Why do health policy experts and wonks hate doctors?

in Policy | 62 responses

Health policy experts have never been shy about their antagonism towards doctors.

The focus now appears to be on physician pay, with the Washington Post’s Steven Pearlstein, for one, continuing his anti-physician columns. Derek Thompson, over at The Atlantic (via @AllergyNotes), continues the assault, with a recent blog entry wondering if doctors deserve to be paid less.

I touched upon this topic last year, in a USA Today op-ed, Doctors’ pay cuts save little in health care costs, and paraphrased prominent Princeton economist Uwe Reinhardt saying that cutting physician pay 20 percent will only result in 2 percent of health care savings. And besides, if the current system stays in place, doctors whose pay is cut will simply respond by doing more procedures.

Furthermore, many health policy experts bring out the tired statistic comparing American physician salaries with those abroad. The problem is that these are not apples-to-apples comparisons. Both the cost of medical school and malpractice insurance are exponentially higher Stateside. Fully subsidize medical school and bring malpractice premiums down to the levels of other countries first, before talking about tackling doctors’ pay.

Until then, comparing physician salaries with those in Europe is a largely meaningless exercise, and only serves to expose many health wonks’ innate contempt for the medical profession.

Comments

http://www.ohiosurgery.blogspot.com buckeye surgeon
The Gawande article (which most health care pundits were so quick to praise) hasn’t helped matters either. Remember, Gawande concluded that McAllen’s problem was a “culture of money” that had infected its physicians. Then he sets up an either/or scenario of the Mayo Model (collectivist, salaried, patient-first doctors collaborating as a giant happy Waltons family) versus the McAllen model (greedy, me-first physicians who own strip malls and apartment compexes and nefariously self refer unnecessary procedures to themselves), even though McAllen is admittedly an outlier. That article has done more damage to physician credibility than anything written in the past ten years…..
family practitioner
buckeye:
McAllen is only an outlier because it is not a major metropolitan center. The problems within McAllen are not outliers, but exist quite clearly in Miami Beach, New York City, Boston, Philadelphia, Los Angeles, and other metropolitan regions, Check out the map on msn documenting average medicare expenditures per medicare benficiary. The range is tremendous and the outcomes are not different. Studying the map, the conclusion is quite clear: the more specialty medicine, the more things cost.
We doctors have got to admit that we are a big part of the problem.
http://www.seefirstblog.com Evan Falchuk
Kevin,
It’s a great question – I’ve blogged about it several times at See First.
After Pearlstein’s latest rant against doctors, I think the problem is he (and others) just misunderstand doctors. They think of them like stock brokers, trying to make commission dollars pushing questionable stocks. They discount – or don’t think of – the possibility that most doctors go into medicine to actually help patients, and are primarily motivated in this way.
If you look at health care through that lens, you can of course find examples of doctors abusing the system to their benefit, but this isn’t the norm. We need more doctors to speak out on this point and call out those who would try to oversimplify the problems of our health care system by suggesting “it’s the doctors, stupid.”
Evan Falchuk
http://www.futurewaredc.com Chuck Brooks
The denizens of the washington cesspool have always been terrified of anyone who is successful, partly because it highlights their own sense of worthlessness. Even before Milliken and Microsoft, before IBM and Standard Oil, the useless can use the raw power of government to try and make things go their way.
Chuck Brooks
FutureWare SCG
Tom
Kevin,
I could not agree more with your thoughts, and suggest that they need to be made more often and more loudly by the physician community. It is clear that the wonks simply take a “scape-goat of the day” approach to answering very complex issues. It appears that they have turned their sites from Big Pharma to physicians without recognition of the nuances of patient care, which readily apparent in the Gawande article. The phrase “with similar outcomes” is often used with little discussion of what exactly that means — the devil is certainly in the details with statements like that.
Full Disclosure: I work for a large biopharmaceutical company and have seen this approach utilized repeatedly to diminish the value that new medicines bring to patient care (admission: we need reform and are working to achieve that end).
I hope for you, and the rest of the physician community, that you learn from our mistakes — correct what needs to be corrected but do not allow unwarranted, unsubstantiated attacks go unchallenged. It is a path that leads to complete devaluation of all that you bring to patients every day.
