3 ways for doctors to reclaim their value

A few years ago, I sat in a coding lecture for urgent care providers given by a very entrepreneurial physician assistant. An emergency room doctor, who had recently established his own private clinic, put up his hand to ask a question. He seemed puzzled.

“I can see your point about coding at a higher level for a sore throat when I was younger,” he said. “I used to take longer to figure out what was wrong. But now that I’m faster and more experienced, I don’t think I should be using the higher codes.”

Needless to say, the physician assistant was dumbfounded.

Fast forward to today’s practice environment. Oligopolies of third-party insurance companies post billions of dollars for shareholders every quarter for shuffling claims, creating roadblocks to delivering healthcare services, skyrocketing patient premiums and seriously compromising a physician’s value. Physicians thought they were playing the game, somehow believing that it wasn’t about the money, but about doing a damn good job. What happened instead is they devalued their own sense of worth and became willing to accept pennies on the dollar.

There’s a difference between monetary value and perceived value. The actual numerical number assigned to a service, let’s says $120.00 for a physician visit, is actually meaningless. It’s our perceived value of that physician and his or her services which give us the feeling as clients (patients) that we’ve actually received value for those same services. That same physician could set his or her charges at $1,500.00 for the same technical visit, and if a client believed that he was worth every penny, the client would pay it without question. The amount a client (patient) is willing to pay depends exclusively on the perceived value of the physician.

Doctors have allowed themselves to be perceived as “free” in the transaction of healthcare. They have been significantly devalued by government programs such as Medicare which have set fees at the price of a cup of coffee (the crap stuff). Along with this numerical drop, has come a severe decrease in physician’s perceived value. The bureaucracy of these oligarchies has simply followed our own sense of declining self-worth; in other words, doctors can now be had on the cheap.

So how can you, doctor, increase your perceived value to your clients in today’s practice environment? This sinking trillion dollar industry has equated your value to a nickel-and-dime store cost for years of dedicated medical training, acceptance of high risk (a patient’s life is in your hands) and tireless commitment to your profession.

The answer lies in copying the business habits of our competitors; the very health insurance companies and government programs under whose hands we suffer. Here are 3 easy steps you can take to begin to reclaim your sense of self-worth and also your monetary value:

1. Become a cash-based practice. Drop all of your current health insurance plans. Opt immediately out of Medicare and Medicaid. Create a cash-based, tiered program (bronze, silver and gold memberships) which does not use ICD-10 coding. Yes, you heard right. Do NOT use ICD-10 coding systems. This classification, if you are cash-based, is completely useless and only ties you to government regulation such as HIPAA. By using a customized cash-pay fee schedule which has been created outside of current bureaucratic requirements, you begin to think “out of the box” you have put yourself inside, and begin to control your own destiny.

2. Double your prices. Yes, you heard right. Once you have created your customized program for clients (no longer to be called patients), you double your prices. If you don’t, your clients will downgrade your value. They will not perceive you as being worth a higher price.

3. Cultivate a polite, giving, caring but exclusive attitude. Yes, you are worth every cent of the prices you charge. Carry yourself proudly. You went through years and years of training. You hold someone’s life in your hands. You are a doctor; you’ve committed your energy, money and passion to becoming what you are and yes, you are worth it! Stop acting like some high-school drop-out who’s willing to let the bully down the block collect a rental fee to keep him from giving you a black eye!

Concierge medicine is on the rapid rise. If you haven’t already taken the first step and gone cash, you’re already behind the pack. Steps 2 and 3 will take some gumption, risk and willingness to invest in yourself first, and then your practice.

I guarantee the first few months will be gut wrenching.

But once you get used to reclaiming your personal perceived value, your bank account will begin to show you exactly how much you believe you’re worth, doctor.

Natasha Deonarain is the founder of The Health Conscious Movement. She is the author of The 7 Principles of Health and can be reached on Twitter @HealthMovement.

Comments are moderated before they are published. Please read the comment policy.

  • civisisus

    Wow, there’s so much “right-wrongness” about this post it’s making my head spin, so consider my paltry 3 corrective bullets as seeds of thoughts:

    - People don’t hire you for your degrees, or the endless hours of study you’ve put in, or any of that. They have a health care job they need done, & if they’ve found you they have a vague idea you might be someone who can do it a price they’re prepared to pay.

    Do what you can to reinforce their perception. Because it IS about their perception, not yours.

    - Don’t work when other doctors work. Work when people who need you, need you to be working. You may already be doing so – but do you KNOW with any certainty? I’d wager your mortgage payment that you do not KNOW. Start introducing ways you can know. Because if you aren’t working, and available, when people need you, you’re not going to be hired. You’re going to be doing the same old whining you’re already doing.

    - Help people not need to see you. Give them a plan. Help them devise a plan you would endorse. Keep people heallthy, and confirm it from time to time. You don’t know it – because you don’t do anything to know it – but people appreciate being kept healthy. Remind them how much they like it, and underscore what you do to help them accomplish it. Because while you think you aren’t paid to do that, even in the current transactional pay-for-activity environnment, you’re REALLY paid for healgth. Act like it. Live it. Let your patients know that’s what you’re about. Because they don’t know it if you don’t.

    You don’t need to go concierge, you don’t need to double your prices, you don’t need to be exclusive. You need to be a health-bringer.

    • azmd

      Interestingly, none of the three points you outline in any way argue against doctors going to a concierge or direct-pay practice model.

      In fact, in our current healthcare system, third party payers have very little incentive to pay providers to offer flexible hours, or to offer preventative health care services and so those amenities are much more likely to be feasible in a concierge/direct pay practice.

