Doctors Concerned by Obama Health Care Plan
By Alan Stewart Carl | Related entries in Health CareWhile the specifics of President Obama’s health care plan are still being hashed out, doctors are already getting nervous. The fear? The burdens of the new system will be inordinately placed on doctors. Dr. Scott Gottlieb has a good look at the concerns in today’s Wall Street Journal.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it’s open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors’ incomes will decline by as much as 15% to 20% depending on their specialty.
Primary care practices (the frontline of our health care system) already run on tight margins thanks to the costly nature of opening and maintaining a medical practice. Take money out of primary care and you risk lowering quality of care.
Doctors will consolidate into larger practices to spread overhead costs, and they’ll cram more patients into tight schedules to make up in volume what’s lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association.
Additionally, as Gottlieb notes, the best doctors could decide to go cash only or close their practices to any one carrying government insurance. If they’re good doctors, people will pay the premium. This would mean only the rich and those with generous employers will have access to the nation’s best physicians. The government could react by banning private pay and forcing doctors to take the government plan, but are we willing to strip away that kind of personal choice while deincentivizing a career in medicine?
As I’ve said before, the goal of health care reform should be to provide better care to more people. Obviously that requires a certain level of affordability and not every sector of the current system can come out a winner. But we need to think very carefully about where we make cuts. If decreasing payments to doctors decreases quality of care, have we made progress or are we just shuffling around the problems? As far as I’m concerned, we should pay close attention to what doctors have to say about any new plan.
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May 12th, 2009 at 9:55 am
All good points worth concern Alan.
Since this seems to be going forward, maybe now is as good a time as any to have folks chime in concerning
1-what they think the most troubling problems are with healthcare, and
2-the one or two things they’d like reformed healthcare to provide.
My answers
1-cost growth
2-
a. lifetime continuity of coverage
b.standardization of processes and paperwork that make the process more intelligible for consumers
May 12th, 2009 at 10:46 am
So doctors think they need to make how much, exactly, in order not to crash the health care system? Do they have a dollar figure in mind?
This is a strong-arm threat: keep us rich and happy or we’ll screw you by ignoring the needs of our patients.
Okay, here’s a thought: how about we open the immigration floodgates to doctors from all over the world who can meet US qualifications. Doctors who would, to a man or woman, find themselves making far, far more than they do in their home countries. French doctors would double their incomes.
Or how about we launch a crash course of medical school expansion? Pump out an extra 50k doctors every year and I bet doctors will find they can deliver good service even if they can’t afford a boat.
Here’s another thought: move most routine care from doctors to nurse-practitioners. About 80% of what a pediatrician does is diagnose ear infections. It’s not hard: I can do it. But we have to see a doctor because only a doctor can prescribe the meds in the event it’s a bacterial rather than a viral infection. Essentially a racket that costs billions each year.
Similar examples are everywhere throughout medicine. Why are we still requiring annual blood tests to check on my Zocor which I’ve been taking without side effect for more than a decade? Think maybe we could do that blood work every two years and cut costs in half?
Why do I need to pay a doctor to tell me I can take Ambien? No test is performed. The doctor has no information whatsoever on which to base that decision: he just collects a check. Ambien’s a controlled substance but I can buy aspirin over the counter? I guarantee you an overdose of aspirin will kill you quicker than Ambien.
We have a system built by and for doctors. We keep the supply of doctors down and their income up. We build in incentives for them to move out of primary care and into specialties. They are pampered and coddled in a way no other country’s doctors are. And of course they lobby with an effectiveness no other country would allow.
Our doctors are the highest paid in the world. By far. And our health costs are the highest in the world. By far. This is not a coincidence.
May 12th, 2009 at 11:15 am
Can’t help but wonder, are we are also the nation in which it is hardest (most regulated) to become a doctor? Are we also the nation in which it takes the greatest personal investment of time and money) to become a doctor?
I am happy to acknowledge that doctors have a sense of entitlement from their long-established status. But incentives still matter. Do we really want to turn doctor onto another McJob, or do we want A students to keep going into medicine.
As far as allowing more immigrants to become doctors, I’ll go ahead and play the role of the ugly American and state that I am very reluctant to increase the numbers of doctors that I have trouble communicating with because English is their 2nd language.
