Doctors and Money - This Little Piggy Goes to Market
Let's go to Market! What would happen to doctor payments if the free market was allowed to work? Let's begin.
A few postulates about the public:
A few postulates about doctors:
But wait, there's more...
Now let's look at cost:
Of course, the other side:
I hope that at least some of the above completely annoys both patients and doctors. The patients reading this will be saying to themselves that I am wrong about the things I say about the public perceptions of doctors and the doctors will say I am totally on drugs (a charge often made on this site after one reads what I write. Some may even call me a traitor. I am none of those, but I'm not afraid to air the dirty laundry, either.)
If the public think doctors are pigs let's send the piggies to market and see what we are worth. BTW, I think pigs are pretty cute, very smart, and quite tasty.
At least the last time I looked, the United States was a free democracy that allowed capitalism to thrive. Every kid can grow up to be President, and that the free market rules in business. The law of supply and demand. The more people that want your service, the more you will get paid. If no one can afford your service, you will be forced to lower the price of your service. The free market. It actually works. It may explain why a majority of people in this country sleep in beds rather than caves.
To look carefully at this issue I devised the following thought experiment. I actually did real research for this article. I talked to other people. Colleagues, friends, and patients. This is how is all went.
Here are the assumptions I made:
I invented a sample practice based on real numbers after interviewing a number of colleagues in the practice of Orthopaedic Surgery. This model is based on Orthopaedic Surgery because it is the world I know. I kind of like to write on something I at least know something about. The conclusions drawn from this informal study probably applies to all medical practices, but you make your own decision on that.
Based on real information this is what our "WebMD - Get a Medical Life" practice looks like:
Here is the experiment -- a survey which I want all of you to take. Answer the questions in order. At the end of the question group are the real answers and then we let the sparks fly.
(Theme from Jeopardy... Da da da da da da da, da da da da DA da da da da da, da da da da da da da, da da da da da da da.)
Write your answers on a paper. No cheating, now!
Here are the results of my straw poll when I asked a bunch of people the answers to this question. See if your answers compare to what the people I asked told me what they thought. Compare what you wrote to what people I asked told me. They probably are quite similar.
Okay. Now answer the following multiple choice questions.
I will give you an answer (not necessarily the real answer) to the above questions. You answer each with one of the following choices:
Answer the following three questions:
Write your answers down. I will give you some time.
Da da da da da da da, da da da da DA da da da da da, da da da da da da da, da da da da da da da. Repeat once. Extra credit fill-in: I am singing the ??????? Theme?
Based on what you wrote and what I supplied you from my survey, you have an idea of not only what the public perceives what Dr. SmithJones gets for the hip replacement but also, based on the lowest amount mentioned on the first survey you learned whether you thought this was too low, high, or just right. Pretty good information. Remember, this is the free market in action.
One last question and then we put it all together.
Make the following assumption: There is some type of insurance plan that pays 100% for the hospital, hospital physicians like anesthesiologists and pathologists, equipment, blood transfusions and all other institutional type services (often as high as $25,000.00). You, therefore, pay none of these pills under the DRK Universal Health Plan (DRK- Doctor K). You are, though, responsible to pay only for the doctor's fee (like you may pay for a plumber, for example).
Answer the following questions:
When I conducted the survey, a near 100% answered section 2 either that the made up numbers (for example $3000.00 for the hip replacement) was either "Just Right" or "Low." No one thought the amount was too much. Needless to say, considering one does not get a hip replacement often, the yearly pay-off of this reasonable fee seemed to all an interesting and realistic idea.
Doctor Procedure Minimum - Acceptable Free-Market Fee - Actual reimbursement
The current reimbursement going to this group of 3 surgeons is severely and artificially depressed as compared to lowest the free market would accept to pay. Based on the lowest the public would be willing to pay a doctor for services, doctors are receiving less than 50%.
After all, there are few industries in which people choose to work where the salaries are artificially depressed to below-market rates.
Keep in mind that doctors are not a single group of workers. Each doctor or doctor group is an independent business so medicine as an industry cannot be viewed as though the doctors are employed by others. If that was the case, then doctors would legally be allowed to unionize and act in concert in negotiations with insurance companies. Currently, even this is illegal.
It is illegal for physicians to collectively bargain or organize as any single group because the government views them as separate businesses organizing to influence the market and this is considered against antitrust statutes. It is amazing that the government uses one law that tries to assure free trade and protect a fair market while the same law actually prevents competition with the insurance companies and inhibits the free market!
The artificial depression and selective destruction of free markets in medicine continues in medical programs like Medicare. Many patients are unaware of the gross inconsistency of Medicare regulations as compared with regulations in other industries. For example, if a physician chooses to be part of the Medicare program, that physician cannot charge higher than allowable Medicare rates. That, of course, I believe, is fair. If you choose to be part of a program then you need to accept the provisions.
