Beware: YOUR stimulus dollars at work

[caedmon]

http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs

---

Members don't see this ad.

 

[PMR 4 MSK]

Socialism, here we come...

 

[Finally M3]

*shrug* it's what we deserve.

This wasn't a surprise to any physician who voted for Obama. Congratulations on this new layer of bureaucracy you have inflicted onto our lives. Can't wait to see more tort-friendly regulation being added to the agenda as well.

 

[Nico47]

I think it's our collective fault.

We as doctors let non-physicians make these crucial decisions for us. We don't have a united voice to make relevant change in D.C. We have politicians and lawyers debating how _we_ should practice medicine.

Grrrrrr.

What to do?

 

[brimcmike]

I think it's our collective fault.

We as doctors let non-physicians make these crucial decisions for us. We don't have a united voice to make relevant change in D.C. We have politicians and lawyers debating how _we_ should practice medicine.

Grrrrrr.

What to do?

Organize and cooperate.

Which would take setting aside our American, professional-class bias against organization and cooperation as a mutual economic strategy. I suggest that it is naive, irrational and non-empirical not to see that this abiding, but dogmatic principle has been used against us over and over for the last 30 years in blatant, Nietzchean will-to-power style, i.e., anytime we might synergize as a group to a degreee that would make us an effective economic and political force, our economic and political adversaries have only to hint and whisper of the "Unionization of the Medical Profession" or utter "Socialism" to throw us into disarray sufficient enough that we get our candy stolen all over again.

Principles are great until they can be used cynically as an unconscious hot-button to distract from an otherwise obvious, and easily defensible power-grab.

This process described above has be going on, completely out in the open, for decades, and yet we are utterly paralyzed to do anything effective about it besides complain after-the-fact.

If you don't think that this a clear example of successful psychological welfare against a group of bright, well-educated, resourceful people with otherwise relatively abundant cultural and economic capital, I don't know what to say.

 

[PMR 4 MSK]

Organize and cooperate.

Which would take setting aside our American, professional-class bias against organization and cooperation as a mutual economic strategy. I suggest that it is naive, irrational and non-empirical not to see that this abiding, but dogmatic principle has been used against us over and over for the last 30 years in blatant, Nietzchean will-to-power style, i.e., anytime we might synergize as a group to a degreee that would make us an effective economic and political force, our economic and political adversaries have only to hint and whisper of the "Unionization of the Medical Profession" or utter "Socialism" to throw us into disarray sufficient enough that we get our candy stolen all over again.

Principles are great until they can be used cynically as an unconscious hot-button to distract from an otherwise obvious, and easily defensible power-grab.

This process described above has be going on, completely out in the open, for decades, and yet we are utterly paralyzed to do anything effective about it besides complain after-the-fact.

If you don't think that this a clear example of successful psychological welfare against a group of bright, well-educated, resourceful people with otherwise relatively abundant cultural and economic capital, I don't know what to say.

You also need to factor in that any time doctors complain about changes, the retort and/or media just will portray us as money-hungry elitists, who don't have our patient's best interests in mind. We are supposed to be total altruists - since we have sacraficed so much in our careers to get where we are, we should continue to sacrafice for "the greater good." We are not supposed to subscribe to capitalist ideas, as much as discussion of payment for services rendered are verboten in the exam room

People look around and see a doctor driving a Mercedes or Lexus, and think, "He makes too much money!" They see the bill for a simple office visit and say "$90 for 10 minutes of his time? It takes me all day to earn that!" Most of the public believes we are all way overpaid, were born with silver spoons and take 4 3-week vacations per year in Martha's Vinyard. (Oh, wait, that is what are president does...).

I can't tell you how many times I've heard the comment "I guess the doctor needs to make another boat payment." (My boat is paid in full, thank you very much ) Or things like "How many cruises have you taken this year paid for by drug companies?" I'll actually take people to task for that one.