Catholic hospitals are already in the vanguard in importing lower-wage foreign nurses and laying off experienced Americans. Consider the number of young American women (and yup, some men) piling up close to 6-figure mountains of debt to become nurses because they were told there was great need. Then tell me we ought to lower the bar and keep letting more foreign doctors and nurses practice here.
May 12th, 2009 at 11:29 am
They are absolutely right some of these changes will screw specialists.
A big reason we spend so much more on health care than anybody else is that we refuse to pay for preventive medicine. Take chronic conditions like diabetes. It’s cheaper to give insulin away free than to wait for somebody to skip a dose and go into a coma. But we don’t do that, so instead of paying a primary care doctor for an office visit, and a months worth of insulin, we pay ER specialists loads of money to save people from diabetic comas. Med students know this, so 98% of them want to become specialists.
Don’t worry about Doctors refusing the government plan. Some will. But 131 million people are 40% of the market, and that’s an awful lot of customers those guys just dumped.
Don’t worry about primary care compensation either. Right now Congress is considering bumping up the reimbursement rate for primary care and paying for it be screwing specialist. If Obama gets his way on everything primary care docs will all get raises, but the specialists will be in big trouble.
As for the posters qs:
1) Costs. They got to go down.
2) Everybody gets the primary care they need.
May 12th, 2009 at 11:38 am
Wow, Michael — You sound like a libertarian. Welcome — freedom from state regulations brings down costs. An amazing concept — You’ll be getting your official libertarian card in the mail shortly.
May 12th, 2009 at 11:54 am
J. Harden:
Hah. I was infected long ago by the libertarian virus, in fact I joined the party in its early years. (Back when we were just finding the monolith and learning to use bones as weapons.)
I parted from the LP because I thought they were overly rigid and unrealistic. I belong to the Pragmatist Party now. (Slogan: Make it work.)
But the libertarian instinct is still there in my blood system. Sort of like political malaria.
May 12th, 2009 at 12:10 pm
I was infected long ago by the libertarian virus, in fact I joined the party in its early years. (Back when we were just finding the monolith and learning to use bones as weapons.)
I thought you looked familiar.
I wrote off the Libertarians as a party aftrer attending a Libertarian national convention. Though I would love to go to another one, if only I could have the tin-foil-hat concession.
May 12th, 2009 at 12:16 pm
See, that’s because if you’re sane, it’s hard to be more than a cafeteria libertarian. Which works in all the same ways as cafeteria catholicism, right up to and including being unwelcome at the first word of apostasy.
May 12th, 2009 at 12:33 pm
MReynolds makes some good points.
If they go the insurance for all route, I’d like to see it be a high premium such that it qualifies for an HSA which should spur choice (not a lot there right now) in the finance industry that offers HSA.
People should be treating medical insurance like an investment not an expense. Socking money away for when things go wrong should be incentivized and made as easy to do as possible.
People go to the doctor for things that they don’t need to, so high premiums should cut down on that silliness.
Cost controls should be placed on preventative care, but should be paid or at least heavily subsidized by the plan. Lower the cost, up the volume. Preventative care is cheap, doesn’t require a doctor most of the time, and saves big considering the reduction in serious medical problems.
Which also gets us to people going to doctors for things that nurses can handle, because they have no choice. That should be addressed.
Medical school costs are ridiculously prohibitive.
May 12th, 2009 at 12:34 pm
I thought you looked familiar.
I was the monkey attempting to smoke a tapir tail.
May 12th, 2009 at 1:13 pm
M. Reynolds,
I just want to let you know what a complete idiot you are. Most physicians have 12 years or more of training, sacrifice their 20’s and 30’s, and have well into six figures of medical school debts. Not to mention, once in practice they are subject to frivolous malpractice suits and high malpractice premiums, calls and emergencies at all hours of the night, and the continous struggle to maintain fair reimbursements from both HMOs and medicare/medicaid.
If someone should be the victim here, it should be the insurance companies. Doctors and nurses are the ones providing the service, yet 50 cents on every healthcare dollar goes to the health care company. Doctors in this country deserve every penny they make, chump.
May 12th, 2009 at 2:08 pm
When you consider doctor’s fees, you must differentiate between office visits and procedures. Doctors are not overpaid for office visits, which is why there is a shortage of internists. The common office visit is not responsible for rising health care costs. Look at where the money goes, and don’t penalize those on the front lines of health care. My insurance premium has increased at a much faster rate than the payments that my internist receives from my insurance company for my office visits.
