Comments on: My reaction to President Obama’s speech to the AMA http://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html Wed, 15 Feb 2012 00:14:00 +0000 hourly 1 By: Richhttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-94322 Rich Sun, 21 Jun 2009 16:14:14 +0000 http://www.kevinmd.com/blog/?p=37866#comment-94322 Kevin, I agree with your comments in the recent NY Times article, http://roomfordebate.blogs.nytimes.com/2009/06/18/better-medical-care-for-less/#comment-92293, that state that physician payments need to be divorced from patient volume. I once worked in a practice that booked a patient for almost the same time slot (5 minutes apart) as I had exam rooms assigned to me. It was all to keep up the practice's revenue as reimbursements declined. Needless to say I left that practice and now, I'm sure, deliver much better medical care at a reasonable pace. I certainly have more time to listen to the patients, and my own blood pressure is better! Kevin,
I agree with your comments in the recent NY Times article, http://roomfordebate.blogs.nytimes.com/2009/06/18/better-medical-care-for-less/#comment-92293, that state that physician payments need to be divorced from patient volume. I once worked in a practice that booked a patient for almost the same time slot (5 minutes apart) as I had exam rooms assigned to me. It was all to keep up the practice’s revenue as reimbursements declined. Needless to say I left that practice and now, I’m sure, deliver much better medical care at a reasonable pace. I certainly have more time to listen to the patients, and my own blood pressure is better!

]]> By: Pathttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93472 Pat Fri, 19 Jun 2009 14:37:12 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93472 Setting aside the litigation issues. Cost is the driver here. The one real thing Obama is proposing is to require open architecture for EMR. Jay Rockefeller has a bill before Congress that will require open architecture and establish a medical informatics public utility (not government) to house EMR. See a demo at medicalinformaticspublicutility.com. Doctors and hospitals will retain their independence and will be able to competet on the basis or results. Setting aside the litigation issues. Cost is the driver here. The one real thing Obama is proposing is to require open architecture for EMR. Jay Rockefeller has a bill before Congress that will require open architecture and establish a medical informatics public utility (not government) to house EMR. See a demo at medicalinformaticspublicutility.com.
Doctors and hospitals will retain their independence and will be able to competet on the basis or results.

]]> By: Matthttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93191 Matt Thu, 18 Jun 2009 22:19:17 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93191 " And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have."Susan, I'm not sure how you define frivolous, but the vast majority of lawsuits are filed by businesses suing businesses. Tort filings are down over the last 20 years, so this explosion you're claiming doesn't exist.As for the disincentives, there are clear economic disincentives for filing dog cases, especially on contingency, because you don't get paid by the hour, plus you're fronting all the expenses. You'd quickly go broke under that economic model.Here's your median compensation for physicians from the DOL:http://www.bls.gov/oco/ocos074.htm#earningsHere's your median for attorneys:http://www.bls.gov/oco/ocos053.htm#earningsNot even close. ” And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.”

Susan, I’m not sure how you define frivolous, but the vast majority of lawsuits are filed by businesses suing businesses. Tort filings are down over the last 20 years, so this explosion you’re claiming doesn’t exist.

As for the disincentives, there are clear economic disincentives for filing dog cases, especially on contingency, because you don’t get paid by the hour, plus you’re fronting all the expenses. You’d quickly go broke under that economic model.

Here’s your median compensation for physicians from the DOL:

http://www.bls.gov/oco/ocos074.htm#earnings

Here’s your median for attorneys:

http://www.bls.gov/oco/ocos053.htm#earnings

Not even close.

]]> By: Susan Hhttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93189 Susan H Thu, 18 Jun 2009 21:23:38 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93189 Matt, you must recognize the disparity between treatment of alleged legal and medical professional malpractice is skewed in favor of lawyers. And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have. Ultimately, anyone smart enough to get through medical school will realize that law school is faster, cheaper, and the back-end is safer and better rewarded.Matt, you had claimed that: "Given the average salary of medical practitioners is 50% higher than legal practitioners,..." I looked on PayScale.com to compare hourly wage rates, and found the following, which contradicts your assertion:Median hourly wage rates for lawyers were higher than the median hourly wage rates for doctors by 100% in the category 20+ years experience, higher by over 18% in the 10-19 years experience range. Zero to 9 years wages were higher for doctors that attorneys but not 50% higher. Matt, you must recognize the disparity between treatment of alleged legal and medical professional malpractice is skewed in favor of lawyers. And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.
Ultimately, anyone smart enough to get through medical school will realize that law school is faster, cheaper, and the back-end is safer and better rewarded.

