Interesting WaPo article on physician pay

[TheWallnerus]

Didn’t have a chance to read the actual study yet - but I’m interested why they didn’t include median earnings for each specialty as well as the means?

For my specialty (derm) some of the same forces including consolidation, increasing both residency slots and midlevels have also come together to decrease earnings for new + younger physicians, albeit perhaps to a lesser degree than radonc.

In derm though there are a handful of high-up private equity owners and celebrity YouTubers/ cosmetic branders that don’t make a “measly” few million in that “top 1%” of doctors- they make hundreds of millions. I would be interested if the study corrected for supreme-outliers like this which could really skew that mean (as well as the “top 1%” numbers). Literally a handful of these could move the mean earnings up 100k or so.

Also, is there any selection bias here (was there any way for doctors to not allow viewing of their anonymized tax info?)

Rad onc pay and reimbursement and patient loads are very Pareto. This has been shown again. And again. And again. And again.

The mean salary data for rad onc misleads a human mind. Just like when I tell everyone that Warren Buffett and my average net worth is over one billion dollars! I don’t even know why I hang out on SDN.

---

Members don't see this ad.

 

[sirspamalot]

Rad onc pay and reimbursement and patient loads are very Pareto. This has been shown again. And again. And again. And again.

The mean salary data for rad onc misleads a human mind. Just like when I tell everyone that Warren Buffett and my average net worth is over one billion dollars! I don’t even know why I hang out on SDN.

We all do for the same reason. At least here you can complain openly.

Not that it'll do any good.

 

[Lamount]

Regulation, i.e. government picking favorites and enabling them to consolidate power such that there is no source of viable competition, is how you get to having monopolies in the first place. Obviously there need to be protections in place for the individual, like workplace safety; that's not what I am referring to as regulation. You're using a straw man argument (and ad hominem attacks) to make your point, though I'm not quite sure what that point is.

Are you suggesting that MORE government is the answer to all of our ills? Like, watching recent events play out has left you thinking "you know what we need, is more power in the hands of these people"? If that is the case, I'm frankly surprised you aren't more supportive of ASTRO's efforts; they are just as good as government officials!

Short of overturning Citizens United, there is no way to get corporate interests out of healthcare regulation (or any government regulation).

 

[OTN]

Bezos owns both WaPo and Amazon. Amazon is getting into the business of providing healthcare.

Here we have an article published by WaPo which tries to start getting public support and discussion going around the idea that doctors are paid too much. Paying doctors less would increase the profitability of Amazon’s bottom line, at least in their healthcare service lines.

That’s all I think there is that needs to be discussed.

 

[medgator]

Bezos owns both WaPo and Amazon. Amazon is getting into the business of providing healthcare.

Here we have an article published by WaPo which tries to start getting public support and discussion going around the idea that doctors are paid too much. Paying doctors less would increase the profitability of Amazon’s bottom line, at least in their healthcare service lines.

That’s all I think there is that needs to be discussed.

I don't see any right wing media outlets advocating for higher doctor pay. This likely has nothing to do with Amazon or bezos.

Screwing physician compensation is an equal opportunity sport played on both sides of the aisle.

CMS funding is a fixed pot with an aging population/more customers coming and a % GDP expenditure on healthcare that ranks among the highest in the world

 

[theradiator]

To the National Bureau of Economic Research - you know what would be more interesting than physician compensation? Compensation of private equity managers, insurance executives, hospital management and most relevant academic economists. Also, kudos to dentists and orthodontists who successfully fought off Medicare expansion of dental care to maintain independence - although consolidation is lurking in that space also.

 

[deleted1111261]

Where do you think medical innovation, growth and stability would have come from without Medicare ?

I sympathize with Reagan’s early arguments, but I honestly think this was the way. What it morphed into is a different story.

Medicare was the worst option, but the least worst of all… I cannot fathom radiation oncology existing in its current form without the government spending (the tech, the ubiquity of linacs, the salaries, the convenience to patients compared to hub / spoke models, etc)

 

[Lamount]

Am I the only one who thought the article wasn't terrible? They spend a fair amount of their efforts making the point that physician salaries are NOT what drives healthcare costs, and also point out that we spend our 20s/early 30s making less than blue-collar workers.