May 12th, 2009 at 2:18 pm
Cost is the biggest issue with health care and in the end to tackle that requires either restricting services or lowering what is payed for services. Doing things in a more efficient way will help somewhat, but that alone is not going to solve this problem.
May 12th, 2009 at 2:56 pm
Here’s something to think about from a Prehospital Emergency Medical Services perspective.
If an ambulance service is restricted to what Medicare pays, many will go out of business or will need to be subsidized in other ways (property taxes or something).
As the EMS chief for a Basic Life Support provider, I can testify that Medicare pays less than 1/2 of what it costs to put an ambulance on the street. We set our supply prices at 3-4 times the actual cost because of the people who don’t pay and underpay (medicaid, medicare, and those covered by “low cost” insurance plans). It’s MUCH worse for Advanced Life Support providers.
Government “healthcare plans” pay ambulances a flat rate and will not reimburse for the costs of supplies, medications, treatments, equipment used, etc. They pay roughly $240 for a BLS transport and about $270 for an ALS transport. Paramedic ambulance bills are typically $900-1500 in this area of the country. Ours are usually $500-600.
In our organization, insurance/medicare revenues pay for supplies and the ambulance itself. Property taxes cover the cost of the maintanence, insurance, firefighter/EMT salaries, overhead expenses, etc.
Personally, I don’t like the idea of lowering the standards for becoming a doctor – not when my kids life is at stake. I want the smartest, best doctor I can find.
Another reason that the US spends more on healthcare than other countries is because the US shoulders a huge portion of the research burden. Once our researchers find a cure or develop a new medicine, other countries just copy the formula. They just ride on our coat-tails.
May 12th, 2009 at 2:57 pm
Some have been trying for years to get doctors to form a UNION.
They have mostly shrugged off the idea.
Today, the calls for a UNION are increasing by the day.
So,
UAW = Special treatment.
Does,
AMA = Special treatment.
Let us see.
The UAW strikes and we don’t get crappy cars that no one wanted to buy in the first place.
The AMA strikes and we get…………………?
Bring it on, Mr. President and Mr. Reynolds.
May 12th, 2009 at 3:12 pm
Dave T:
They “sacrifice their 20’s and 30’s.” Sacrifice? Say what? I’m sorry, but did we send out a desperate call for sacrifice?
Please, save us! And earn four times the average income!
Did someone put a gun to their heads and demand they learn to intubate?
They were pursuing their chosen careers. A rather lucrative career with notably little risk. How many doctors are killed in the line of duty? How many are ever laid off?
The AMA lobbies to limit the number of medical schools, which lowers the number of doctors, which raises the cost of health care for everyone, making health care less available, resulting in more unnecessary illness. Maybe you can explain to me just where the sacrifice comes into that cycle.
Doctors are well-paid and well-respected. You want “sacrifice?” Go talk to the doctor’s cleaning woman who earns minimum wage so she can keep her kids fed.
As for education loans, lawyers usually go to work owing a hefty bill, too. Are they “sacrificing” all those hours in the law library?
May 12th, 2009 at 3:48 pm
Mr. Reynolds,
All I have to say,
I will do my very best to save your life and the life of your family if they happen to cross my table.
You have no respect for physicians.
I understand that mentality.
We do the best we can, but we can not save everyone or cure every illness.
We do work long hours in very stressful circumstances.
I just ask for a modicum of respect.
We are either heroes or villains.
Who knows?
I might be your hero someday.
May 12th, 2009 at 3:52 pm
MIke suppose we set aside the issue of whether it’s a benevolent sacrifice and focus on the issue of the extra toil required, and on motivation.
What will motivate folks to undertake the extra toil if compensation is substantially diminished? Will the most capable folks still pursue medicine?
Surely if medicine is made a less attractive field, the result will be more lawyers. :-) You want to be responsible for that?
May 12th, 2009 at 3:56 pm
Cynic:
I’ve shown no disrespect for doctors. I have friends who are doctors, one a very highly-regarded plastic surgeon who specializes in the worst burn cases.
But respect is not deference. Respect does not involve special status. The doctor-as-god thing is over, done with, buried.
Frankly, you sound mawkish and self-pitying. So I’m curious: what other occupations deserve such high self-regard? Are you alone on your pedestal or is it possible that lawyers, priests, firemen, waiters, businessmen, soldiers, janitors, factory workers and clerks also sacrifice, also deserve respect, also work long hours in stressful situations and provide a useful and necessary service?