      • http://twitter.com/hystericalogic Anna Rachel

        This dribble would make the smallest amount of sense if it weren’t for the fact that current healthcare models DO NOT assume that doctors (particularly the grossly overpaid ones in the US) should not expect a basic minimum level of lifestyle afforded by their work. Doctors are very well remunerated (too well in your country, imo, I think it attracts some of the wrong types of people to the field).

        Oh and if this were true “will find that fewer bright, idealistic students will be able to justify
        devoting the time and money to become qualified to do that work.” – nobody would become PhD scientists. You make the false assumption that the same kind of thing that motivates people to be investment bankers motivates people to become doctors – i.e the bottom line, and that simply isn’t true for most people.

        As long as remuneration is kept at a sane level, bright minds will always be attracted to medicine. You do not need excessive remuneration to attract bright minds to medicine – it’s certainly not what attracted me or most of my peers.

        • azmd

          I think perhaps you meant “drivel” not “dribble?”

          In any case, you sound quite young, and you are clearly being trained at government expense to practice medicine in another country. I would suggest you are not in a position to comment knowledgeably about practice models and physician compensation in the U.S.

          That being said, I do agree that there are many specialists here who are badly overpaid. But this conversation is really about primary care providers. In the U.S., remuneration for PCPs who have paid for their own medical education, and will be expected to pay for their children’s education, is, in fact, approaching unsustainably low levels. You wouldn’t know about that, because you are not living and working within our educational and medical system.

        • Jbsilva

          I honestly don’t understand how you talk so confidently about American physician compensation when your from another country that has a single payer system and government subsidized education. However you do, and don’t seem to stop so here I go.

          First, you seem unable to grasp the fact that even though 157,000 looks like a big number, it doesn’t factor in debt, the average being 150,000 for American medical students, plus 4 years of deferred income, plus 3-6 years of residency with near minimum wage income makes the salary of 157,000 dollars first earned around the age of 30 actually just decent. I agree with you that one can easily support themselves on even 100,000 first gained as a thirty year old, but will they be able to afford decent colleges for their kids? Will they be secure if someone in their own family has a serious medical emergency? Yes, bordering on no, which seems kind of crappy for someone who spent a decade of his life learning how to help people with their basic needs.

          Moreover, with medicare paying even less and insurance companies trying to squeeze more profits out of the system, this salary is in danger of going even lower while debt remains constant or is increasing. Despite obvious qualms I have with this article, concierge doctors represent a push back against these forces. They provide an avenue for doctors to demonstrate their value in the real world market and have more bargaining power when these large forces try to force them to take less money. Sure this goes against your idealism and the idealism of many doctors even in America, but when working in a private system, if someone can pay you less they will. Rather than succumb to market forces, doctors must employ their own. Get over it.

          • http://twitter.com/hystericalogic Anna Rachel

            I must concede that you make excellent points that I had not considered. I must say though that this convinces me more than ever that your entire system (speaking of health and education here) is in drastic need of an overhaul.

      • buzzkillerjsmith

        As you well know, it’s not all or none. Your sentence “They need to be paid…” is absolutely right. But the clown who posted here was talking about income maximizing come hell or high water. I know you don’t believe in that, azmd.

        • azmd

          Actually, I am a big believer in a single-payer system, as you know. But since that seems unlikely to happen in the U.S. in my lifetime, I am also a believer in whatever practice models will enable physicians to regain some of our professional autonomy. I do disagree with the suggestion that we all double our fees. That seems kind of silly. But I agree with the idea that we should expect to be treated with respect.

          • buzzkillerjsmith

            Agreed.

    • Mengles

      A doctor can’t keep a patient healthy. Only a PATIENT can keep a patient healthy – as they are the ones making decisions in their lives. A doctor is there to evaluate you and give you medical advice, which you are free to take or disregard. It’s called patient autonomy – the first thing taught in medical school.

  • Candace McNaughton

    I wonder about concierge in the context of mandated health insurance. One reason that I contract with insurance companies is that I know as a consumer, if I have health insurance, I am going to go to someone in-network if possible. That is where I will start to look. If everyone is carrying insurance, they will likely take that tack. I don’t want to just be the doc for the elite few who don’t take that path.

    But I will say this for sure: While I go to great lengths to work with my folks to promote health and I don’t do this for the riches, I still need to make an income. It turns out Contractual Discounts skim 40% off my potential income. Yikes. Where is the middle ground?

    • Mika

      “If everyone is carrying insurance…”

      Yes, but just because “everyone is carrying insurance” doesn’t mean all doctors will accept it. Doctors like the author of this article will not accept Medicare or Medicaid, for instance. That’s their right, as doctors aren’t slaves, but it does mean that if every medical practice in a given area gangs up and decides not to have anything to do with the millions upon millions of Americans who are “insured” by Medicare or Medicaid unless they can front up the cash, then what?

      • azmd

        Then people will find a way to budget for their ordinary health-care expenses, just like they budget to maintain their cars. They will be smarter shoppers, will demand more transparency in pricing, will take more responsibility for coordinating their care, and will make cost-benefit decisions for themselves before using medical services. These are all perfectly desirable goals that our current healthcare system is voicing a motivation to pursue, however, the third-party payer system that we have creates perverse incentives for waste and inefficiency.

  • buzzkillerjsmith

    Shorter Dr. D, MBA, emphasis on the MBA

    It’s about you making lots and lots of money. The patients who can’t afford your exclusive services can go straight to hell. Disgusting.

    buzzkillerjsmith, MD, no MBA

    • Close Call

      I assume your practice is open to all those who can’t afford insurance? Is yours a free clinic?

      • http://twitter.com/hystericalogic Anna Rachel

        Wow what a weak attempt at straw-manning somebody. Did he say that? Did he say that doctors should charge nothing for their service? No he didn’t, he just made the very salient point that the kind of sickening, excessive greed portrayed in this article should not be incorporated into the practice of modern medicine. You see – it’s possible to charge people for your services without overcharging. I’m sorry that you found that concept so confusing, and that to you the only two options is to financially rape somebody or provide your services for no fee.