Did you know, though, that if a physician chooses NOT to be part of the Medicare program, the physician is legally not allowed to charge the more than the allowable Medicare rate? This means that when Bill Gates turns 65 and has Medicare for insurance the doctor can only charge him 15% above the allowable $33.10 for that follow-up visit for his high blood pressure visit.
When did we give the government permission to dictate the amount of money a person in private business is allowed to charge? Are there national dry cleaner rates for people over 65? Are there national designer clothing rates that a department store must charge? The only industry I know of that does anything close to this are gas and electric utilities.
Medicine is not a public utility -- yet. Whether it becomes one is neither the issue nor scope of this entry. This issue is that in when physicians pay vendors for services such as supplies and employee wages, they live in the free market. When it comes to reimbursement, current government programs coupled with the inconsistent regulation of the industry prevents doctors from living in a free market.
Here's what a true free market would be like: Dr. SmithJones would earn anywhere from twice to six times what he currently earns. The reason for the large range is because if the reimbursement will be increased and expenses will remain fixed.
Once Dr. SmithJones starts getting paid even the lowest market rate he will probably stop trying to squeeze in 100 patients a day in the office, spend more time with each patient. This will lower the raw number of patients he sees and possibly improve patient satisfaction and treatment which is yet another benefit of following the free market.
Wrong question. This is the real life answer representing the free market for services rendered. The free market does not lie. The free market is not emotional. Is $25,000 too high or too low for a new car? Also wrong question - the cost is based on the free market. The rest of the country functions on free market principles; your business probably does as well. Pharmaceutical companies and insurance certainly do. If the doctor went to market, the numbers presented show what he would get.
Health care in the United States is reimbursed at below-bargain basement rates. In businesses in this country where you pay bargain basement prices you get bargain basement quality and service. It is only through the ethical nature and dedication of a majority of doctors in this country, who choose to practice blind to the reimbursement and treat individual patients equally and fairly, that this does not happen and medical delivery remains of the highest quality.
Unlike a piggy going to market, doctors are lambs to the slaughter of the business and political agendas at work in this country.
I will see you later; I have an errand to run. I am definitely going to the market...how about you?
QED
Next installment: This Piggy Stayed Home- What happens to the future of health care when the best and the brightest choose not to go into health care but into corporate Wall Street type jobs?
Related Topics:
Technorati Tags: health care, doctors, money, medicare
A few postulates about the public:
- The public has absolutely no clue how much their own doctor gets paid
- The public has no clue how much the average doctor gets paid
- The public has no clue how much even the wealthiest doctors make.
A few postulates about doctors:
- Doctors have no clue how much the doctor across town is making ( or how much their patients make for their jobs)
- Doctors have no clue what their services are actually worth in a free market
- Doctors have no clue what their worth is as compared to other professions
But wait, there's more...
- The public thinks that doctors are grossly overpaid.
- Doctors think they are grossly underpaid.
Now let's look at cost:
- The public has no idea how much it costs to support and run a medical office
- The public has no idea of the cost of training a doctor
- The public has no idea of the amount of time their own doctor spends treating patients
Of course, the other side:
- Doctors are not the most savvy businessmen and have no idea how to efficiently run a service company
- Doctors think the world owes them forever for the financial and personal sacrifice they made to go to medical school
- Doctors think that they are entitled to a huge amount of money for every service they do with the patient.
I hope that at least some of the above completely annoys both patients and doctors. The patients reading this will be saying to themselves that I am wrong about the things I say about the public perceptions of doctors and the doctors will say I am totally on drugs (a charge often made on this site after one reads what I write. Some may even call me a traitor. I am none of those, but I'm not afraid to air the dirty laundry, either.)
The Experiment
If the public think doctors are pigs let's send the piggies to market and see what we are worth. BTW, I think pigs are pretty cute, very smart, and quite tasty.
At least the last time I looked, the United States was a free democracy that allowed capitalism to thrive. Every kid can grow up to be President, and that the free market rules in business. The law of supply and demand. The more people that want your service, the more you will get paid. If no one can afford your service, you will be forced to lower the price of your service. The free market. It actually works. It may explain why a majority of people in this country sleep in beds rather than caves.
To look carefully at this issue I devised the following thought experiment. I actually did real research for this article. I talked to other people. Colleagues, friends, and patients. This is how is all went.
Here are the assumptions I made:
I invented a sample practice based on real numbers after interviewing a number of colleagues in the practice of Orthopaedic Surgery. This model is based on Orthopaedic Surgery because it is the world I know. I kind of like to write on something I at least know something about. The conclusions drawn from this informal study probably applies to all medical practices, but you make your own decision on that.