And how many of them make what you make?
May 12th, 2009 at 4:10 pm
KK:
French doctors perform as well as ours do for half the pay.
I am all for people making money. To be honest I make more than most doctors and work a lot less. (Of course I have no benefits and no job security. Waah. Poor me.) I like people to make money if they are good at their jobs.
But unlike doctors I don’t have the option of lobbying to limit the extent of my competition. In my little world I have to compete with every single person on the face of the earth who wants to compete with me. Any guy with a laptop and a command of the language can take me on.
And I can guarantee you that as a matter of statistical fact it is harder for me to succeed in my line of work and make a good living than it is for a doctor. Put another way, there are a hell of a lot more high-earning doctors than there are kid book writers.
I get irritated when people who are lucky in the big DNA lottery, and who then use their innate skill to become well-off, whine about it or act as if they have a lifelong entitlement. There’s nothing in the constitution about doctors earning 200k.
Set standards for admission to medical school, for residency etc… Then open the process. If we can keep high standards with another 100 or so med schools pumping out doctors, good: more competition in the actual marketplace which, in theory at least, means the better doctors will survive and prosper.
Right now we make the cut at med school admission by creating a bottleneck there. The system rewards those who come from wealth because the system favors the elite college grads. Why not rely on the marketplace to reward or punish rather than relying on deans of admission?
May 12th, 2009 at 4:44 pm
Mr. Reynolds,
You have made your point and it should be shared with others.
May 12th, 2009 at 5:00 pm
Goodness Michael —
You had me at “competition”. Where have you come from my friend? It is like you woke from the stupor of the Obama fairy-dust. (Hey, wouldn’t that make a good kids book? I’ll think I’ll compete with you.) I represent a number of aromatherapists, message parlors, acupuncturists, a couple of yoga studios and one gal that lites a big stick of sage on fire and dance around you making funny noises. I can tell you, there is no need to go to a doctor after you’ve done all that…(you’re already dead.)
No, you’re absolutely right. The key is cost and the reason for the high cost of healthcare in this country is because of incessant government intervention and regulation. Big Health LOVES Big Government Solutions. There’s an economic term for that..it is called “Rent Seeking”.
Now, as for lawyers, we have our own little rent-seeking mechanism which I shall protect to my death. It is called…The Bar. It comes with the neatest perks, specifically it allows my club (The Bar) to charge for certain services that people who are not in my club are not allowed to charge for and that has the gloriest effect of increasing the price of those services.
Now, we shall speak of it no more…
May 12th, 2009 at 5:00 pm
People go to the doctor for things that they don’t need to, so high premiums should cut down on that silliness.
As a manly American man who typically waits until I’ve been sick for at least a month before going to the Doctor I have to disagree.
Actual evidence shows policies based on this principle increase costs. What actually happens in manly American men ignore various warning signs, assuming they’ll get better. And most of the time they do get better. But somebody’s actually ignoring the warning signs of heart trouble, or late onset diabetes. And will end up going to the ER with a heart attack, or in a coma due to hyperglycemia. And that’s really expensive.
So a) you only save money if said manly men skipped hundreds of unnecessary office visits, and b) somebody almost died. Spending more to die young ain’t my idea of good policy.
May 12th, 2009 at 5:34 pm
J. Harden:
Dude, I’ve always been a capitalist. Picture big old bald guy smoking a fat stogie and driving a black German sedan.
I’m a Democrat because there’s a difference between capitalism and unregulated, non-transparent capitalism. And because I don’t fit in the tent with Dobson, LImbaugh and Hannity. And because I don’t want to have hungry kids staring in the window while I work my way through Grant Achatz’ tasting menu. I also accept the principle that because I’ve been lucky I can pay a bit more to carry the costs of our civilization.
Give me a rational, secular conservative alternative and I’ll re-examine my affiliation.
May 12th, 2009 at 6:18 pm
My entire family is in the health care realm (only 1 doctor though) and I can tell you that most doctors aren’t making a shitton of money these days. The doc my mom works for just performed a 4 hour surgery with one other doctor on a woman’s foot who had shattered several bones.
The insurance company paid them, not him, them 236 dollars. That doesn’t even cover the supplies used. So before you go around blaming doctors, maybe you should find out where all the money is actually going.