        • buzzkillerjsmith

          Thanks.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        People who happen to be physicians should not be the only ones financially responsible for providing health care to the poor, which is what you are asking for.
        All of us, physicians included, should chip in through taxation, as we already do to a certain extent. Actually, physicians that “accept” Medicaid are already contributing a disproportionate amount.
        Expecting a decent fee (most of the time), not exorbitant and not “perceived”, whatever that may be, is not in any way similar to an “exclusive” practice of medicine.

      • buzzkillerjsmith

        Not a free clinic, but open to all. The uninsured must pay no more than we are paid by insurance, and we do have a FAP (financial assistance program) to help out the uninsured. This is clearly not how it happens in a lot of clinics and hospitals.

        And of course your comment is idiotic at bottom, all or none foolishness. Please up your game or buzz off.

        I try not to be abused, but I do not maximize my income at the expense of other people in this society whom God loves as well as He loves me. My partners feel the same way. I could be earning a lot more money, but would it make my life much better? Probably not. I haven’t missed a meal in a long time.

        Maybe you should try it. Or maybe not–if you have had business training.

        • http://twitter.com/hystericalogic Anna Rachel

          ^this is the kind of doctor I want to be. Thank you.

          • Original_Cait

            If you are going to be a doctor in Australia, it is the Australian taxpayer paying you anyway, not your patients. It’s easy to be “selfless” with other peoples’ money.

          • http://twitter.com/hystericalogic Anna Rachel

            Sigh. Not necessarily true. We have a large private practice industry here as well and you’ll find that the majority of specialists divide their time between the public and private sectors.

  • http://twitter.com/hystericalogic Anna Rachel

    I honestly couldn’t tell if this was satire or not, although noting that you had the MBA (the anti-intellectual scourge of all graduate degrees) convinced me that you probably do mean this nonsense.

    Let’s take it point by deluded point, shall we?

    1 & 2 – Become cash-based and double prices. Ha! That is actually so insane it’s laughable. American doctors are grossly overpaid as it is (look at your salaries compared to the rest of the world – they are the highest, despite your health outcomes being absolutely rubbish compared to other first world countries). This will not fix anything – it will just make things far, far worse.

    3 – Doctors went through years of training. Yes, they did. So did PhD research scientists (arguably a far more intellectually demanding pathway) and still they make far less than you. Years of training does not equal give me more money than everybody else. Lots of people go through years of training. Don’t be so bloody entitled.

    You hold someone’s life in your hands. Yes, you do. However – so do many other professions. It’s been said before, but sanitation workers save far more lives than doctors do so this argument is a little disingenuous. Again – holding someone’s life in your hands does not equal pay me more money! And honestly – your advice to cultivate a more exclusive attitude. As if there isn’t enough entitled, exclusive douchebaggery in medicine. Way to alienate the public!

    No wonder your country’s health system is a hysterical mess – with greedy imbeciles like yourself clamouring for more money, more respect, more everything – in a system where you already have the most of everything.

    I really hope I never end up the kind of doctor that you are. Ever. Do medicine a favour and defect to investment banking – we don’t want you.

    • trinu

      The issue of pay with American doctors is a bit more complicated than you make it out to be. The biggest confounding variable is the difference between primary care physicians and specialists. Certain specialties are overpaid, but primary care physicians are GROSSLY underpaid in the USA. Generally other countries also have a higher percentage of primary care physicians and a lower percentage of specialists compared to us.

      • http://twitter.com/hystericalogic Anna Rachel

        No, sorry but you are demonstrably wrong about that. Your primary care physicians still make more than primary care physicians in other first world countries like Australia, Canada, France, Germany etc. Sure, the discrepancy is larger for specialists, but they still make more.

        • trinu

          The average salary for family doctors in Quebec, (the province with the lowest average pay for primary care) is 171K (yes, I took the exchange rate into account). In the USA the average is 157K.

          • http://twitter.com/hystericalogic Anna Rachel

            I have no idea where you are getting your statistics from. No other developed nation pays their primary care doctors as much as the US, including Canada. This isn’t a controversial statement.

          • Suzi Q 38

            Can you show us a link with your information?

          • trinu
          • http://twitter.com/hystericalogic Anna Rachel

            lol, did you seriously just quote web articles as evidence? Even the undergrads I tutor know better than that…

          • buzzkillerjsmith

            This is correct. PCPs in Canada earn less than we do here.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Instead of me trying to explain why the absolute difference in pay is not a good measure, read Paul Kelleher’s concise summary, and make sure to follow the links to the papers he is quoting http://notunlikeresearch.typepad.com/something-not-unlike-rese/2011/09/international-comparisons-in-physicians-earnings-.html

            Basically, the public perceives physician compensation to be excessive because of the widening inequality between the top earners and the rest of the country, and docs are probably the only top earners that most people ever encounter nowadays, since all the other ones live in gated communities or some other stratospheric locale.

          • http://twitter.com/hystericalogic Anna Rachel

            ….. that paper is comparing doctors earnings to other high earners in the country. Given that your top 1% earn obscenely high amounts of money compared to the rest of the country (and world..) then I’m not surprised that the salaries of American doctors pale in comparison. This just makes the argument that doctors earn too much, but other people in America make way too much.

          • Noni

            Yawn. The whole “greedy doctor” argument has gone to the wayside here. It is well known that insurance companies and hospitals reap tremendous profits on the backs of hardworking physicians. Is it greedy to expect to be compensated enough to be able to pay your rent and office staff? Is it greedy to expect to provide a service and then not have to fight tooth and nail with a variety of insurance companies and the government to receive compensation?