Best,
Tom
Joseph Sucher, MD FACS
The negative press towards physicians and the tremendous cost of medicine do not come from any one single problem. On the negative physician perspective, I noted on the day I entered medical school, everyone had the same comment to me; “you’re going to be rich.” I was astonished (and I am far from being rich).
The public is convinced that we are all on the golf course and going to fabulous getaway’s in Tahiti. Until the public understands that specialists like myself work 100 plus hours a week and don’t earn nearly half of what they think I earn and that primary care doctors have to see 50 to 75 patients a day to keep afloat… well.. we will continue to be vilified. Our fore-fathers of the 80s to 90s really hurt us tremendously by their excess.
Today’s excesses are born of a different problem. Society demands that we do everything possible to improve their health and do it to perfection. They ask the medical profession to “make them better”; many times caused by their 20 plus years of unhealthy lifestyle choices. It is no secret that we smoke too much, eat too much, drink too much and exercise too little. Couple this with the the following: 1. Dramatic improvements in diagnostic devices and therapies. 2. Rapid growth of pharmaceuticals. 3. Ability to treat people with catastrophic illnesses due to the growth of intensive care units.
Let’s also look at a few changes in health care since the 1960s. 1. If you had a heart attack, you either lived or died… no emergent CABG or Angio.. no CCU… if you made it.. you’re doc told you to move to Florida. 2. Kidney, Lung, Heart, Liver failure… No transplant for you. 3. Stroke. Good luck. 4. Cancer.. I can’t even scratch the radical changes here. 5. Trauma.. no such thing as a Trauma Center until the late 1970s.
It is clear that we need radical health care reform. But this reform will not happen if our society is unwilling to reform themselves. This health care pie is only so large. We must make tough decisions about how we will slice the pie. But we need to educate our public that their physicians are more of the solution than the problem.
JFS
paul
i would gladly take a paycut in exchange for elimination of all the bs we in our profession go through- educational loans, the threat of lawsuits, disrespectful/abusive patients, insurance hassles, admin with no clinical training telling us what to do, satisfaction surveys that are more important than patient outcomes…
just be aware that many would-be applicants won’t necessarily feel the same way, and without the promise of financial success won’t be willing to endure the torture of training to become a physician. which is worse? greedy doctors who are in it for the money or no doctors at all?
http://tezcans.blogspot.com/ Ayse
i totally agree about subsidizing the med edu and solving the malpractice litigation issue. this would only help with reducing the health care cost but also attracts more people into medicine.
Susan H
Interesting to compare and contrast CNBC reporters’ justifications of TARP bailout recipients’ bonuses to CDO traders, with their critiques of doctors’ ‘high salaries’.
http://medicalpastiche.blogspot.com Peter
Pearlstein and Thompson fail to realize that decreasing physician compensation forces physicians to increase volume. More office visits, more procedures, more lab tests. Physicians have underlying costs that they can not correspondingly decrease: they still need to pay for an office lease, secretaries, and nurses.
If the goal is decreasing overall healthcare costs, physician compensation should be increased so there is less pressure to increase income by increasing volume.
Susan H
Doctors’ and nurses’ future performance are monetized bundles of ‘uncollateralized debt obligations’ (UDOs) of entities collecting insurance premium profits.
Who is the guarantor?
Healthcare Observer
Like it or not, the sheer cost of providing healthcare in the US is a major contributor to high overall costs, and a good part of that – given that healthcare is labour intensive – is salaries/fees, not just for physicians but also for administrators (the head of a large American hospital can earn a million dollars or more – much more than say a European counterpart). I don’t see any doctor hating going on here – the key argument is basically about inequality overall in America where huge differentials exist between the rich and poor, more so than most other developed nations.
skepticus
Kevin, Perhaps health care wonks hate doctors because they are so resistant to logic and fact–and are only concerned with their own salaries and prestige.
I have no idea what paraphrase you’re doing of Uwe–but as the McKinsey Foundation report shows conclusively
http://www.mckinsey.com/mgi/publications/US_healthcare/
the cause for higher costs of healthcare in the US than in peer countries IS DOCTORS’S SALARIES.