May 12th, 2009 at 7:52 pm
I agree generally with MReynolds about the merits of changing the way some medicals services are delivered — e.g., give nurse practitioners a bigger role — and increasing the numbers of providers of certain services — e.g., more physicians either educated here or attracted from abroad, particularly primary care docs. I think these are good and necessary, because the structural limitations imposed by the doctors’ monopoly will continue to be a constraint on the availability of quality care for everyone, no matter what “reforms” are instituted. There are only so many patients that X doctors can serve, which is why the specter of rationing care goes hand in hand with exoanded access. The obvious solution is to expand the number of providers.
I’m less optimistic that this will curb costs much, if at all. The average doc does not earn a particularly princely income, although some do make millions a year (personally, if I ever need heart surgey, I want to get one of the guys who can make millions perfoming heart surgery).
Anyway, physicians and other clinical providers account for only 21% of the total health care costs, while hospital care accounts for the largest share — 30% — and is the fastest rising component of total spending. Prescription drugs are taking the rap as a fast-rising component, which is true, but they only account for about 10% of the total. And remember that many drugs are keeping people healthier so that they don’t land in emergency rooms or require even costlier care, so it may well be that the growth of prescriptions helps hold overall costs down.
Hospitalization is the biggest nut to crack. For decades, people have been saying we need better preventive care, better access to primary care providers, etc. better coordination of care in cases of people with multiple illnesses, etc.. And for decades, not much has happened to change any of that. Meanwhile, hospitals — not for profits every bit as much as for profits — are always pleading poverty, while running among the most powerful lobbies in Washington and the state capitals to keep the money flowing in. But there is a huge amount of overlap in services provided by various hospitals (in big metro areas anyway) that duplicates costs and drives up insurance reinbursements. One major way to limit the need for hospitalization is, of course, preventive care. Yet, Medicare DOES NOT PAY for “routine” annual check ups! Think about it. The over-65s are day by day more likely to get high blood pressure, high cholesterol, early diabetes, and other troubles that will land them in the hospital at some point. But they are no more likely than 55- or 45-year olds to go for an annual check up if they have no symptoms and feel good, when it will cost them $200 to $500. This is the place to start getting serious about preventive care and saving money on hospitals. Hear any Congressmen suggest that lately? Too simple for them.
All that said, my own view of this “crisis” is a bit unconventional. Pols of both parties are always decrying the “skyrocketing cost of health care.” but so what if we spend 6% or 8% or even 10% or more of GDP on health care? After food, shelter, clothing, education for my kids and public safety, I can’t think of anything I’d rather spend money on than staying healthy and living longer. When all of us collectively reach the same conclusion, we choose to buy a lot of health care, and the costs “skyrocket.”
The forces driving health care costs up are these:
– The population as a whole is aging.
– We are living longer and we want — and expect — to be healthy and active for a longer time than our parents or grandparents.
– Medical practice, technology and drugs are advancing at a faster pace, making new and better diagnoses and therapies available, almost literally by the day.
– The health care that is possible is available to roughly 250 million Americans through one or another insurance plan (the flip side of the 45 million who are uninsured). That’s a lot of people.
We can nip and tuck at the costs, but they are going up as long as these powerful factors are in play — i.e., as far into the future as we can see.
So the issue is how to extend care to people who have no coverage, period, which brings me back around to Reynolds point: there is now way we are going to be able to do that without increasing the numbers of providers and changing the way care is delivered — not the amount or quality of care, but the manner in which it is delivered. We need a system that puts primary and preventive care at the center. That’s what real reform would look like.
May 12th, 2009 at 7:57 pm
Correction:
I mean to write, “so what if we spend 16% or 18% or even 20% or more of GDP on health care?” not 6 or 8 or 10%
May 12th, 2009 at 9:54 pm
Upon recieving insurance for the first time in years, I went to see a General Practicioner on Park Avenue in Manhattan for my asthma (why Park Avenue, I don’t know). He told me I needed a test, and oh yeah it cost $800. With my 20% co-pay, I was on the hook for $160 (it wasn’t great insurance). I asked what test, and why did I need it? He said it measured and charted the volumn of air I was able to pass through my lungs, so it would be an indication of how well or poorly I was breathing. I said, I could tell him that, since I’ve had asthma all my life, konw all about it, and could prescribe my own maintainance meds if he wanted to know that, too. He insisted. I said no. He came back in the room and “cut me a deal”. He waived my co-pay. He insisted. I was intimidated . I relented. I took the stupid test, which showed a graph of my breathing, and sure enough I was weazing! That cost my insurance company $640. I was insensed at the obvious waist and greed that I was witnessing. He obviously and gratuitously manipulated me into a test I didn’t need, that was a cash cow for him. I protested after the fact, left with my prescription – yep for meds I’ve been taking for many years – and told him he was the problem with the health care system in this country. To think that there are children suffering who can’t get basic health care becuase their parents are poor, and meanwhile this GP in Manhattan is cashing in $640 bucks for a worthless test I didn’t need was more than I could bear. Since then, no less than two more doctors have tried the same scam, only in thosse cases I absolutely refused.