            I’m going to wager that as a research scientist you get a salary, correct? Did you ever dream of becoming a research scientist and not being compensated for your work? As much as you want to refute it medicine IS a job and it’s something docs deserve to be compensated for without tribulation.

            I’d love to know what you think would be “reasonable” compensation for a physician.

          • http://twitter.com/hystericalogic Anna Rachel

            I’m not a research scientist anymore (and when I was I got paid less than the average nurse so please, do not lecture research scientists on unfair remuneration – they are the poster children for it) – I ‘defected’ to clinical medicine. I think that physicians in my home country (Australia) are paid fairly – so that’s what I think is fair remuneration. Nobody here is arguing against fair compensation. Did I ever say that? I am just arguing against obscene compensation which does nothing but drive up healthcare costs and alienates a public that is sick to death of dealing with an overpriced, inefficient health system.

  • trinu

    There is no way to create a caring attitude when everything else on your list makes it sound like getting care from you will by like dealing with Comcast customer service.

    • Suzi Q 38

      My husband is a manager of three small departments in a medium sized city. He works 40 hours a week, M-TH (10 hours a day). He has Fridays completely off. He makes $150K, and only has a BS in planning. He thought of getting his Master’s, but realized that he didn’t need to, as long as he had experience. No malpractice insurance needed.
      He went to the local college for 4 years and he did not take out any loans to pay his tuition. I hope that the reality is that the PCP’s make more than that.
      We just live in a really modest house and city. Our kids attended state schools. For years we drove “beaters while the kids attended Berkeley. We paid cash for their education.

      My point is that if the PCP’s are only making $157K on average, they aren’t doing it for the money. They put in a lot more hours and have a lot more hassle from people that don’t appreciate them.

      • http://twitter.com/hystericalogic Anna Rachel

        *deeply amused at implication that $157K/year for an individual person’s salary is not that much

        • Suzi Q 38

          I don’t think it is given taxes, insurance, medical school loans, etc. Plus they have to live.
          In addition to that they gave up several years in medical school. I am amused that you are deeply amused.

          • http://twitter.com/hystericalogic Anna Rachel

            I’m really sick of the giving up several years in medical school argument hey. PhD scientists give up way more time in uni (at least 10 years) and are remunerated much less. It’s not an argument. Also everyone pays taxes – so again, not an argument. Every graduate has student loans etc. The only compelling part of your argument is the insurance one, and even with that I would still argue that $157K a year is a lot of money. I’ll be quite happy with that (adjusted for inflation) salary when I’ve finished my post-graduate training as a doctor – then again I don’t live in America and so probably have a less insane idea of what ‘wealth’ means.

          • trinu

            The amount of training for a PhD scientist, including the the postdoctoral work (4 years college possibly 2 years for a masters, 4 years for a phd, and 2 years of post-doc) , is about the same as for a primary care physician (4 years college, 4 years med school, 3 years residency), but the cost is much less for the PhD.

          • http://twitter.com/hystericalogic Anna Rachel

            Firstly – a PhD (in the hard sciences at least) takes longer than 4 years (that is very optimistic) and it’s incredibly optimistic to think that you’ll only do a single two year post-doc (almost never happens, especially these days…). Secondly, PhD candidates (I’m going to have to restrict my example to the medical sciences here) are actually contributing novel research during their studies i.e they are actually working as medical researchers in the field, publishing papers and making advances in the field etc, whereas medical students are just learning. So it’s completely equitable that the cost is less. A PhD is more comparable to residency training, than medical school.

            Thirdly – the salary and job security upon finishing training is considerably less for PhD medical science graduates. It never even approaches that of a physician at any point in your career.

            Honestly, if you are going to try and say that physicians have it worse than PhD scientists in terms of length/difficulty of training and remuneration, that’s a game you will lose very quickly.

          • trinu

            Perhaps things are different in your country, I was giving the time frames assuming an American education. I see no point in arguing further with an ignoramus so thoroughly convinced of her own intellectual superiority.

          • http://twitter.com/hystericalogic Anna Rachel

            I researched PhDs in America once upon a time (and career pathways) and no, it’s not that much different. In fact it seems to take longer in your country.

          • Guest

            So you’re still a student. Get back to us when you’ve spent a little time in the real world supporting yourself and paying taxes.

          • http://twitter.com/hystericalogic Anna Rachel

            I worked as a full-time research scientist for a while after honours and apart from that have been living out of home supporting myself through jobs since I was 19 (supported myself with no government student assistance through the entire of undergrad) so thanks but I’m well acquainted with the real world.

          • Original_Cait

            She’s just trolling now. She really has nothing to add to this article, which is about American PCPs in the American healthcare system. Fin.

          • azmd

            I am going to go out on a limb here and guess that your medical education was paid for by your government, and as such you will have no educational debt when you start practicing. The chances also seem good that your children’s education will be largely paid for by your government, as well. I am going to furthermore guess that you practice in a country where there is single-payer medicine. Doctors in such systems have fairly nice lives, as they are government employees with generous benefits.

            It’s really not realistic, then, for you to comment knowledgeably about what is a reasonable salary for a PCP in the U.S. Let’s just say that at the salary you are describing as “a lot of money,” it would not be possible for a physician in the U.S. to expect to send his or her children to college without significant financial aid.

          • http://twitter.com/hystericalogic Anna Rachel

            Nope. We get loans for all of our degrees just like you (and mine is pretty huge so far). So your entire argument is invalid.

            Also no, I’m not in a single-payer country either.

          • azmd

            Interesting, I was under the impression that an Australian medical degree was an undergraduate degree, thereby sparing one the expense of undergraduate education. I have also heard that most Australian medical students pay about $10,000/year for their education, compared to $50,000/year in the U.S.