 

[deleted1111261]

Lamount - re read it

I agree with you. It is actually really well done - the methods are good. It doesn’t capture everything. Mean is suboptimal. But, it’s a dataset that does inform us.

Ownership leads to wealth

Our salaries are falling precipitously

It will be helpful to follow this data for several years.

 

[Mandelin Rain]

Bezos owns both WaPo and Amazon. Amazon is getting into the business of providing healthcare.

Here we have an article published by WaPo which tries to start getting public support and discussion going around the idea that doctors are paid too much. Paying doctors less would increase the profitability of Amazon’s bottom line, at least in their healthcare service lines.

That’s all I think there is that needs to be discussed.

Unbridled capitalism wins again!

 

[theradiator]

Where do you think medical innovation, growth and stability would have come from without Medicare ?

I sympathize with Reagan’s early arguments, but I honestly think this was the way. What it morphed into is a different story.

Medicare was the worst option, but the least worst of all… I cannot fathom radiation oncology existing in its current form without the government spending (the tech, the ubiquity of linacs, the salaries, the convenience to patients compared to hub / spoke models, etc)

Having a safety net "public option" is certainly helpful for seniors to ensure access to life-saving and life-extending cancer treatment. However, government regulations such as technology mandates and MIPS reporting requirements have undoubtedly contributed to practice consolidation and thus a lower opportunity to achieve technical ownership to make the top 1 to 10% of physician earners. As an unintended side effect, it also greatly enriched insurance companies through Medicare Advantage.

It is true that dental innovation may be slower due to absence of a government payer such as Medicare. With the current fee for service model for dentistry, our dental friends can proudly own their own small practice and that opportunity is not available to radiation oncologists.

 

[elementaryschooleconomics]

Am I the only one who thought the article wasn't terrible? They spend a fair amount of their efforts making the point that physician salaries are NOT what drives healthcare costs, and also point out that we spend our 20s/early 30s making less than blue-collar workers.

The actual NBER report is >60 pages with a supplement document that is also a few dozen pages.

It's excellent.

The Washington Post choosing that headline was very intentional, of course. It sucks in people who don't have a basic understanding of descriptive statistics.

So in a way, the Post also did an excellent job, too - writing a compelling headline with compelling graphics to get people to read and talk about it.

But if anyone were to use this average salary data to make career decisions as a med student, or as evidence of the health of the field, or anything of that nature...I would encourage those folks to dust off a book:

 

[deleted1168505]

It was not capilalistic principles that led to the death of small business in America and physician owned practice in medicine.

Minimum wage was mentioned. That's a good one. What do you think happens when the federal govt implements a $15 minimum wage. $15 in Nebraska is very different than $15 in SF. So when the 20 year old at your hardware store in rural NE comes to you and says he can't work for you anymore because the Amazon warehouse is paying $15 and you're only paying $11, what do you think happens? Your only option is to pay more to keep your doors open, which means you have to raise prices, which are already higher than Amazon's to begin with. People can afford to buy less with their increased wages due to inflation/more dollars in the system, so what good did that really do except consolidate power in a few mega corporations that drove the small guys out of business.

These things are always more complicated than feel good bumper sticker slogans.
So, I'm not surprised Amazon is coming after highly compensated doctors because they want a piece of that pie, in far-from-free market where the rules benefit them. Totally predictable.

 

[communitydoc13]

Imagine charges without Medicare. What we (healthcare in general) charge is not remotely payable by most people.

PSMA PET for newly diagnosed prostate cancer, no longer payable by medicare. 8k per scan out of pocket. Nice tool too.

Dentists get to act like they do because there is a very weak narrative that dental care is essential. Orthodontists, as far as I can tell, treat rich people and middle class people willing to take on debt to put braces on their kids. It is unclear to me how necessary most orthodonture is.

But the oncology cost issue is outrageous. We have very little to do with it, but do need to aggressively look for a way to be part of the solution.

The combination of demography, targeted therapy and immunotherapy (without gvt negotiation of costs) as well as improved outcomes in metastatic disease and the need for more intense f/u in the adjuvant setting by medonc means:

1. Cost of systemic therapy is outrageous.

2. The schedules of your medonc colleagues are not sustainable. (q6 week f/u on high numbers of metastatic patients now living longer and your locally advanced breast patients getting both neoadjuvant and adjuvant therapy therapy for long duration alone are examples). I thought medoncs schedules were filled with new patients. This is not necessarily true. Their follow-up and on treatment patients alone can rapidly fill their (or mid-levels) days.