How many more procedures are like this one, and how many more docotros are out there trying to cover their expnsive rents and morgagess and hobbie crafts with as many of these useless cashcows as they can? How many nose jobs are called diviated septums and how may recreational users get viagra? Just to name a few.
FYI, Michael REynolds, I am a Democrat cut of the same cloth. Please someone start a party for us.
May 13th, 2009 at 4:34 pm
Well the fact that medicare pays shit just means that the rest gets dumped on private insurance and private payers. We’re all paying for it, that’s why cries of socialism are completely irrelevant in the national healthcare discussion. We’re all paying, but companies are profiting.
May 13th, 2009 at 5:10 pm
mcEachran — You’re blaming the doctor because you’re a sucker when it comes to spending other people’s money (i.e. the insurance company). You weren’t a sucker when it came to spending your own money and the smart doctor knew it and thus he waived your co-pay.
I have argued that Health Savings Accounts lower healthcare costs because it makes people smarter about how they spend their money for healthcare. Your story is a PERFECT example of this. Insurance pays and who cares. But if the dollars are mine — then we get a little smarter about our decisions.
So let’s think about what kind of choices we are going to make when we get a single-payer, universal coverage healthcare system. The market requires people make value choices and I understand that a lot of people don’t like this concept when applied to healthcare, however there really is no choice unless one wants a grossly inefficient system that produces…
starving children outside the window of Alinea that I like to flick crispy calamari at while I sip on some vino.
May 13th, 2009 at 5:44 pm
Michael Reynolds,
I’m an MD in surgery. More specifically a surgeon in training. Last week I worked 126 hours. The week before that I worked 112 and the week before that 121 hours. I am paid $41,550 per year. So based on the number hours I work I make $6.34 per hour. This is less than minimum wage in the state I live in. This also does not count the countless hours I spend studying and preparing for surgeries at home.
I haven’t seen my 1 year old son awake in 4 days. I’ve had one conversation with my wife in the last week.
In addition I have acrued over $250,000 in educational debt. I will not finish my training until I am 37 years old.
In my future I will be called at all hours of the night to help people in need – remove appendixes, gall bladders, colon’s etc – don’t get me wrong I love to operate. However, I will have no choice when I am called. If I wish to continue my profession I will have to go. Why shouldn’t I get to charge what I want? Imagine if you told a locksmith he couldn’t charge what he wants to help you when you are locked out in a thunderstorm at 3:00AM.
Mr. Reynolds, I challenge you to find a “lawyer, priest, firemen, waiter, businessmen, soldier, janitor, factory worker or clerk” who has worked these hours at this wage for 12 years.
This does not make me any better than those people. I do this because I love doing it. However, if you think I don’t deserve to make a healthy wage when I am done with my training then you need to have be examined by a psychiatrist (although maybe the pschiastrist will close up practice because you won’t make it worth it to him to practice).
Mr. Reynolds, until you take a walk in my shoes you should keep your mouth shut and not enter into a debate which only exposes your ignorance.
Finally, for everyone else. Let’s talk specific numbers….What do you all think a doctor deserves to earn? Well, the average pediatrician in washington, DC finished training with $250,000 in debt and is paid $94,000/year.
America, don’t our kids deserve pediatricians valued at higher then $94,000 a year?
I just want everyone to be clear that we are NOT talking about millions. The days of doctors making millions are over and have been over for quite some time. However, for what I have SACRAFICED, I deserve to not have to worry about how I am going to pay off my debt, afford a mortgage and put dinner on my son’s plate. At $94,000 a year with increasing malpractice insurance costs this is a very REAL concern.
May 13th, 2009 at 6:20 pm
I agree that what doctors charge is high, but so is everything else. For an emergency room visit, we received a bill for $3000 for the ambulance ride. That seems extremely excessive. A few months later, my daughter fell and cut her head. The bill included nearly $700 for 6 staples to close a laceration (the ER doctor’s fee for the diagnosis was separate).