Based on real information this is what our "WebMD - Get a Medical Life" practice looks like:
- The practice has three surgeons
- The gross revenue collected from patient fees is 3.6 million dollars
- The overhead of the practice which includes everything except salaries is 60% of revenue (believe me this is a real number!). In actual dollars for our thought experiment this is 2.16 million dollars
- Each doctor works an average of 70 hours a week, not including being available for phone calls or visits to the emergency room on off-hours every other day = another real number.
- The practice is in a community where there is a normal mix of insurance companies and Medicare.
- The practice is on the panel of every insurance company that exists in their area. This goes by other common terms: The doctor accepts the patient's insurance, the doctor is par with the insurance... I think you get it.
- Each surgeon in this busy practice sees an average of 4,000 office visits a year. This is a lot of visits. Needless to say, they probably don't spend a ton of time with each patient.
- The practice philosophy is based on excellent surgery, commitment to proper diagnosis and treatment, and making money, which is why this group chooses to work longer hours and see more patients.
- The group is a respected group in its community from the point of view of patient satisfaction and the perception that if you need surgery this is a group to have it with. A "Go To" group.
- In the town next to this group is a group from a prestigious university clinic that chooses to accept no insurance. They charge what they consider the rates they feel they are deserved. For the purposes of this thought experiment, assume that the quality of the surgery and the diagnosis and treatment as compared to our hypothetical practice are completely equal.
- One major procedure that this group does is a hip replacement. They do a full range of Orthopaedic procedures, though.
- The surgeon you go to is Dr. SmithJones. You are going for a hip replacement.
Here is the experiment -- a survey which I want all of you to take. Answer the questions in order. At the end of the question group are the real answers and then we let the sparks fly.
Questions:
- How much to you think Dr. SmithJones receives from Medicare/HMO to perform a total hip replacement? This fee includes the pre-operative evaluation and ninety (90) days of post-operative care rolled into a single fee.
- Dr. SmithJones has another surgeon there as a first assistant (assume this is a required and important role). How much does the assistant surgeon, Dr. Surgical Assistant, receive to assist a total hip replacement?
- Dr. SmithJones has an assistant, Dr. Patient Assistant, who shares in daily visits to the patients every other day. How much does Dr. Patient Assistant receive for this service each time he visits the patient?
(Theme from Jeopardy... Da da da da da da da, da da da da DA da da da da da, da da da da da da da, da da da da da da da.)
Write your answers on a paper. No cheating, now!
Here are the results of my straw poll when I asked a bunch of people the answers to this question. See if your answers compare to what the people I asked told me what they thought. Compare what you wrote to what people I asked told me. They probably are quite similar.
- In answer to the question: How much do you think Dr. SmithJones actually receives for the surgery? One person came in with the lowest number at $3,000.00. The next lowest was $5,000.00. The majority had numbers ranging from $8,000.00 to $12,000.00.
- In answer to the question: How much do you think Dr. Surgical Assistant receives for assisting in the surgery? The numbers ranged from $500.00 to $2,000.00
- In answer to the question: How much do you think Dr. Patient Assistant gets for seeing the patient in the hospital after the surgery (per day/per visit). The numbers ranged from $50.00 to $150.00.
Okay. Now answer the following multiple choice questions.
I will give you an answer (not necessarily the real answer) to the above questions. You answer each with one of the following choices:
- That amount is too little
- That amount is too much
- That amount is just right
Answer the following three questions:
- Dr. SmithJones received $3,000.00 from Medicare/HMOs to perform a total hip replacement. This fee includes the pre-operative evaluation and ninety (90) days of post-operative care rolled into a single fee.
- That amount is too little
- That amount is too much
- That amount is just right
- 2. Dr. Surgical Assistant receives $500.00 to assist in the hip replacement surgery.
- That amount is too little
- That amount is too much
- That amount is just right
- Dr. Patient Assistant receives $50.00 for each day he visits the patient in the hospital after surgery.
- That amount is too little
- That amount is too much
- That amount is just right
Write your answers down. I will give you some time.
Da da da da da da da, da da da da DA da da da da da, da da da da da da da, da da da da da da da. Repeat once. Extra credit fill-in: I am singing the ??????? Theme?
Based on what you wrote and what I supplied you from my survey, you have an idea of not only what the public perceives what Dr. SmithJones gets for the hip replacement but also, based on the lowest amount mentioned on the first survey you learned whether you thought this was too low, high, or just right. Pretty good information. Remember, this is the free market in action.
One last question and then we put it all together.
