (like everyone is asking for) – that day will come soon. I just don’t think it will make it any better – it will only make it worse.

You don’t see a patient dying on the floor un-noticed in a physician’s office – it can only happen in a corporate facility run by business people!! All the indicators are pointing to a day that this will happen more and more – people will be dying on the streets, and corporate medical facilities where doctor’s merely employees and go home when their time is up. Patient’s will be paying for their phone calls – paying more for the calls answered in the night – may be we can out source phone calls about a cranky patient from ER to a doctor in India to deal with. May be they have a HOLISTIC alternative cure to someone who had too much to drink on a Friday.

The biggest problem is – when a Doctor wears white coat they are expected to be kind and polite – they should take their white coats off and put on a more business attire. Demand money from patients before they can walk in to the patient room. Most of us don’t have any problem paying the premiums to an insurance company – because if we don’t pay – we loose our coverage. But paying the co-pay at the doctor’s office is negotiable – doctor will see us anyway.

Imagine the doctor sending you home if you don’t pay your co-pay upfront. Imagine doctor sending medicare patients home when they demand the money that medicare doesn’t pay (MCR only pays 80% of the rates that are already low)

Including physicians, who want to be paid in the top .5% of the world, but don’t want to be responsible for their mistakes or give the public any metrics to judge their quality.

As for the patients, they aren’t getting something for nothing. Many are paying for their health insurance, which is the way you guys seem to want to get paid, since you keep signing up to take the health insurer’s money. They’re also paying for Medicare/Medicaid out of very paycheck they ever got. And again, you guys seem willing to accept that method of payment as well given that physicians were there from the beginning and have been signing up for it for 4 decades.

You guys want to blame everyone else for the fact that this is how you get paid, yet it’s all your fault. You sign the contracts. Your profession made the original deal.

And you’re so naive too. Look at Kevin’s advice: “Contact your government representative.” Nonsense. Spend some money on your govt. representative. That’s what the insurance industry does.

You think tort “reform”, your only moderate “success” to date has passed because you contacted your representative? Don’t be stupid. It passed because while the insurers riled you up so you would be the public face, they were spending tons of money on legislators. Sure, you ignored that so you could wax poetic, but that’s the facts.

You want results – spend your money. Stop being so childish, you’ve been living on the government teat for a long time, don’t pretend you don’t know how it works.

You are correct in that most doctors would be poor businessmen. Most went into medicine to practice medicine, not business

Some will, but most won’t. Those with good business sense and business skills will, but most of you don’t have those. Nor do most of you really want to be in the free market where those insurance plans and medicare supply you with a steady stream of patients. Right now, none of you compete on the quality of your skills – you get patients because of the plans you’re associated with.

That’s why the challenge to “go to the phone book” is so silly. No one gets a physician that way. We go to the booklet sent by our insurer and look at who is in network. That won’t change anytime soon because the vast majority of you can’t/won’t leave the current reimbursement system because you know nothing else and can’t afford to try. And really, you have no one but yourselves to blame for being caught in that cycle.

You can complain about cuts in payments, but the truth is few if any of you could make near as much money doing anything else. Now, there are some of you who might relish the opportunity to compete based on your skills as a physician and a businessperson, and those will probably thrive. But that’s not very many.

Don’t know where you live but try this experiment and then report back with your findings.

Go to the yellow pages and find “physicians”. There will be a few full page glossy ads for some cash only plastic surgeons sandwiched somewhere inbetween the big glossy personal injury lawyer ads that cover and populate the whole book. You will find a lot of physicians in small print and start calling. Tell them that you are on medicare and/or medicaid and see if you can get an appt for follow up of a chronic problem with an ENT, neurologist, primary care doc, etcetera. If you find an appointment then do subgroup analysis to find out whether they are U.S. trained, board certified, and have understandable English and whether you would be seen by them or a midlevel provider.

Second part of the assignment would be to poll all the hospitals within a 20 mile radius and ask them if they would have an ENT doc, neurosurgeon, GI, neurologist, hand surgeon, etcetera available to treat you if you bacame unfortunate.

So give it a try curious and let us know.