            Australia also touts its universal healthcare system which is largely paid for by the government, as being a part of the reason that Australians enjoy such a long life expectancy. Another nice thing is that all university education for Australians is heavily subsidized by the government, so educating your children there is much less of a burden.

          • http://twitter.com/hystericalogic Anna Rachel

            That’s okay I wouldn’t expect people from other countries to know about Australian medical education :)

            About twenty years ago you would have been completely spot on in your description. However we have taken a leaf out of your book in recent years, and as such *most* medical education in Australia is now graduate entry i.e we have to complete an undergraduate degree, sit GAMSAT (our version of MCAT) and then do a four year graduate course in medicine – all paid for (albeit deferred through loans) by the student.

            University here, as per our American counterparts, is more and more being run like a business.

            Of course our medical school cost is lower than the American schools, but the discrepancy is not that big to account for the discrepancy in our salaries.

            We do have a great universal healthcare system, yes, but we also have a large private health system (and without private health insurance you will sit on waiting lists forever waiting to get things like cataract surgery) so it’s not perfect.

          • Original_Cait

            There are three types of medical school places available at Australian universities.

            –Commonwealth supported places,

            –international undergraduate full fee-paying places, and

            –bonded places.

            Commonwealth supported places are university student places funded through the Commonwealth Grants Scheme. Under the scheme, the Australian Government funds each university for an agreed number of places. As a student you pay a component of your degree – about $8,500 for medical students in 2009 – and the remainder of about $18,000 is subsidised by the government. You can access HECS-HELP to defer payment of your course fees.

            Source: AMA (Australian Medical Association) website, “Becoming a doctor and bonded medical school places – a guide for prospective medical students”.

          • Original_Cait

            There are two types of medical degrees available in Australia:

            –a five or six-year Bachelor of Medicine and Bachelor of Surgery (MBBS), and

            –a four-year graduate entry medical degree.

            If you are applying for a five or six-year Bachelor of Medicine and Bachelor of Surgery, you will need to complete Year 12 of your secondary education and obtain a very high university entrance ranking.

            You are required by most medical schools to sit the Undergraduate Medical and Health Sciences Admission Test (UMAT) to assess your personal qualities and aptitude to be a doctor. An interview with the medical school is usually part of the selection process.

            If you are applying for a four-year graduate entry medical degree you will need to have completed a bachelor degree in any discipline. You are required to sit the Graduate Australian Medical Schools Admissions Test, the graduate entry equivalent to UMAT, and are interviewed as part of the selection process.

            Source: AMA (Australian Medical Association) website, “Becoming a doctor and bonded medical school places – a guide for prospective medical students”.

          • http://twitter.com/hystericalogic Anna Rachel

            FYI the undergraduate medical courses are being rapidly phased out in Australia, we’ve adopted the US model for the most part now (we have even stolen the MD classification).

          • Original_Cait

            I understand your school (UQ) is “developing” a four-year MD programme, and “subject to approval” it will be offered for the first
            time in 2015. Yet you make it sound like it’s a fait accompli, something that’s already been happening.

          • http://twitter.com/hystericalogic Anna Rachel

            Our MBBS is still a four year grad entry program i.e you need an undergrad degree and have to sit GAMSAT to get in, and has been for decades now…. there are a few provisional HS entry students who sit UMAT instead but they still have to do an undergraduate degree before they start medicine at UQ – they just don’t have to sit GAMSAT. UQ only offers a four year graduate entry medical program.

            Just because a med program isn’t an MD, doesn’t mean it’s undergrad entry.

          • Original_Cait

            The current MBBS program is classified as an undergraduate (bachelor) program. This is a level 7 qualification in the AQF. All Australian medical programs (with the exception of the Melbourne MD) are currently undergraduate programs (even though some of them have graduate entry streams) and meet the Level 7 criteria on the AQF.”

            That is from the UQ website itself, dear. Stop trying to bullshit these poor Americans. Go find another blog to troll.

          • http://twitter.com/hystericalogic Anna Rachel

            It’s undergraduate but still graduate entry. I know it sounds weird and confusing and trust me, all Australian students agree that it is weird and confusing – but it’s the truth. Look a little harder and you will see that you need to complete a bachelor’s degree before entry into the program.

            If I were making this up then why would students need to sit GAMSAT (graduate australian medical schools admission test) to get in? Even the HS provisional entry students (the minority) who sit UMAT still have to finish a bachelors with a certain GPA before they start the MBBS.

          • http://twitter.com/hystericalogic Anna Rachel

            Oh and you are super creepy for looking up which school I’m from.

          • Original_Cait

            You’re embarrassed you got caught out telling porkies. That’s understandable.

          • http://twitter.com/hystericalogic Anna Rachel

            Ugh. I already explained that the MBBS is an undergraduate, graduate-entry program. It’s not my fault that UQ is intellectually challenged in the categorisation and description of their graduate entry medical program.

          • http://twitter.com/hystericalogic Anna Rachel

            FYI most other Australian med schools are the same i.e if they do have undergraduate medical programs – they are still graduate entry. Very few programs in Australia still allow entrance into med school straight from HS. It’s a ridiculous confusing situation and that is part of the reason they are all switching to the MD.

          • azmd

            And you are super-silly for posting inflammatory and untrue statements on a discussion board and then thinking that others wouldn’t check you out.

          • Caitlin

            Australian Uni expenses ARE heavily subsidised by the taxpayer, Australia IS a single-payer country, Australian GPs get around $200,000 per annum (more in some cases), and talking about the private system is a furphy because (a) all private GPs still bill Medicare (the single-payer system) for the Medicare-covered portion of their patients’ bills, as they would with their public patients, and then just hit the patients’ private insurance up for the rest, and (b) the only reason a GP would go into an exclusively private practice is FOR THE MONEY, something our precious Ms Anna would seem to be against on principle.