I'm paid well, but I do work that very few people do in my community, and even fewer do well. I believe supply-and-demand works well if left alone. I have learned how to work smarter, not harder, and therefore have more take-home pay than when I was solo. Because of that, the current thinking is I need to "pay my due." Nobody cares that 5 years ago I almost had to declare bankruptcy, and narrowly avoided it by borrwing $1500 each from my parents and my wife's. They don't care that I spent 12 years in school and training after high school. They don't care how much debt I left school with, let alone how much more I paid back.

They only care that the economy sucks, their employment situation and/or bank account are bad, and here's this greedy, rich doctor making too much money off the poor helpless patients. So he should pay.

 

[Deucedano]

You also need to factor in that any time doctors complain about changes, the retort and/or media just will portray us as money-hungry elitists, who don't have our patient's best interests in mind. We are supposed to be total altruists - since we have sacraficed so much in our careers to get where we are, we should continue to sacrafice for "the greater good." We are not supposed to subscribe to capitalist ideas, as much as discussion of payment for services rendered are verboten in the exam room

People look around and see a doctor driving a Mercedes or Lexus, and think, "He makes too much money!" They see the bill for a simple office visit and say "$90 for 10 minutes of his time? It takes me all day to earn that!" Most of the public believes we are all way overpaid, were born with silver spoons and take 4 3-week vacations per year in Martha's Vinyard. (Oh, wait, that is what are president does...).

I can't tell you how many times I've heard the comment "I guess the doctor needs to make another boat payment." (My boat is paid in full, thank you very much ) Or things like "How many cruises have you taken this year paid for by drug companies?" I'll actually take people to task for that one.

I'm paid well, but I do work that very few people do in my community, and even fewer do well. I believe supply-and-demand works well if left alone. I have learned how to work smarter, not harder, and therefore have more take-home pay than when I was solo. Because of that, the current thinking is I need to "pay my due." Nobody cares that 5 years ago I almost had to declare bankruptcy, and narrowly avoided it by borrwing $1500 each from my parents and my wife's. They don't care that I spent 12 years in school and training after high school. They don't care how much debt I left school with, let alone how much more I paid back.

They only care that the economy sucks, their employment situation and/or bank account are bad, and here's this greedy, rich doctor making too much money off the poor helpless patients. So he should pay.

I completely agree. Most people dont realize that doctor's salaries count for about 6% (or something like that) of total health care cost, but regardless reimbursments for physician's time is the first thing to go because the public thinks we make too much money.

On a side note, I will have 200K in debt by the time I leave school and even more when I finish residency. I would like to pay off my loans and live comfortably. Is it possible under this system to make 200k doing outpatient msk/pain?

 

[PMR 4 MSK]

I completely agree. Most people dont realize that doctor's salaries count for about 6% (or something like that) of total health care cost, but regardless reimbursments for physician's time is the first thing to go because the public thinks we make too much money.

On a side note, I will have 200K in debt by the time I leave school and even more when I finish residency. I would like to pay off my loans and live comfortably. Is it possible under this system to make 200k doing outpatient msk/pain?

Currently - yes, easily. In the coming years ... ????

 

[SSdoc33]

Nobody cares that 5 years ago I almost had to declare bankruptcy, and narrowly avoided it by borrwing $1500 each from my parents and my wife's.

i care

and, btw, how many wives do you have?

 

[brimcmike]

This strategy is of course older than the Romans. We are as vulnerable as any group to to this venerable strategy. We simply have to realize that we face huge resource and power disparities against economies-of-scale corporate/industry opponents, or perhaps better to think of "them" as competitors for the pie. I think that we are not-so-smart when it comes to appreciating the nature of the healthcare-finance pie, the rising clamor for it, and the array of other players who have shown up, usually uninvited, to help themselves to as big a piece as they can get. Others have, and they are acting accordingly, and in my estimation are winning more pie.

We are very probably the "wealthiest" folk that many people ever come in contact with. Most people will never even breathe the same air as the actually wealthy. So, as a convenience, we catch a lot of the collective envy and jealousy inherent in the human condition. So be it.

I am personally not motivated to strive and maximally and/or ostentatiously stratify in 6-figure-land. I have a little over $180,000 in student loans. I remind myself frequently that I volunteered for this. So, no whining. I come from working-class roots, and so earning anything over $100K is amazing to me in my secret inner-core. I pay my bills. I live below my means. I am grateful for this ride.