As for the stupid apples to oranges argument, it just shows your lack of facility with logic or accounting. First, areas with relatively low malpractice like dermatology make oodles more than their European counterparts. Thus, medmal can hardly explain the Euro-US difference.
The incremental cost of medical school again is minor when amortized over an entire career. Again, the average UK doctor makes around 140K; the average US doctor around 300K. Med school costs around 200K, say 300K if you want to include opportunity costs. HMMM . . . . looks like the U.S. doctor recoups his investment in 2 years.
Kevinmd, we health wonks hate doctors because you only care about your own wealth and status. The sooner doctors are silenced and eliminated from healthcare debates the better.

http://www.kevinmd.com Kevin
skepticus, thanks for demonstrating the stereotypical innate contempt health policy experts have towards doctors.
Uwe Reinhardt’s citation could be found here:
“Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.
This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy. ”
http://query.nytimes.com/gst/fullpage.html?res=9B00EEDE163AF936A3575BC0A9619C8B63
Thanks,
Kevin

Dan
Go ahead and try to reduce doctors salaries and see how many people want to enter medicine. I can tell you most people in my medical school class would have NEVER taken on 300K worth of debt to get paid what a nurse can make these days….
Susan H
Being put on the defensive is never a winning position. It seems at this point the only way to force understanding is to demand legal professional conditions similar to those of medicos, and quit the traditional practice of medicine.
Let society do without for a while as it decides how best to divide the healthcare dollar.
arf
Average UK GP makes closer to 140K – POUNDS maybe.
When I ask UK GP’s they describe something more like US$200K income. Consultant specialists still do much better, depends how much private work they want to do.
Average USA physician is $300K ??
I’m doing something seriously wrong.
skepticus
Ah, Kevinmd, so indifferent to facts and truth.
According to the 2007 McKinsey report, US healthcare expenditures are roughtly 500 billion more than expected by international comparisons. 85% of this amount is due to physician and hospital costs. I have no idea where Uwe’s getting his numbers.
But, let’s say he’s right. 2% reduction is costs is not inconsiderable. Ahh . . . but medmal costs are usually figured at around 1%. You get awfully worked up about that 1% but defensive about savings that could be TWICE AS MUCH. Are you illogical or self-interested?
As for illogical, isn’t Uwe Reinhardt a healthcare wonk. He’s not hostile to doctors. Maybe you’re just reacting to those wonks who are and trying to pathologize them. Wouldn’t be the first time doctors have tried that strategy.
As for the scare of doctors leaving medicine. Doctors went on strike in Israel in the 70s. Deathrates dropped. The Dartmouth Atlas has shown no relationship between number of doctors in an area and healthcare outcomes. Leave medicine–you’d be doing us all a favor!
Susan H
Would someone please define normalized “physician salary’?
Net hourly wage, especially net of malpractice premiums– which no other profession seems to require, would be a fairer comparison of professional compensation than gross annual income.
While calculating, be sure to include physicians’ 4-10 year unpaid or low-paid training years, when other professionals are enjoying earnings enough to save and compound toward retirement… Or are being subsidized toward retirement and provided ‘free health care’ by employer plans.
How can we conscript all these workers with medical-envy into service? Perhaps having more workers willing to tolerate current employment conditions would lower healthcare costs.
Doc99
@arf: Roger that! I’m clearly doing something wrong.
residentdoc
Skepticus,
Obviously, you are new to the healthcare scene. You are hashing out myths that have be disproven over and over again (if you dare quote infant mortality I will snap). For example, how can you lump doctors and hospitals into the same group. DOCTORS ARE NOT HOSPITALS. Hospitals include nursing, ultrasound, phlebotmoist, janitors, cafeteria, etc.
The cost of our law system does not come from teh cost of trials which still stands at a staggering 1 percent like you said (just think how much this truly is), but it comes from defenensive medicine or what I hear everyday called CYA. In my training, we have built in algorithms of CYA medicine that have now become standard of care for no other reason then to protect us from lawsuits. We know what the test will show exactly 99.9 percent of the time. Basically, I just gave a chemo patient about 50,000 dollars of the best antibiotics for the last 2 weeks because she was spiking fevers that were most likely a result of chemo.