            Ms Anna is having you on, people. As an adolescent America-bashing entitlement-minded “occupy”-type redistributionist, she’s just cross that her government is siting on about 27% approval and about to be tossed out on 14 Sept. Views like hers are NOT typical of the average Aussie.

          • http://twitter.com/hystericalogic Anna Rachel

            Everything you just said about my country’s health system is pretty much wrong. Australian GPs do not earn that much on average, our GPs earn less than your GPs (not my opinion – but a fact) and your GPs don’t earn that much so how is that possible?

            Oh and our private health insurers don’t cover a single penny towards GP visits, nor do they cover inpatient consults for specialists. Medicare rebates a portion (like you said) and the patient just pays the rest.

            Yes our universities are heavily subsidized by the tax-payer – so what? That just means that in my country, whether or not you go to university is based purely on how well you perform and has 0 to do with how much your parents earn. However, that doesn’t mean I won’t have considerable student loans when I finish grad school. I just won’t have the insane ones that my American counterparts will. It’s insane how much your educational institutions charge for higher education.

            p.s I’ll be thrilled when my government is turfed out on September. I can’t stand Julia Gillard. You know absolutely nothing about me, so please, spare me your simplistic ideological categorisations. Some of us are actually capable of independent political thinking beyond those that fit into discrete party boxes.

          • Original_Cait

            “Everything you just said about my country’s health system is pretty much wrong.”

            No, everything that /you/ spouted overnight about /my/ country’s health system was pretty much untrue. You just didn’t expect there’d be anyone else here familiar with the Australian system to fact-check you.

            “You know absolutely nothing about me”

            I’ve read your Twitter feed. “The gushing morons realise that the Iron Lady was a piece of pure conservative propaganda, right? #Thatcher”. Or “Vomit @ revisionist Thatcher diatribe. She = mismanaged the economy,
            war monger, anti-working class, harboured war criminals etc #Thatcher”. You’re not an “independent” of any stripe, dear.

          • http://twitter.com/hystericalogic Anna Rachel

            Okay so your country’s health system isn’t the most costly in the world even though you arrive ~50th in terms of health outcomes, and I also must be imagining the fact that you charge medical students insane amounts of money to actually become doctors therefore putting them in massive amounts of debt which then (somewhat understandably) puts them in a position where some feel justified charging obscene amounts of money for the services they provide therefore driving up the cost of health care ….and we are back at the beginning again.

            ps I’m not sure what point you’re trying to make re my Thatcher comments. Is your point that nobody could despise Thatcher without subjugating themselves to a leftist ideology? That kind of sounds like you are saying that I cannot hold opinion X without subscribing to ideology Y, which of course is complete nonsense. Yes I hate Thatcher and all she stood for. I also hate the left wing party in my own country and am against a lot of things that the left subscribe to – a recent example I can think of that has wound me up is affirmative action. Like I said – not everybody is a slave to ideology.

          • http://www.facebook.com/cyndee.malowitz Cyndee Malowitz

            I think your comments deserve 100 thumbs up!

          • Suzi Q 38

            Oh please. I am not a doctor, but I believe at the end of the day, they have the right to earn a living, just like anyone else. Not everyone is willing to work for free like you do.

          • getagrip

            I think you should set up some kind of charity for the poor Doctors. I bet you’ll make millions selling these sob stories. Do you work for Simon Cowell by any chance? LOL

          • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

            Science PhDs get their education paid for. Big difference.

          • equality

            The Australian health, education, welfare and taxation systems are so different from America’s, it’s not useful trying to make comparisons.

          • http://www.facebook.com/cyndee.malowitz Cyndee Malowitz

            Can I clone you and transport you to the U.S.? We need more physicians with your attitude!

            Just think of all those professors with PhDs in Chemistry, Microbiology, Genetics, etc…how much money do you think they’re pulling down?

      • buzzkillerjsmith

        PCPs are underpaid, granted. I live it. But dedicating yourself to taking care only of the wealthy is absolutely disgusting. We are not businessmen. We are not businessmen. I repeat that to myself a lot.

        • http://www.facebook.com/cyndee.malowitz Cyndee Malowitz

          I’m glad to see there are still some physicians around who care more about their patients than the numbers in their bank account.

        • Suzi Q 38

          I agree. You should do it because that is what you are good at doing and want to do it.

          I am a teacher. I wouldn’t like teaching to all privileged and wealthy students either.

          This week I am helping out a couple of Chinese dissidents. They were afraid about what I would think about them if I knew. They need jobs, and are scared but grateful to be here. I am also wondering how to instruct them to get medical care if they need it.

          We don’t always do our jobs for the money, but the money pays the bills.

  • http://twitter.com/hystericalogic Anna Rachel

    You make a fair point, but in defense of the PhD route, the PhD students are more comparable to interns and residents really i.e PhD students are actually doing a job. They are conducting novel medical research, tutoring, publishing papers and generally doing a lot of grunt work in a lab. I believe that the existence of the stipend reflects that they are actually contributing labour, albeit in a supervised fashion (which is why the stipend is so low haha).

    Contrast this with medical students who are really just learning without contributing (in fact they arguably cost money lol).

    I would also make the point that the discrepancy in career earnings between PhD medical researchers and their clinician counterparts positively dwarfs that of any discrepancy in student debt.

  • http://twitter.com/hystericalogic Anna Rachel

    Yes but American GPs still earn more than GPs from all of those countries. That was my original point.

    • Original_Cait

      No, you’ve backtracked because some inconvenient facts just stomped on your narrative.