Make the following assumption: There is some type of insurance plan that pays 100% for the hospital, hospital physicians like anesthesiologists and pathologists, equipment, blood transfusions and all other institutional type services (often as high as $25,000.00). You, therefore, pay none of these pills under the DRK Universal Health Plan (DRK- Doctor K). You are, though, responsible to pay only for the doctor's fee (like you may pay for a plumber, for example).
Answer the following questions:
- I need to pay Dr. SmithJones $3,000.00 for the hip replacement. I can pay in a single payment or over a one-year period at 0% interest. This would work out to $250.00/month for 12 months. The payments are fully tax-deductible.
- I think this is fair and reasonable and I would pay this.
- I think this is too high for this service.
- I need to pay Dr. Surgical Assistant $500.00 for his role in assisting Dr. SmithJones for the hip replacement. I can pay this in a single payment or over a one year period at 0% interest. This would work out to $41.67/month for 12 months. The payments are fully tax-deductible.
- I think this is fair and reasonable and I would pay this.
- I think this is too high for this service.
- I need to pay Dr. Patient Assistant $150.00 ($50.00/day for three days) for his role in seeing me in the hospital after the surgery. I can pay this in a single payment or over a one year period at 0% interest This would work out to $12.50/month for 12 months. The payments are fully tax-deductible.
- I think this is fair and reasonable and I would pay this.
- I think this is too high for this service.
When I conducted the survey, a near 100% answered section 2 either that the made up numbers (for example $3000.00 for the hip replacement) was either "Just Right" or "Low." No one thought the amount was too much. Needless to say, considering one does not get a hip replacement often, the yearly pay-off of this reasonable fee seemed to all an interesting and realistic idea.
What are the real numbers?
Doctor Procedure Minimum - Acceptable Free-Market Fee - Actual reimbursement
- Dr. SmithJones Total Hip Replacement $3000.00 - $1347.86 - 42%
- Dr. Surgical Assistant Assisting Surgery 500.00 - $183.31 - 37%
- Dr. Patient Assistant 3 days of post-op visits $150.00 - $00.00 - 0%
The current reimbursement going to this group of 3 surgeons is severely and artificially depressed as compared to lowest the free market would accept to pay. Based on the lowest the public would be willing to pay a doctor for services, doctors are receiving less than 50%.
What happened to the free market?
After all, there are few industries in which people choose to work where the salaries are artificially depressed to below-market rates.
Keep in mind that doctors are not a single group of workers. Each doctor or doctor group is an independent business so medicine as an industry cannot be viewed as though the doctors are employed by others. If that was the case, then doctors would legally be allowed to unionize and act in concert in negotiations with insurance companies. Currently, even this is illegal.
It is illegal for physicians to collectively bargain or organize as any single group because the government views them as separate businesses organizing to influence the market and this is considered against antitrust statutes. It is amazing that the government uses one law that tries to assure free trade and protect a fair market while the same law actually prevents competition with the insurance companies and inhibits the free market!
The artificial depression and selective destruction of free markets in medicine continues in medical programs like Medicare. Many patients are unaware of the gross inconsistency of Medicare regulations as compared with regulations in other industries. For example, if a physician chooses to be part of the Medicare program, that physician cannot charge higher than allowable Medicare rates. That, of course, I believe, is fair. If you choose to be part of a program then you need to accept the provisions.
Did you know, though, that if a physician chooses NOT to be part of the Medicare program, the physician is legally not allowed to charge the more than the allowable Medicare rate? This means that when Bill Gates turns 65 and has Medicare for insurance the doctor can only charge him 15% above the allowable $33.10 for that follow-up visit for his high blood pressure visit.
When did we give the government permission to dictate the amount of money a person in private business is allowed to charge? Are there national dry cleaner rates for people over 65? Are there national designer clothing rates that a department store must charge? The only industry I know of that does anything close to this are gas and electric utilities.
Medicine is not a public utility -- yet. Whether it becomes one is neither the issue nor scope of this entry. This issue is that in when physicians pay vendors for services such as supplies and employee wages, they live in the free market. When it comes to reimbursement, current government programs coupled with the inconsistent regulation of the industry prevents doctors from living in a free market.
Here's what a true free market would be like: Dr. SmithJones would earn anywhere from twice to six times what he currently earns. The reason for the large range is because if the reimbursement will be increased and expenses will remain fixed.
Once Dr. SmithJones starts getting paid even the lowest market rate he will probably stop trying to squeeze in 100 patients a day in the office, spend more time with each patient. This will lower the raw number of patients he sees and possibly improve patient satisfaction and treatment which is yet another benefit of following the free market.
Is the fair-market price too high or too low?