But if this patient had become septic and died we would have lost millions. So tell me… have you factored that 50K into your estimates. Now, rinse and repeat every day of my life over and over and over. Before you say that I do this to make a profit let me assure you that I don’t. I am paid on salary as are all my attendings.
Finally, if you REALLY believe that not seeing the doctor will improve your health then by my guest! No one is forcing you to go to the doctor. No, but when you get a lump you’ll be the first one to seek out a onc doc. I really hate hypocrites.
http://drwes.blogspot.com Dr. Wes
The reason policy wonks hate doctors is because they blow budgets by keeping people alive.
skepticus
residentdoc: No one has been able to measure–or detect–defensive medicine. Kessler tried in a very complex model in the 90s. They’re big problems with it; other researchers have failed to find a relationship between likelihood of lawsuit and “defensive practices” And, yes, hospitals are not doctors– must be all those janitor salaries that are driving health care costs. The one percent includes insurance payments. The cost of trials are bourne by insurance companies,not the healthcare industry.
Susan H: Again, do the numbers. US doctors on average make sevearl 100Ks more than their European counterparts. Amortized opportunity costs (incremental to you next best choice in occupation, remember everyone needs a graduate degree these days) and direct cost of medical school and medmal (particularly if you’re a dermatologist) doesn’t get you there.
Dr. Wes. . . . our heroic little doctor. You blow budgets for sure. Save lives? Albania has a life expectancy that’s less than 1 year shorter than our own. It spends about 1/100th per capita on healthcare. For every life you guys save, you’re probably killing someone else.
Susan H
Skepticus it is not so hard to answer a straightforward question, unless you do not like the answer.
The question was: what are NET hourly wages of U.S. physicians on a normalized basis?
“do the numbers. US doctors on average make sevearl 100Ks more than their European counterparts.”
I believe the hours worked by European doctors are far fewer, and the potential medmal liablity(thus medmal insurance overhead cost) is limited.
I
skepticus
Susan H–
I don’t even know what you’re talking about when you refer to the “hourly wages of U.S. physician on a normalized basis.” Normal to what? Are you trying to be statistical?
Some European doctors work less, some more. BUT, virtually all American doctors make more than their Euro counterparts even in fields with low malpractice like dermatology. Medmal isn’t driving the wage disparity, people.
Matt
Physicians routinely claim that we need a European style approach to our medical malpractice system and extol the virtues of Europe in this regard. Putting aside the fact that they don’t really know what they’re talking about with European systems, they never acknowledge the fact that universal healthcare and deeper social safety nets take a lot of the need for malpractice away. Now they want to complain that others do it to them?
A bit hypocritical to complain about othera doing the same thing don’t you think?
anonymous
Nothing you say makes sense? No one is saying that medmal drives wage disparity. MedMal drives the overall cost of the healthcare system. You just don’t care to listen to what people are telling you if it doesn’t fit into your Skepticus skewed way of distorting facts and just plain making stuff up.
NW Hospitalist
“Dr. Wes. . . . our heroic little doctor. You blow budgets for sure. Save lives? Albania has a life expectancy that’s less than 1 year shorter than our own. It spends about 1/100th per capita on healthcare. For every life you guys save, you’re probably killing someone else.”
Maybe our life expectancy is poor because or the poor choices Americans make. Our obesity rates climb, our life expectancy worsens. I hate the way the medical system is blamed entirely for the life expectancy in this country when all I see all day is self-destructive behavior that I am supposed to fix, perfectly, for free…
Oh, and I work on average 65 hours/wk and make $190K a year. I’ll gladly take less money, but then I want to call some shots here – less hours, less insurance/paperwork and the ability to choose not to see a patient when they are self-destructive, unreasonable or angry. Deal?
Matt
What’s stopping you from doing that now?
Susan H
NW H.
So at that hourly billable rate, you must not have chosen to be a doctor for the money.
I believe there is an inherent decency and kindness which doctors and nurses possess, lacking in many other professionals.
But kind, decent people recognize it, and appreciate what you do.
Medical Student
The irony of this is that it is partly the artificially low reimbursement for primary care that is causing the health care crisis to begin with. This much is obvious, when patients can’t find primary care docs and medical students are fleeing from the field, that means there is a failure of the market.