Matt, you had claimed that: “Given the average salary of medical practitioners is 50% higher than legal practitioners,…”
I looked on PayScale.com to compare hourly wage rates, and found the following, which contradicts your assertion:

Median hourly wage rates for lawyers were higher than the median hourly wage rates for doctors by 100% in the category 20+ years experience, higher by over 18% in the 10-19 years experience range. Zero to 9 years wages were higher for doctors that attorneys but not 50% higher.

]]> By: Matthttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93187 Matt Thu, 18 Jun 2009 20:15:35 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93187 Susan, sanctions typically won't be reported except in the state bar magazines. I don't recall one related to med mal, but I'm in a small state and don't read the monthly bar magazine every month.I would never contend that all med mal suits are meritorious. Nothing involving humans is perfect. Susan, sanctions typically won’t be reported except in the state bar magazines. I don’t recall one related to med mal, but I’m in a small state and don’t read the monthly bar magazine every month.

I would never contend that all med mal suits are meritorious. Nothing involving humans is perfect.

]]> By: Susan Hhttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93185 Susan H Thu, 18 Jun 2009 19:25:48 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93185 Matt, cite a case of meaningful sanctions against any attorney for frivolous medical malpractice litigation. Or is it your contention that all medical malpractice charges are meritorious? Matt, cite a case of meaningful sanctions against any attorney for frivolous medical malpractice litigation.
Or is it your contention that all medical malpractice charges are meritorious?

]]> By: Matthttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93184 Matt Thu, 18 Jun 2009 19:15:59 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93184 "Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award"Can't. It would have had to go up on appeal, and I don't follow the appeals court unless it relates to cases in my areas of practice. The only reason we know so much about physician legal issues is because they are trying to get tort reform.And, most of those are settled, and settlements are confidential. “Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award”

Can’t. It would have had to go up on appeal, and I don’t follow the appeals court unless it relates to cases in my areas of practice. The only reason we know so much about physician legal issues is because they are trying to get tort reform.

And, most of those are settled, and settlements are confidential.

]]> By: Susan Hhttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93183 Susan H Thu, 18 Jun 2009 19:10:16 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93183 Pat, society does not care about doctors. Society is letting doctors be extingushed by lawyers. Society is allowing HMOs and insurance plans and government to set rates which do not allow medical providers to break even. Doctors (and don't forget nurses, the new prey) can't survive, union or no union. Maybe all docs and nurses need to move to offshore boats (International waters and civil law) or Indian Reservations (Tribal civil remedies) and operate cash-only practices. My belief is that healthy members of society will let a point of crisis be reached before addressing inequities that fostered the crisis. Pat, society does not care about doctors. Society is letting doctors be extingushed by lawyers. Society is allowing HMOs and insurance plans and government to set rates which do not allow medical providers to break even.
Doctors (and don’t forget nurses, the new prey) can’t survive, union or no union. Maybe all docs and nurses need to move to offshore boats (International waters and civil law) or Indian Reservations (Tribal civil remedies) and operate cash-only practices.
My belief is that healthy members of society will let a point of crisis be reached before addressing inequities that fostered the crisis.

]]> By: Pathttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93181 Pat Thu, 18 Jun 2009 18:48:25 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93181 When an HMO knows your practice has enough of their patients to be a critical volume of your business, upon annual renewal they will offer you a new contract which pays significantly less than the old one. They surmise that you cannot afford to drop their plan. If you protest the answer is take it or leave it. Are you suggesting that if doctors unionized they could achieve higher reimbursements through a union negotiated contract? When an HMO knows your practice has enough of their patients to be a critical volume of your business, upon annual renewal they will offer you a new contract which pays significantly less than the old one. They surmise that you cannot afford to drop their plan. If you protest the answer is take it or leave it. Are you suggesting that if doctors unionized they could achieve higher reimbursements through a union negotiated contract?

]]> By: Susan Hhttp://www.kevinmd.com/blog/2009/06/my-reaction-to-presidents-obamas-speech-to-the-ama.html#comment-93069 Susan H Thu, 18 Jun 2009 16:50:43 +0000 http://www.kevinmd.com/blog/?p=37866#comment-93069 Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award

]]>