      • http://twitter.com/hystericalogic Anna Rachel

        Like the ones you cited re GP salaries in Australia? Nope. All salary data points to the fact that American doctors are overpaid compared to their counterparts in other countries. Which was my original argument…then we got into some convoluted stuff about medical school loans and I admitted that I won’t be as indebted as my American colleagues (I just took issue with my education being categorized as paid for by my government, which is only partly true).

      • http://twitter.com/hystericalogic Anna Rachel

        Oh and I think the most salient point here is that your (I am assuming here that you are American) health care system is pretty awful compared to mine. I am always confused by Americans who defend their health care system (the most costly in the world with what is, quite frankly, embarrassingly bad health outcomes) – it’s like they have a severe case of Stockholm Syndrome.

        In regards to the physicians who defend it, well, call me a cynic but I can only assume they speak from a platform of self interest i.e they want to aid in the inflation of a rubbish health care system with their ridiculous charges.

  • Guest

    In addition, azmd, the legal/liability system is different and lawsuits aren’t nearly the problem in Australia as they are in the US.

  • C.L.J. Murphy

    I’m pretty sure this article was tongue-in-cheek.

    • Mika

      I don’t think it was. In an article she wrote here November 15, 2012, “Why I decided to opt out of Medicare as a provider”, she explained that she just wasn’t making enough money off Medicare patients if she let them use Medicare insurance, and since a lot of other doctors in the area had also started refusing Medicare, it’s not like these horrible hobbling illness-wracked losers had any choice but to pay cash up front anyway. As she explains, “the only other place left is the over-stuffed emergency room down the road. So they come to us.”

      “We have a great cash pay option for people who don’t have insurance. For $75 dollars, anyone can come to see us anytime if they have a loyalty card, purchased at a nominal fee. They can receive any additional services of their own choice, each charged separately for very reasonable costs. For example, an x-ray of any body part is $50 dollars.

      “An injection of an antibiotic that has the potential to save an
      extremely expensive visit to the emergency room and possible
      hospitalization is $40 dollars. Our net, after treatment of those same Medicare beneficiaries, would be around $130, collected immediately at the time of service.”

      And from her Amazon bio (she sells books too): “In 2005, Natasha opened three integrated healthcare clinics which featured a cutting-edge combination of acute care practice (urgent care) with chiropractic medicine, acupuncture, massage therapy, and rehabilitation. For both herself and her patients, she has witnessed the amazing capacity for the human body to change, not only through the use of drugs, diagnostics, interventions, chemotherapy, radiation, and many other disease-focused treatments, but also from a mind, body, emotional, and spiritual perspective.”

      But if you’re not able to cough up the cash, you’ll have to let the ER be your primary care provider once again.

      We are about to be a country, ACA or no ACA, where everyone has health “insurance” but only the privileged will get health “care”. But at least the doctors will be fine.

  • Elvish

    Another rubbish article posted on KevinMD.

    A non-physician asking physicians to double their prices in order to “reclaim” their values, then somewhere else, someone else is suggesting replacing physicians by non-physicians to solve our our problem.

    I did not know that the value of physicians was by how much they made. I thought our value comes from helping others when they are weak and vulnerable.

    People like the author and other opportunistic individuals who like to call themselves entrepreneurs are part of the problem of our health care system.

    “Cultivate a polite, giving, caring but exclusive attitude”; what is this supposed to mean ? if you think about, this advice is a complete nonsense.
    You want exclusivity ?!! I thought good doctors were those who treated the rich and the poor with the same love and professionalism !

    I tell you, our problem is not the money, our problem is our eroded society, our problem is the dysfunctional, paradoxical right and wrong.

    • Mandy

      “Cultivate a polite, giving, caring but exclusive attitude”; what is this supposed to mean ?

      —————————–

      It means that the author was trying to be too clever by half.

    • http://www.facebook.com/cyndee.malowitz Cyndee Malowitz

      Can we clone you?

    • http://www.facebook.com/profile.php?id=1338422225 Tom Garvey

      Exactly! Medicine is a calling, not a business opportunity.

  • http://www.facebook.com/shirie.leng Shirie Leng

    mmhmm. Until there is some skin in the game for patients, everybody just assumes everything is free.

    • equality

      I think hi-deductible catastrophic policies for all is the way to go, no more “comprehensive” coverage thru work or the government. Just like how everyone pays for basic maintenance on their homes and cars, and learns to budget for that, and has insurance for if something HUUUUUGE goes wrong. Charity or taxes could help subsidize the catastrophic insurance for the truly poor.

      • Suzi Q 38

        This year, we may have to go with our PPO, but a high deductible. My husband got word that the one with the low deductible is going to be $950.00 a month (up $100.00 a month from last year). If the new deductible is $5K, I could go with that. We would have our premiums reduced to $500 a month.
        Instead of paying about $12K a year, we would pay the $5K deductible and $500.00 a month. We would be only saving a grand, so it is something to think about.

    • azmd

      And third party payers take full advantage of physicians being socialized to sacrifice their well-being for the good of their patients, by making us seem greedy for expecting to be paid enough to pay back educational loans and also educate our own children. Asking us to make sacrifices in order to care for our patients should not extend to expecting us to sacrifice our children’s future in order to practice medicine.

      • Guest

        Our neighbor who owns a successful family run air conditioner business drives a Mercedes convertible. Good for him! I really do think that’s great! But our pediatrician drives a 2001 Ford Focus, he and his wife are putting every dollar they make into getting their student loans paid down. Good for them, too, for being responsible! But they deserve to succeed for all their hard work too, and if not buy a Merc, at least be able to send their kids to a decent school! If we’re not careful, all the Smart Kids are going to become Air Conditioner Mechanics rather than Doctors!

        • Suzi Q 38

          I think that they should do whatever they want to do.
          Not all physicians are fiscally responsible and drive “beater” cars until their student loans are paid off. When I read your post, I thought they were so smart. I can only respect how they have decided to “own” their debt and systematically get rid of it.