The comparison between European and American physician salaries is wrong and disingenuous. The market forces on us are completely different. American physicians receive more years of education and take significant financial risk with student loans. Since we have a more difficult and risky path, the market equilibrium is higher. Unless we can factor out these market differences we can’t compare American physicians with their European counterparts.
http://thehappyhospitalist.blogspot.com/2009/06/do-internists-have-confidence-in-their.html Happy Hospitalist
Only 5% of the population see value in their health care. They spend 50% of the dollars. The other 95% feel like they spend too much. And they do, because they are making the other 5% feel real good about the bargain they are getting.
it’s hard to be loved when 95% of the population feels you are over priced.
Susan H
Maybe time to realize that help is not forthcoming from policymakers. Thinking about possible solutions…shift the costs of med-mal coverage to patients?
Could patients, rather than doctors,be the ones required to purchase malpractice insurance(like we used to buy flight-crash insurance policies at airports!)?
Screening patients for their attitudes toward their medical ‘entitlements’, and their knowledge or ignorance about medicine and law, might make patients malpractice premiums more equitably priced, being individually tailored.
So, patients would purchase medical malpractice policies with premiums based upon their health conditions and attitudes, which should be actuarily quantifiable.
Patients could choose to go bare, and save the cost of that insurance, or get an uncapped reward policy at a presumably high premium, or somewhere in between.
Karl
YES, KEVIN — THERE ARE SOME REAL MORONS IN PUNDIT-LAND
The pundits suffer the same severe learning problem that Harvard Law grads such as Mr. Obama and Gov. Granholm of Michigan face –
They know everything.
They just haven’t ever really done anything. Plus, doing a budget with a calculator makes them crap in their pants, they are so afraid of numbers.
They’ve never directly dealt with uncooperative patients. With a loud, annoying family that has at least one lawyer-relative. Support staff AND management who hate their jobs. Ditto uncooperative insurers.
I would call the Harvard Law crowd, Steve Pearlstein, CNN, Michael Moore, and 99% of medical-bloggers “authentic morons” — but would be insulting morons.
Like the CNN morons who sucked-in, 100%, that press release about lack of medical insurance as a major factor in bankruptcy.
Produced by Himmelstein of Harvard Med, a Socialist who has pushed for single-payer for 20 years. Boy — that was objective! Ha!
As if, spending money on cigarettes, booze, dope would NOT cause financial problems, Dr. Himmelstein? Well — duh!
Thanks to “community organizers” and other useless entities, we live in culture of complaint. If I make more than them, I’m a capitalist pig. If I don’t, I’m a loser.
I’m going do, what I gotta do. Losers can do whatever — I could care less. Really.
Frank Castle
BRAIN-DEAD
“residentdoc: No one has been able to measure–or detect–defensive medicine.”
WTF? Anyone who has been a manager KNOWS s/he HAS to check with LEGAL if ANYTHING looks like trouble. Unless s/he wants to be FIRED.
Yeah, yeah, reality doesn’t fit theory. And BHO is qualified as president.
http://tezcans.blogspot.com/ Ayse
wow! i am new to this blog but couldn’t help to notice the animosity of some commentators. discussion is a great way to find solutions to problems but venting on to an opposing view does not help the cause. we all come to our views through different experiences so there is no need to accuse one another as being incorrect.
Karl
2+ 2 = 5?
” .. we all come to our views through different experiences so there is no need to accuse one another as being incorrect.”
So .. 2+ 2 = 5?
Sure. And most times, stupid is just stupid. Like yahoos who think there is an unlimited amount of money to pay for unlimited navel-gazing and thumb-sucking. Get real.
http://greatervalleyphysicians.com Pankaj Karan,MD
I have been in practice for13 years as a board certified Internist. This is what I belive now after 13 yrs:
1. Capitation and Fee for service work has to be tied to performance based medicine to ensure high qiuakity of healthcare
2. Care must be directed by PCP and PCP should be held responsible to contain cost and should be incentivized to practice evidence based medicine
3.Medicare fraud and Medicaid fraud must be stopped to bring some cost containment. I see eery day procedures being done on pts unnecessarily. Got to stop it.
4.Parity of payscale: all specialty and PCP salary or compnesation should be equalized .People should go in different specialty not for money but for passion only and Primary care shoudl be main focus for healthcare changes being considered by President Obama.