Wrong question. This is the real life answer representing the free market for services rendered. The free market does not lie. The free market is not emotional. Is $25,000 too high or too low for a new car? Also wrong question - the cost is based on the free market. The rest of the country functions on free market principles; your business probably does as well. Pharmaceutical companies and insurance certainly do. If the doctor went to market, the numbers presented show what he would get.
Health care in the United States is reimbursed at below-bargain basement rates. In businesses in this country where you pay bargain basement prices you get bargain basement quality and service. It is only through the ethical nature and dedication of a majority of doctors in this country, who choose to practice blind to the reimbursement and treat individual patients equally and fairly, that this does not happen and medical delivery remains of the highest quality.
Unlike a piggy going to market, doctors are lambs to the slaughter of the business and political agendas at work in this country.
I will see you later; I have an errand to run. I am definitely going to the market...how about you?
QED
Next installment: This Piggy Stayed Home- What happens to the future of health care when the best and the brightest choose not to go into health care but into corporate Wall Street type jobs?
Related Topics:
Technorati Tags: health care, doctors, money, medicare
40 Comments:
I'm a primary doc and I agree with the numbers you posted for the reimbursement of the orthopedic doc because I have discussed fees with an ortho colleague. He was doing IME exams to moonlight becuase he was getting paid about $1000 per total hip. Kind of sad, isn't it. If I were starting over, I would NOT pick medicine as a profession if I wanted to have any kind of a life.
I can't resist a comment--my cat recently had to have a tumor removed from his rear leg. Board-certified veterinary surgeon, large city, night before and night after in the vet hospital. Total cost (out of pocket) = about $2,500.
$3,000 is fair for a hip replacement?????
just to clarify...total cost included X-rays, blood work, anesthesia, etc., not just surgeon's fee. But it was a mass excision!!!
In answer to anonymous cat owner:
equating removing of a simple mass with a hip replacement is limited in understanding.
In a human (I recognize a human is not as important as your cat), removal of a simple mass in the leg is actually significantly less than what you paid for your cat. A typical managed care induerer will mpa the surgeon $300.00 and the hospital $500.00.
In the future, you should resist comments like the ones you wrote until you get some of your facts correct.
$3000.00 for a hip replacement is bargain basement prices.
The issue is that your vet is not regulated but your surgeon is.
Doctor K.
I think patients don't understand that doctors are actually underpaid inthis country. It is ridiculous when the NY Times, according to Kevin MD http://www.kevinmd.com/blog/ compares doctor salaries in the US to European countries. What does the salary structure in Europe have to do with the salaries in the US? Nothing! How many hours do they work? Are they available for calls.
I think this post is right on. Doctors are restricted by so many laws in what they can do even to negotiate with insurance companies.
Who will be going into medicine in 10 years?
My family practice D.O. in private practice (not a group) was recently forced to post a notice in his waiting room stating something like "While Dr. ____ would like to spend a lot of time with every patient, reimbursement policies of Medicare and some managed care plans mean patient visits must be restricted to one primary complaint. If a patient requires follow-up of chronic conditions, they will need to schedule separate appointments for that care."
Sadly, I completely understand his dilemma since we have been beneficiaries of the military health insurance plan for 32 years and know how low the "allowed amounts" are.
On the flip side, a non-insured patient is charged amounts almost double what is allowed in our insurance plan for any type of patient care from any type of medical provider (hospital, lab, doctor, & more). My doctor arranges reduced rates for cash "customers" based upon their ability to pay. He turns no one away.
Personally, we think the current system is completely broken and completely agree with the premise of the original post.
We not only worry about whether there will be enough doctors in the future, but whether our current family physician and specialists will quit accepting our insurance plan.
I don't know if I feel differently than the rest of the public, but I don't feel that doctors make to much money.
In fact, I would be willing to contribute a little more to the health care system if doctors could practice medicine instead of trying to figure out how to make living.
One of the methods to have doctors practice medicine is to:
1. Release the obstructive and oppressive regulations in areas of Medicare and Stark Regulations.
2. Adopt medical liability reform like in Illinois- $500,000 cap on a doctor being sued and 1M on a hospital.
3. Allow doctors to collectively bargain rates with insurers.
Start somewhere.
Doctor K
Fried Liver,
Do you make a living? Have you ever spent any time figuring out how you will do it, how you will support a family? Do you work 70 hours a week? Tell me what is so wrong about a doctor wanting to make a living to support his/her family?
I'm probably one of the few people that knew the answers to Dr. K's question. I knew because I bother to read the statements that my insurance company sends me. It lists how much my doctor charges and then lists how much they actually paid. Usually it's less than 50% I've often wondered how his practice can stay afloat once the overhead expenses get factored in.