          So what if the air conditioner mechanic drives a Mercedes. He may owe a lot on that car.
          If he does, he is nothing more than a “cliche.”

          I get your point.

          There are all kinds of ways to earn a living. Just pick one and do it well. The pay is what it is, or change your plan and make more.

      • getagrip

        Boohoo, poor Doctors not getting paid enough. What a joke… Get a grip!

        • Guest

          You will be crying when no doctor will see you because of that very reason. Enjoy your midlevel care!

        • http://www.facebook.com/LFelsman Lisa Felsman

          That is a disrespectful comment. MDs and DOs have a high level of responsibility and they should not have to apologize for having a high salary to match it.

          • azmd

            I don’t even think we need a high salary. But we should be able to afford to give our children the same educational opportunities available to the children of bankers, lawyers, government lobbyists, insurance executives and hospital administrators. Shouldn’t we?

          • getagrip

            At the end of the day, 95% of people probably do not earn as much as a Doctor. Therefore, it can be quite annoying when people suggest that this profession is somehow underpaid.

        • Suzi Q 38

          I used to think like you do, until I did my research.

  • Suzi Q 38

    Thank you.

  • Suzi Q 38

    Thanks again. Interesting study/article.

  • Noni

    Sorry for the double posting :)

  • http://www.facebook.com/LFelsman Lisa Felsman

    I can’t see myself abandoning the patients who can’t afford “exclusive” care. What kind of profession are we if we don’t help those who need it? I’m all for finding ways to provide equal and excellent care for all persons. Yes, I know that dealing with the government will create hassles along the way.

  • Stefani Daniels

    So long as patients are shielded from the need to reach into their wallets, the ‘value’ of a office visit cannot be measured. Value will be measurable when the patient has to pay for it directly. .

  • concernedmedico

    Plumbers value themselves HIGHLY than doctors have done lately.

  • waffleweave

    While I understand the author’s position, the reality is that a trades person a.k.a. plumber, painter, computer tech, handyman, etc. may be able to charge what they feel their service is worth, the public also has the right to shop around and find the service at the fee that is within their budget. Unless something is an emergency such as the toilet over flowing into other rooms for example, most of those services can be done without when money is tight. In the case of healthcare, a person generally needs a physician’s service also in the case of an emergency so the doctor has to be willing to post the charges for services in the open so people can see what they are and shop accordingly. The going rate for a plumber is $95 an hour in the area where I live. Would a physician who sees perhaps 3 patients in an hour be willing to accept a fee of $35-40 per visit?

  • Anne

    What a terrifying world this would create for the unfortunate patient afflicted with a complex, chronic disorder (in my case genetic so you can’t even blame my behaviors for bringing it on myself), who requires frequent physician visits and many expensive tests and drugs. Think about it.

    I don’t disagree the US medical system is broken, but putting the burden back on patients who are bearing the cost of the failing economy, lower wages, higher debt, and everything else impacting doctors and driving down their compensation.

  • karen3

    1) You are covered by HIPAA whether you bill ICD-10 or not.
    2) The value problem is not one of “perception” but rather of reality. If Dr. Google provides more timely and accurate diagnoses, if filling out lab slips on order it yourself websites is cheaper and easier than 4 “billing opportunity” copays, if the doctor is constantly pimping the latest untested and very expensive drug, while costing a half day of leave time, the value proposition is much less. If the doctor causes patient harm. the value proposition is less.

    It’s real value that drives costs. If doctors hand over their part of the health care cost pie to MRIs and have a 40% error rate on dx, the financial pickings are alot slimmer.

  • http://www.health-conscious.org/ Natasha Deonarain, MD, MBA

    It’s always interesting to study the relationship between being proactive, and being reactive. Doctors, traditionally, have been highly reactive primarily by the way they think, the way they run businesses, they way they cannot see big picture things especially when it comes to future trending. This reactive nature, has lead to the healthcare disaster we currently encounter, and our role inside it as being unable to understand how monetary value works, or how ‘perceived’ value works. Inside the context of the current paradigm, the belief systems of what “IS” today, the translation of practicing outside the system and what ‘elements ‘ will then become relevant, is like apples and oranges. They cannot be compared. They exist in separate paradigms, or perspective. And so to compare a concierge practice and it’s mechanics with current regulation and rules, or even the current system as it ‘IS”, is a fruitless endeavor (no pun intended). It’s sort of like the sinking of the Titanic. Those who have focused on being ‘reactive’ in this context, are like those in the water clinging to the shards of the hull of a boat that has sunk, while still proclaiming that the Titanic is an unsinkable ship. Those who understand that this ship has already sunk, and who are now proactive, are those who are not hanging out on these blogs and positing, but making a new life for themselves, able to predict the future trends where, outside the current mechanics of a system that is very, very quickly imploding in front of our eyes, the rules become obscured. The rules can’t keep up with rapidly shifting trends. And so, empowerment of the individual ensues, where, the thought-boxes that we were keeping ourselves inside dissolve. We are free to create a new life, with a healthy income, with happiness and productivity, and above all with being able to give to the most important person in the transaction, our patients. If you don’t believe me, ask my new friend, and orthopedic surgeon who is completely concierge since 2010. If you don’t believe me ask my colleague who is a cardiologist, completely concierge and able to self-determine. If you don’t believe me, ask the multi-specialty group in Utah which is completely concierge or the neurology group in Arizona which is completely concierge. If you still don’t believe me, you must be one of those clinging to the shards of a sunken ship, still in the belief system that ‘there is no way it could ever sink. To survive in the near future, I might suggest that you switch from being reactive, to proactive, and learn exactly how to save yourself at this point, rather than worrying about how your government, health plans, or corporate leaders will fix it for you.