My daughter has a seizure condition and the medication the doctor would like to put her on costs as much as $900 per month. Yet we called a pharmacy in Buenos Aires, Argentina (my wife is from there and travels there every year) and the exact same medication costs about US$50 there. Can someone explain why the same medication costs 1800% more here than in South America?
May 14th, 2009 at 4:03 pm
J. Dos. – I agree with you in principle, childish name calling aside. But yes, I am blaming the doctor in this case. Doctors use the white coat, small cold rooms, endless waiting, and framed degrees to good effect. You think the little tie-in-the-back-with-your-ass-hanging-out gown is made that way becuase it’s neccessary? BS – it’s intimidation by design. I was sick that I was complicit in the scam, and vowed never to do it again. I don’t think all doctors are unethical, but there is too much incentive, and it’s too damn easy. But I agree with your main point, that if everyone is spending someone else’s money, there is no “break peddle”. The problem is we’re supposed to trust doctors. I guess when free money and “ah-who’s-it-gonna-hurt-really” is involved, we can’t.
May 14th, 2009 at 6:01 pm
“small cold rooms, endless waiting…little tie-in-the-back-with-your-ass-hanging-out gown” — Hah, I’m pretty sure you’ve describe “torture” according to the Obama GoogleBoyz. I’ve often said that physicians should strictly abide by the Army Field Manual. Throw in some needles or a colonospcopy and it makes a routine check-up feel like an extraordinary rendition to Egypt. Your average physician makes a CIA field operative look like timid little school girl at her first dance.
Doctors = War Criminals
May 15th, 2009 at 5:51 pm
Michael: If you look at the health care cost, about 85% goes to the hospitals and only 15% to doctors. Most of the health care costs goes towards hospital buildings, technology and imaging centers etc. that’s why you see hospitals building new buildings all over the country. Doctors incomes are going down in this country. I am not a doctor but do come from family of doctors.
Many professions in this country start making money at yopunger ages. Doctors have to go to schools, read text books, journal for long hours. Then they have to go through long residency and internship programs anwhere from 3 to 8 years for pennies. Other professionals start making money and put that in 10% return, you are talking hundreds and thousands of dollars.
In this country Doctors have to deal with patient’s families, attorneys, insurance companies and hospital adminstrators etc.
If you bring doctors from other countries, I can guarantee you the standard of healthcare will go down. I have seen doctors in other countries practicing sub standard medicine.
You are priviliged to be in this country and enjoy the best system in the world for which you should be thanful for. You take zocor, you are lucky that you have no sideeffects, think about thousands of others who develop major problems from Zocor and ambien etc.
Good Luck
June 11th, 2009 at 9:44 pm
M. Reynolds, You seem quite impressed with your overly simplistic veiw of the world. You feel the need to brag in a childish fashion…. oh you write kiddy books.You are one arrogant dude, I must say doctors are way underpaid if a kidddy book author does better. It is a sad thought that you feel you deserve to make more money than a doctor. I forgot, what you do and think is clearly more important than medicine.
June 13th, 2009 at 3:15 pm
None of the above comments has addressed a very significant fact about paying for medical care in the USA. You need an insurance policy to get the ‘negotiated rate’ from providers (doctors and hospitals.) If you consider yourself reasonably healthy and want to pay your providers for the services they provide for you, you must buy a $10,000 – $50,000 dedictible policy, submit your claims to the insurance company, have them approved or rejected by a minimum wage worker who may frequently make a mistake and deny coverage even though the insurance company is paying nothing (after all, the deductible clock is ticking) so that you need to spend hours on the phone establishing that the claim is for covered services. In the process, the insurance company collects a premium primarily to provide you with access to discounted prices for medical care. Someone help me understand how this makes sense.
June 20th, 2009 at 4:07 pm
You can not negotiate a selfpay rate with hospitals but you SURE can with doctors. Most will gladly take the medicare rate.The problem is not with the routine stuff which a doctor can treat with office visits, but if something really goes wrong ie. cancer, requiring inpatient treatment, the hospital bill will kill you if your illness does not. However, you can negotiate a payment plan with a hospital which is far less than the monthly cost for insurance. Also if you go to a hospital ER without insurance they must treat you, so why not pick the best.