Dr. K's next blog, "This Little Piggy Stayed Home" is the one that is going to be frightening. I'm already reminded of the book "Atlas Shrugged" by Ayn Rand. Everyone should read that book.
Swank,
I do make a living. I am an educator so I know what it feels like to scrape out a living on a measly salary.
Tell me what is so wrong about a doctor wanting to make a living to support his/her family?
Since my statement supported doctors (and you can add nurses to that) why do I get challenged in the above statement.
My local COUNTY charges $180.00 per ten minute appointment to see their County doctor..
A private practice doctor charges $75.00.
Some County employees want to do a MINIMUM amount of work for a MAXIMUM amount of pay.
Doctors are not satisfied with WEALTH, THEY WANT MEGA-WEALTH.
Can you identify the SHEER GREED in one of the above?
As a disabled RN on medicare I see this story from everyone's view-
point.The ortho doc should be able to make a living and give quality care to his patients.I,too read my insurance statements and see how poorly M.D.'s are reimbursed. I do think one of the solutions is to change the ease in which patients can sue and win baseless litigation.I have seen good medical professional sued when they had done nothing wrong. There are times when juries are not made to understand the medical complexities of a case,and thus decide on emotion instead of medical judgement.Back to the origianl topic,simply because I agree docs don't get paid enough doesn't mean I believe that I agree that my insurance security which is medicare(because I am disabled) should be done away with.
A few Comments:
Fried Liver was very supportive of the doctor payment issue and thank you for that.
Swank- as always- great points.
The issue I would like some focus on is the followng:
Why are we so afraid of deregulating the restrictions on doctors? Insurance comapnies get a free ride because doctors are legally not allowed to negotiate as a group with them.
In the end we will see unrecoverable consequences from talent leaving healthcare.
Dr. K.
I don't get it. Why do people tink that $150,000 a year is a low amount of money. Didn't doctors go into medicinefo a reason more than making money?
Does anyone out there have a story where a doctor was money hungry and it didn't help there health?
I had a private practice doctor years ago.
He used to waste MY appointment time by BRAGGING about his collection of ROLLS-ROYCE cars, asking had I noticed his ROLLS-ROYCE in the parking lot that day. I was not there to listen to him BRAG ABOUT HIS COLLECTION OF ROLLS-ROYCE cars.
This to me is the epitome of GREED.
In all fairness, I have had the same specialist for 37 years. She has kept her fees low, and has not raised her fees to me in 20 years.
Like everything else in life, there are people who are in medicine to SINCERELY HELP, and others WHO CANNOT BE SATISFIED WITH MORE AND MORE MONEY.
I don't get why people think anyone that wants to make money is greedy. Jay Leno has a huge collection of cars but I've never heard anyone call him greedy. What is so wrong with wanting to live in a nice house, drive a nice car and provide for your family? Everyone wants to make more money.
If someone spends eight years in college and then 6-7 years doing a residency and getting a fellowship they certainly deserve way more than $150,000 a year. The president of a small university makes more than that. Even if they *only* work 60 hours a week that's less than $50 an hour. I can charge $75 an hour to fix a computer.
My orthopedic surgeon drives the same kind of car as me only his is several years older. My family doctor lives in the same middle class neighborhood as me. The vet that lives in the neighborhood has one of the nicest houses and also a lot more toys. Nobody ever seems to get angry when vets want to make more money.
If you want to see greed look to the insurance companies and the politicians they have in their pockets. Those guys make a lot more than doctors and couldn't care less about my medical care.
Amen, Swank! My husband both have chronic health issues and we also pay close attention to the those
'explanation of benefits' from our insurance carrier after we've received medical care. My husband in particular had his hips operated on four times in the past two years (long story). Anyway, it makes our head spin when we see what our hospitals & doctors have to write off as 'contract adjustments', and what they are actually paid. I give much credit to our existing medical professionals and to those who are persuing a career in medicine. Gives new meaning to the term 'dedication'.
I live on a mere 21,000 a year.
I'm retired---51 years old.
I can no longer afford ANY kind of health insurance.
And I am still expected to pay exorbitant medical bills on WHAT LITTLE I RECEIVE A YEAR.
I would be willing to condribute more as well if doctors spent more time on healthcare as opposed to 'being on vacation' so frequently
Don't forget----on top of $150,000 a year----the sly gifts and kickbacks and gifts doctors receive as a courtesy of pushing drugs for the pharmaceutical companies.
I see this issue from a number of different points of view. I've just finished my second year of medical school. The school I attend has tuition this year of $33,000/yr, which is typical of private med schools, and is steadily increasing every year. I will graduate with a minimum of $200,000 in debt, not counting interest. My family is not rich, I come from an average middle class background. This is true of almost every other student in my school, some of which are supporting families of 2-3 children as well. I am terrified of thinking of how I will ever repay this debt, especially if I go into primary care.