5.Home health and DME cost must be reduced considerably to bring it to HMO reimbursement level.
6.Electronic health record MUST be pushed untill goal is achieved
LynnB
I think all of us doctors are going to high-tail it to the state where we will net $300K yearly. Just tell me where it is and I’ll put my 1969 2300 ft split-level on the market. Too bad my 1993 Volvo can’t pull the trailer . . The 2000 Volvo is in the shop again, so maybe my husband can take a Greyhound. WaHOOO
If you want to know what physicians make you need to parse it it two basic ways
1. Surgeon s vs non-surgeons
Within surgeons we have our general surgeons and our specialty surgeons . OB/gyns do some of both but are paid as surgeons and sued as if they were General Motors .
One of our surgeons , who is in a low -call specailty was whining that he made < 800K, which made the room go silent, and completely dried up his referral base among the PCPS and his sweet post-op coverage deal with the hospitalists and general surgeons was stopped the next quarter. Its not that he makes a lot, its that he does so because he is shifting work to salaried people. and whining as well .
2. In the non-surgeons we have procedure docs-cardiology and GI and even oncology, ( I think) In reality oncologists have to bill enough to have chemo chairs and nurses. Their higher billling moves chemo out of the hospital , and reduces the cost to the patients , and more importantly the almighty insurance companies.
We then have non-procedure docs, general internists , FP, Rheumatologists (why is Remicade not a procedure? who knows) , endocrinologits and psychiatrists and pediatricians .
Hospitalists in my neck of the woods make $160-$190 and can if they take extra nights , get up to $220 . That never goes up no matter how long you are there because Medicare pays everyone the same. Are lawyers and accountants all paid the same? I think not.
Office docs in my system are on salary if they admit to the mother ship and practice in the right zip code (not that unequal pay for equal work is unfair) . Outside the metropole we make $21/RVU. One vist about one RVU .. Some are 1.3 some are .76 , and you get audited if your profile is off the Medicare norm.
One visit takes 15 minutes to do and 10 minutes to document. Both take me longer, because as this post shows I am verbose and type poorly. One of our partners types 90 wpm and he takes only 5-6 minutes to document . Voice rec leaves out words like “not” and “stop” so you must proof it extensively, leaving a grabled note that is no use to anyone but the bean counters . C’est la Vie.
Most people in general internal med in my town see 17-23 per day . I can only see about 20 , usually like 18 because like most women docs I get a LOT of phone calls. For the reading pleasure of patients over half of those come in after 3 pm, so I have to stop my office hours 45 minutes early so I can answer them . Of course , unlike lawyers we don’t bill for this or for email, and I have to complete it before the phones are turned off.
…..why we need to be taking calls……………………
A patient called last week with abdominal pain on Wed (6/ 24), I was post call, she was given an appt by the staff for the next week, when I was in office full time. I saw her Thursday (6/25) on my lunch, because I had a sense of concern. She had a pulsing mass, (Aneurysm, it seemed , but I DO NOT KNOW THAT UP FRONT, I was just scared) confirming CT could not be done right away because she is allergic to the dye, done the next morning Friday, -she had a big ‘un above the renal arteries. I was on call Thursday night , up most of the night with a guy with Fourniers gangrene plus a couple of admits and the usual cross-cover stuff. I called the radiologist at 10 am Friday 6/25 as soon as I woke up and was on the phone most of the day with surgeons, the patienst, the ER (poor Tom, poor Marie ) and the referral vascular surgeon . Total billing for all that . about one RVU. Total time 3 1/2 hours . Would I have let that go ? No, that’s why I went into medicine .Incidentally, GIM wonks she was high riisk and had had an abdominal ultrasound 18 months prior with a normal looking aorta .