 

[PMR 4 MSK]

i care

and, btw, how many wives do you have?

Reminds me - what do monogamy and polygamy have in common? One spouse too many...

 

[PMR 4 MSK]

I live below my means.

The whole secret to surviving our current "economic crisis" and building your nest egg for the future, summarized in five words.

Not living by this is why we, as a country (and the rest of the developed world) are in the mess we are now.

It took me several years to learn it.

 

[Paddington]

In PM&R the pay is average. Now that this Barry Soetero or whatever he calls himself has decreed that CEO's must only make $500,000 perhaps he'll do something similar for medicine.

My friend the future radiologist is quite excited, as he dislikes medicine doctors and his fantasy is that Hussein will crush them with his new socialist mandates, whilst leaving the high earners alone. I hate to tell you, but I used to live in England and Psychiatrists, GP's, surgeons, and radiologists all make about the same there. LOL! It's like robbing a bank: you go where the money is. So it's the folks at the higher end that will have their salaries cut first. Cut early, and cut often as they like to say at the DNC on election day.

The times, they are a changin'. Can't say I like it. But my expectations of future income weren't that massive to begin with, so I'm less bummed out than future rad onc's, surgeons, etc.

What I would hate though is if I got pigeon holed into doing primarily inpatient. This is what some insiders in the PM&R field have told me, is their expectation of what will happen if healthcare is socialized. They don't foresee as many outpatient jobs available in the future for young guys currently in residency.

 

[PMR 4 MSK]

What I would hate though is if I got pigeon holed into doing primarily inpatient. This is what some insiders in the PM&R field have told me, is their expectation of what will happen if healthcare is socialized. They don't foresee as many outpatient jobs available in the future for young guys currently in residency.

Nah, they'll just cut out inpt rehab as too costly and unproven. Then rehab residencies themselves will get the axe.

 

[caedmon]

Hopefully, that first article was one author's viewpoint combining Daschle's book with the actual bill. Here is a link to the bill (healtcare information technology portion starts page 900). I read most of it and it really does look more like a system to establish a national database. Unless I missed something in the legal mumbo jumbo.

http://www.scribd.com/doc/12274824/stimbill

 

[brimcmike]

The McCaughey piece sounded too scary to be true, so I Googled around...

and found that the Senate Committee on Finance has posted FAQs on Stimulus Package Health Provisions in response to rumors and rhetoric generated by the RWNM/VRWC .

 

[Nico47]

I'm posting the most relevant quote from that link shared by BrimCMike:

"This bill does NOT [emphasis added], however, require physicians to follow any particular treatment guidelines, protocols, or other research. . ."

When I made my initial response, I meant to show disappointment in our not being part of a process that directly affects physicians. I don't want it misinterpreted as a reflex reaction to the propoganda of socialism.

I'd like to think that despite our political differences, this thread has shown that we need to have a collective voice to improve our field through policy and law.

It's not all about compensation, either. An issue that was recently tossed around is that of "mini-clinics." Some politicians believe this is the answer to the shortage of PCPs. But what do they know about continuity of care? The person who sees several different doctors for back pain may actually have an underlying malignancy.

I say, it's time for medicine to heal itself and make progress.

(As an aside, the 'Hussein' commentary was a bit much. )

 

[brimcmike]

I say, it's time for medicine to heal itself and make progress.

(As an aside, the 'Hussein' commentary was a bit much. )

Hear! Hear!

Time to set snark and acromony aside.

Any and all can call names; it does no adult good, and does engender division and even harm to enlightened self-interest.

I say beware any and all who get paid to incite division; they are, by definition, doing their employer a valuable service, and it may not just be the ratings .

We don't even have to get along, but for our own good we do need to set to work together effectively.

 

[Amgen1]

according to Tom Daschle's plan the beloved ted kennedy would not be receiving the care all of the democrats are so pleased with. according to his plan that care would not be deemed worthwhile

 

[Poitiers2]

(As an aside, the 'Hussein' commentary was a bit much. )

W. Hussein. Works for me.

*shrugs*

 

[Disciple]

..