However, I do have an issue of comparing the cost of healthcare with the cost of a car. Cars are not essential to life, what I at least view as a basic human right. Medicine is. I could not turn away a low-income patient who needed care. I myself had my appendix removed in January. It was an emergency operation, one that had to be done regardless of my income. I had student insurance, provided through a national medical student organization. I found out the hard way it didn't cover most of the surgery and had over 18,000 in hospital fees. There is absolutely no way I can conceivably pay back that amount of money.
So anyway, it's a messed up system. That I have no idea how to fix.
In 1992 Medicare slashed their reimbursement for surgical procedures by 40-50 percent. Since then we have received two 5 percent increases and several one percent decreases. This year a ten percent cut is scheduled. My overhead has only gone up since 1992 and currently I make about 77,000 dollars prior to taxes.
None of my three children will be in any phase of health care. In twenty years of practice I have yet to see a year when I brought home 150000.
One of the most disturbing factors about this whole subject is that while my reimbursement from all insurance carriers is about half of 1991, medical insurance cost has steadily out paced inflation in that same period. Manage Care has managed to take money away from the care givers and put it in their own pocket.
Mega wealth? Ask an engineer with 20 years experience what he makes and then factor in eight additional years of education, about 120000 in student loans, and about 100000 to start a practice.
To the anonymous poster who is 51yo and retired ..
I sympathize with trying to get by on 21K a year. However, I BEGAN my career as a doctor at the age of 33.
I have young kid (put off kids so I can finish training) and lots of debt (but fortunately not as high as the med student at the private med school).
I would be happy to retire at 51, but odds are, I will still be supporting my family, my debt and trying to survive with enormous overhead while medicare continue to try and cut my salary.
I have no benefits except what I fund myself, out of my salary.
I already suspect your answer, but I wonder why you would choose to retire at 51? Maybe you could pay your bills better if you weren't retired ...
Doctor K,
The following link has little to do with this blog entry but since it's your most recent I thought you and the other posters would find this interesting. Click on the link & scroll down & click on the video clip of Michael Moore on Oprah:
http://rawstory.com//news/2007/Oprah_hosts_Michael_Moore_versus_healthcare_0928.html
_Moore_versus_healthcare_0928.html
Whoops! got cut off.
A few comments:
First- thanks for multiple posts.
It appears that, once again, their is some discussion whether or not this amount of money or that amount of money is a lot or fair. Is 150K for a doctor a lot or fair? What about 250K? This, of course, is not the question. The issue is the fact that doctors are not allowed, by law, to practice in a fair, free market environment. The laws are stacked against them and FOR the insurance companies.
Medicine is by no means a basic human right. It is a skill that one person has and that person, by a certain code of ethics, emparts that knowledge and skill to help another. By the very nature of the ethical structure of physicians is the source of any rights in healthcare.
Every person has the right to freely pursue the type of healthcare they choose, whether that be mainstream, alternative, or religious. If you think that "medicine is right" then who decides what the proper behavior of doctors are to deliver that right. Is it a right to get free care? Is it a right to get the best surgeon in the country? Since there is only one "best" surgeon, how can we supply the "right" of access to that best surgeon to all citizens?
Doctor K
"People have right to medical care" vs "It is right to help people by providing medical care"
Helping people without judgement is the right thing to do.
I think your blog is enlightening. I am the daughter of an over worked, underpaid family MD. My Father is a talented man and even though I grew up in a family with ample resources, I still feel my father was (still is) not paid enough for the sacrifices he has made.
Every vacation, he had his laptop, his charts, his Dictaphone, beeper, cell phone and recently a new satellite internet card to upload charts wirelessly. Anyone who thinks doctors are overpaid or even paid fairly need to come camping with us; there is something disturbing about seeing your Father hunched over a laptop next to the campfire.
My father is a third generation Medical Doctor; my Great Grandfather practicing via horse-and-buggy. Years ago, I asked my brother if he wanted to attend medical school. His answer, “No way. Dad works way too much.”
I am printing this blog and showing my dad tomorrow. Hopefully he can find time to actually read it.
Your Dad:
Cherish those images of your Dad. He represents the backbone of American medicine. He is not getting paid for being on the laptop or for answering all those calls. He does it because it is what he does and who he is. This is beyond social service and is a calling of a higher level.
Thank him for me for his dedication.
Dr. K.