Same week, patient I have seen about once a year on average , who has declined pelvic and breast exam (too embarrassing) and pap (too painful) mamms (too dangerous) for 10 years finally saw a gynecologist with a 2 cm mass one breast . She had a biopsy, the result was not done as quickly as usual , finally came in and then sat there 24 hours , . The gyn has a life and was at the beach with his wife who has recently lost her mother. I felt like the patient shouldn’t wait all weekend . I called her (phone doesn’t accept private #’s like mine, cautionary tale to patients ) Ideally she would come into the office , she would then have to pay a $20 co-pay (compare to my pre-tax reimbursement) . I told her it was malignant, spent 38 minutes on the phone with her (I had to use my cell) after playing phone tag trying to get around the block. Spent 16 minutes on the phone with the breast surgeon, and 8 minutes on the phone with our referral coordinator , receptionist, and 4 minutes with the surgeon’s receptionist. Benefit-she will have surgery at least so she isn’t left with a painful stinking oozing mass in her breast . She understands that some breast cancers especailly since she is post-menopausal are treated with chemo that doesn’t cause nausea or make you lose your hair, but can prevent painful mets . Total billing =$0.
So all you who feel we are slckers and trying to kill people, work for a week with any resaonably competent mid-career doc. I know other people work hard as well, but per hour I am not doing well. For me as a PCP there is very, very little easy money to balance that.
http://tezcans.blogspot.com/ Ayse
Pankaj,
excellent points, but you should run it by karl to see if these suggestions add up to 4 .
TrenchDoc
To all of you who think we are all grossly overpaid – go ahead and encourage the policy changes it will take to decrease our incomes. But let me know in 5 or 10 years when you or your spouses have cancer how happy you are with the care you think you should have gotten. My response to you will be suck it up and deal with it – all of the dedicated and compassionate docs have moved on to other jobs where they can get some sleep, spend time with their families and not worry about getting sued.
Matt
“But let me know in 5 or 10 years when you or your spouses have cancer how happy you are with the care you think you should have gotten.”
The problem with this claim is that whenever something does go wrong, you simply say that the ultimate end of all life is death, and you can’t control this or that, etc. etc. When things go right, you want to take credit, but can’t be found responsible when things go wrong.
And I wouldn’t bank on all these docs finding equal success out of medicine.
Matt
“Total billing =$0.”
So stop signing contract that don’t compensate you for your time. YOU have the power to change that.
Matt
“Hospitalists in my neck of the woods make $160-$190 and can if they take extra nights , get up to $220 . That never goes up no matter how long you are there because Medicare pays everyone the same. Are lawyers and accountants all paid the same? I think not.”
I don’t know where you live, but outside major metropolitan areas and the financial/fortune 500 sector, accountants and lawyers will typically not make anywhere near that on average.
TrenchDoc
Matt
I live in a metropolitan area in the Southeast, there is a law school here churning out lawyers and still the going rate for lawyers is $250.00 to $300.00 per hour. I know because I written the checks to them. As an internest I would settle for those hourly rates.
TrenchDoc
Matt
“But let me know in 5 or 10 years when you or your spouses have cancer how happy you are with the care you think you should have gotten.
The problem with this claim is that whenever something does go wrong, you simply say that the ultimate end of all life is death, and you cant control this or that, etc. etc. When things go right, you want to take credit, but cant be found responsible when things go wrong.”
Docs no longer have the control so we can not make the changes that need to be made. Any doc with any clinical experience knows what the problems are but because we are “paid too much and need to be regulated” our two cents woth is just that.
You say I can’t be found? Well I never heard of a process server not being able to serve papers on a doc when there is any malpractice claim.
http://tezcans.blogspot.com/ Ayse
the plummers’ hourly rate is also more than an internist, or even an oncologist for that matter, when you add all the unpaid services that a physician provides (for example lawyers charge for a phone consult), but i don’t know any plummer that makes $200,000 per year no matter how much he works.
http://tezcans.blogspot.com/ Ayse
trenchdoc
i think you are being too pessimistic about your role and power on making positive changes.
about comparison of physicians vs lawyers: which group do you think has more respect in the society, job security and personal satisfaction?
switching to another profession might be a good idea for life style choices but in terms of monetary compensation, i wouldn’t be so confident. my husband is a computer programmer in addition to being an oncologist; his bread winner job is medicine. the competition is fierce in any job market and fiscal compensation is not worth the switch. most clinicians cannot even go back to academic world because their income prospects diminishes tremendously.
well, whiners will complain whatever the situation is. We weren’t happy when we had all the autonomy, no regulation and the highest esteem in the society because our compensation was not guarantied (think of getting paid with eggs and chicken again); now there is a system that guaranties above the national average earnings, we are complaining that we lost autonomy, power and respect. I don’t think there is a shortage of candidates who would happily take the place of a newly accepted med student.