July 18th, 2009 at 4:07 pm
I am entering my fourth year of medical school. I then plan to do a 6 year residency. I will have over 14 year of higher level education. Next year I have the “match” and I will be assigned to some residency program anywhere in the country by a lottery system. I am looking at my friends who are starting families and I realize the sacrifice I am making for this career. I already work 15 hour days and additionally spend everyother night in the hospital. The relationships between my family and significant other are constantly strained. I love medicine. I dont think a person could survive unless there was some alltruistic undertone to their character. US doctors are the best in the world, we have the most highly trained medical proffesionals. The problem with healthcare is the people we provide it to. We have a very ’sick’ baseline population. Why dont we ban ciggarettes? Why dont we go to where the problem is at which is the unhealthy masses?
Anyway, I just know how much I have put into this career and I dont think it is unreasonable to expect higher compensation.
Oh, and I will have over $200,000 in debt.
September 7th, 2009 at 5:21 pm
I have lost confidense in Drs lately. My husband started having small seizures back in Dec and had 3 since then. Hes had the MRI, 3 EEGs, Cardio Event Monitor, Blood work etc, now they want to do another MRI. He has medicare which doesn’t pay all and we live on 811.00 a month so how can we afford a supplement? I don’t like the healthcare plan Obama has but it seems Drs, Hosps etc could see that seniors can not afford to pay out of pocket especially when a bout with cancer wiped us out in 1991 and we had ins then that paid 95% of all bills.
I do feel for Drs having to pay the malpractice ins they have to and when you think about all the overhead, equipment, hired help etc doesn’t seem theres much left.
September 10th, 2009 at 10:16 am
How in the world could people be saying that doctors today earn too much money? For all the many years of medical school and training for a career meant to save your lives and mine, are people saying they don’t deserve to earn good money? Those are ridiculous statements. Doctors today are in fact being so underpaid. Family practice physicians make just a little over $100,000 in many states meanwhile we have the Wall Street guys who make 2x the amount but of course, no one says anything. Why is it that we judge and complain about doctors making the money when they have spent a good amount of their lives studying for it? Eight to twelve years of studying and training in medicine is undervalued and underappreciated by so many today. How many of you can say you could do the workload, the so many grueling hours of work, and years of studying that doctors have had to put to get to where they are today? There is a reason why some can and do it and others who just complain/comment about them because they couldn’t and didn’t want to endure all those years of studying and training.
And now what happens to the medical students today who in 10yrs will have their own practice? I guess for all their years of hard work and studying, people would rather just see doctors make $50,000 or less. So I guess today what we want is the less you were in school, the more you should make and the more you studied in school, the less you should make. That makes sense to me. Doctors no longer make the ‘BIG BUCKS’ as people may think. That era has long been gone.
September 10th, 2009 at 11:42 am
Most US Doctors aren’t GPs. Most are specialists. AFAIK nobody claims GPs are underpaid.
A $400,000 specialist is making as much as the President. He’s also making four times as much as GPs, despite the fact that every economic study I’ve ever seen says a GP is more valuable than almost any specialist.
They see more patients, which saves more lives. They keep people from getting sick, which saves lives and money. They actually bring in the same revenue to a hospital that a neurosurgeon does.
So the theory is that if you cut specialist pay by quite a bit, used some of the money to increase GP pay, used more to deal with idiotic Med-School costs, you’d still have cash left over.
September 17th, 2009 at 8:15 pm
I’m a specialist and I don’t make anywhere close to $400K. You people are deluding yourselves.
There is a four-headed problem here: Insurance companies, lawyers, doctors and patients.
Right now, I’ve been threatened with a lawsuit if I stop treating a brain dead woman in my ICU. She’s been brain dead for almost three weeks and (by my rough estimate) has probably run up close to $100,000 in medical bills. All of this because the family is waiting for God to perform his miracle.
To the residents and students above. Save your breath. Nobody gives a damn about me or you. I gave my whole life to my patients and they took and took and took. Medicare just sent me a check for $5.67 for one hour’s work. Seems like people are very comfortable telling us what exactly a year of doctor’s work is worth. If my house floods and I need a plumber….I’m paying what he’s charging (which is more than I make an hour).
I’ve also trained foreign medical graduates for the last ten years and if the kiddie book author thinks that the answer is to let more of them practice here…oh boy, I can’t wait til they can’t figure his appendix from his pons. Medical school in most other nations is free….and it shows.