Dr.K,have you forgotten there are over 1000 board certified Drs.still trying to practice with Dr. Hunter Adams at his FREE clinic? What a tribute to a Dr.that seems concerned with the very same issues you are writing 1000's of words about.Evidently,he doesn't have the free time on his hands that you obviously do.There is one big difference between you and I...you seem to want to impress people...all I care about is knowledge that really matters.In other words,tell us something we don't already know.By the way, if you would like a meeting of the minds, I'm ready to match IQ'S any time your ready. Maybe your too busy.God Bless and go eat your roast beef!
Boy Dr. K, it seems quite a few people think Dr.'s make a substantial salary,if only for the jewelry, fine autos, and ego's they see with their own eyes. I have seen the same. After all, don't people WANT to become Dr.'s in part of a very important oath they will take? No offense, but a personal friend of my family commented last week when questioned about the office charges his practice demands..."hey my family has to eat also!" However,at the same time assuring us all that he HAS TO BE A DR. IT'S HIS LIFE! For his reasons, I agree. On the other hand, he drives a Nissan pick-up, going on 6 years old. You figure it out Slick! God Bless and PEACE...of your roast beef!
Boss302kirk,
I was curious, if you don't mind sharing, what line of work you are in?
Dr. K,
I think the practice Boss302kirk is referring to is The Gesundheit Institute if you hadn't seen the movie 'Patch Adams'.
mottsapplesauce,I am a retired licensed engineer for a world-wide bank witholding co.I also was facility manager for a 7 state area for the same co.The knowledge I've attained is firsthand.Many of my closest friends are Drs,which makes for a great learning experience,having sharp ears and an intuitive nature.I can be found at common digestive disorders blogs and boards labeled "pancreatitis for 27 years and alive."I enjoy your comments greatly.God Bless!boss302kirk p.s. You are correct in the name of Dr.Adams'Clinic!
boss302kirk,
I'm glad you enjoy my comments. I work in the healthcare industry, but I'm not a clinician. I had visited Patch's site just the other day & it's amazing how he inspires people. Is too bad we never hear about his progress in the news. Then again, we don't get to choose what we feel is newsworthy, do we?
I keep reading the "whiners"[mostly Drs.trying to justify why they should be more highly compensated]and can't help asking ALL of you...Among Drs.,have you ever heard of the GOD COMPLEX?? You all took an oath,or have you forgotten?The more I read,the more $$$and GOD COMPLEX come to mind!Personally,I would not let someone regulate my salary if I wasn't happy with it.Common sense!I would get out and do whatever I liked and STOP WHINING!!!Maybe that is why I'm retired and happy.God Bless and take no offense...but talk about "sellin' your guns"?Good luck and be happy,whiners.boss302kirk
this has been sadly enlightening. i am over 55 and have been searching for a dr to pay some attention to my various complaints one of which has become very legit i have a colon blockage which now requires surgery asapnow which has been ignored for 6 yrs by the 5 drs whose 5 mins for 275.00 practices put my health in jeaopardy drs dont care abt pts just the almighty $$$$ of which my eobs tell me they get plenty of!
To Mary of the previous post: I don't know what part of the country you live in but I can assure you that the quality of health care varies from region to region, throught the U.S.A. I know $ is a problem but you may want to consider the midwest states for your specific problem. Also, whatever type of insurance you have depends on whether or not your Dr's. referral to a specific facility for a specific problem will be addressed and at least partially paid for by the insurance co. God bless and good luck, honestly. boss302kirk
I grew up poor. Trailer park--the whole 9 yards. I decided to go to college because I wanted to be more than just trailer trash. I decided to go into medicine because I care about people.
As a person with both medical problems and no medical insurance I know first hand that there needs to be change in the US system.
it's the U.S. system that needs changed, not the clinicians.
I'm a college student with no insurance who uses high-interest student loans to pay off medical bills and low-interest student loans to pay my housing & tuition. I live off debt. I will be $300,000 in debt at least by the time I'm done. I'll have to make a hell of a lot of money to pay that back.
Student loans don't happen in countries in europe where higher education is free. Kids from the trailer parks--folks like me--get an education without being $300,000 in debt.
Those european countries also have universal healthcare systems where everyone gets free medical care.
They have crazy tax rates, but at least they have free medical care and free education.
I can't go to the doctor when I'm sick because I can't afford it--There's no Gesundheit Institute in my city.
But if you can afford insurance and your doctor doesn't listen, find one who will--we do exist (granted I'm not fully in practice yet). Sure, there are some douchebag rich guys out there, but most of us are here to make a difference.
It seems to me that primary care doctors may be underpaid while specialists are GROSSLY OVERPAID. As a US health care consumer, I am not willing to pay anymore insurance premiums, taxes, out-of-pocket expenses to physicians. Redistribute the excessive specialists income to the primary care.
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