TrenchDoc
Well I do. I have a patient who owns a plumbing company that employes 10 plumbers and he told me that last year all but 1 made over 100 K and 2 made over 200 K.
http://tezcans.blogspot.com/ Ayse
great for them. when the monetary compensation is the only goal, studying medicine so many years and not to recoup this investment doesn’t make sense, does it? i wonder why the number of applicants to get into medical school is still so high. uninformed bunch?
TrenchDoc
I not sure anyone who does 4 years of college 4 years of med school and at least 3 years of post grad training before generating any income would be considered a whiner. I am saying we will get the kind of medical care we deserve collectively as a society. If we want better outcome results then our collective society can get up off our butts eat right lose weight exercise and quit blaming someone else other than our own bad choices.
Anon
“Well I do. I have a patient who owns a plumbing company that employes 10 plumbers and he told me that last year all but 1 made over 100 K and 2 made over 200 K.”
That’s one. You want to play the averages and see how you come out as a plumber, go for it. Bet the average plumbersalary is less than 1/2 the average physician.
Matt
“I live in a metropolitan area in the Southeast, there is a law school here churning out lawyers and still the going rate for lawyers is $250.00 to $300.00 per hour. ”
So what’s their net? Because that is what matters. And what’s the AVERAGE attorney net?
http://tezcans.blogspot.com/ Ayse
i couldn’t agree more..
http://tezcans.blogspot.com/ Ayse
i mean with the trenchdoc’s last comment about “making right choices to become healthy.”
TrenchDoc
Another approach would be to just bide out your problem just like a home construction job. You choose a doc – take your medical problems to him with a list of your expected outcomes and ask for a bid on what it would take to get you the outcomes you wanted. You pay half up front and the balance upon reaching the desired outcomes. How many of you would do this as a patient? As a Doc, I would come out ahead because now I get 40 percent of what I charge and then my overhead is 55 percent – 15 percent of that is to collect what the insurance company has already agreed to pay me.
This is capitalism at its best.
http://tezcans.blogspot.com/ Ayse
i agree. my husband had also eluded to this alternative. there wouldn’t be a need for billing services, too. however, you probably would need well-drafted contracts with the patients; you know what the indians did to dr. whitman when he couldn’t fix the measles outbreak in 1840s . just kidding; this would also give both parties a personal responsibility. by the way, we still have the problem of low or no income people and the children being left out of this system as well.
Susan H
Trench Doc: where do you want the line to form? All HSA account holders, many disgruntled Medicare recips who have ‘gone bare’(no docs in town can afford to accept new Medicare pts.), and most adults who have had a tutorial in generally shameful insurance company reimbursement practices would all be eager clients.
Here is what I believe a critical mass of patients for any local practice would agree to:
1. Your plan as you outlined above. Presumably estimates would be disclosed up front like plastic surgeons and dentists have always readily done.
2.Work together to establish a contractual agreement on fast-track medmal settlement if god forbid it should ever be needed.
That is, patient is willing to forego painand suffering damages, and accept binding arbitration for some capped amount which would pay for fixing the problem and disability support.
3.Allow the patient some leeway to elect to forego tests which the doc agrees may be extraneous, and allow pt. to go to strip mall labs, or any cheapest purveyor of serum tests or imaging.
When can you start?
TrenchDoc
That is a pretty good outline. Just pay me a 6 month retainer fee up front to cover all office visits. I can outsoure th labs and it would be cheaper for both of us because I would not need staff and equipment for the lab. I could do this with one or two support staff in a 1200 sq ft office.
Susan H
Trench Doc
When can I start?
Honestly, you have outlined such a better system than what we live and die with now.
Why is administration so deafeningly silent on promoting HSAs, or cash pay systems?
The math on ‘regular’ health insurance screams for citizens to convert to HSA. Save two years of those premiums and you can afford to have a cardiac event, and get change back.
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concierge medicine
“That is a pretty good outline. Just pay me a 6 month retainer fee up front to cover all office visits”
this is called “concierge medicine”.