Combine this with the fact that prevalence of cancer and blood dyscrasias increases with age into the 80s and we are hitting a wall now.

Amazon warehouse is paying $15 and you're only paying $11

Amazon is too big. Standard oil and Ma Bell were too big as well. Scale is important to manage in a capitalist system. The management of scale does itself not seem very capitalistic however.

 

[CaesarRO]

Bezos owns both WaPo and Amazon. Amazon is getting into the business of providing healthcare.

Here we have an article published by WaPo which tries to start getting public support and discussion going around the idea that doctors are paid too much. Paying doctors less would increase the profitability of Amazon’s bottom line, at least in their healthcare service lines.

That’s all I think there is that needs to be discussed.

I read the article as suggesting physician pay isn't the major cost in health care which goes against the conflict of interest suggested here.

 

[Mandelin Rain]

Yes, HUGE monopolistic commerce corporations lead by near trillionaires buying and controlling the media and venturing into healthcare is because we have too much regulation in our markets, something, something federal minimum wage (currently $7.25 in 2023(!)).

 

[elementaryschooleconomics]

I read the article as suggesting physician pay isn't the major cost in health care which goes against the conflict of interest suggested here.

Sure, but at the end of the day, the headline of the newspaper article is all that matters.

They already changed it - they got what they wanted:

"How much money do doctors really make and why is it so much"?

Friday article drop.

Right now:

They drove a lot of clicks this weekend.

Strong work, WaPo.

 

[deleted1168505]

Amazon is too big. Standard oil and Ma Bell were too big as well. Scale is important to manage in a capitalist system. The management of scale does itself not seem very capitalistic however.

There have been exactly two populist presidents in the history of the US. The first was Teddy Roosevelt, widely beloved, who busted up the big guys who behaved poorly. This was not inherenty anti-capitialist, and surprisingly the wikipedia article sums it well:

For his aggressive use of the 1890 Sherman Antitrust Act, compared to his predecessors, Roosevelt was hailed as the "trust-buster"; but in reality he was more of a trust regulator.[141] Roosevelt viewed big business as a necessary part of the American economy, and sought only to prosecute the "bad trusts" that restrained trade and charged unfair prices.[142]

Ross Perot did not make it to the presidency, but still brought wide appeal.
The third... well I bet you can figure that one out.

I suspect that many displaying sympathies to some (or all) tenets of socialism have not owned a small business before. Which is fine. Some people are more happy working for a university for whatever they will pay them. That's not wrong. That's the thing about socialism: an evil philosophy that preys on the decency of well-meaning people. I have no doubts you are well-meaning. But this is by design: a feature, not a bug. The end result is always the same: In a system where upward mobility is difficult or actually impossible through free enterprise, the only ways to become successful/wealthy is through corruption and obtaining positions of power within the state or outright crime. This is common in the more socialist countries in Europe: With very high tax rates, people are paid under the table. If you want something done you have to grease them with cash. If you try to pay your employees on the books, nobody will work for you. So you pay them in cash and bribe the officials to let you keep operating. As a result national services are underfunded and in disarray. Great system.

I've had a small internet-based business for about 15 years. The nonsense I have to put up with now makes it almost not even worth doing any more. Every year it's something else to make it more and more onerous. I've had employees in the past and I can't imagine dealing with that now. The regulations are set up more and more to make conducting business only feasible for the large guys able to employ people specifically to deal with inefficient compliance nonsense. Don't even get me started on the tax code.

 

[deleted1168505]

Yes, HUGE monopolistic commerce corporations lead by near trillionaires buying and controlling the media and venturing into healthcare is because we have too much regulation in our markets, something, something federal minimum wage (currently $7.25 in 2023(!)).

Correct. When the system is rigged such that regulatory compliance (among many other inefficiencies) can no longer be met by small business and retain a positive operating margin.
The federal minimum wage is $7.25, correct. This is $7.25 too high. States can figure out what/if any wage requirements work best for them.

 

[Mandelin Rain]

- This is common in the more socialist countries in Europe: With very high tax rates, people are paid under the table. If you want something done you have to grease them with cash. If you try to pay your employees on the books, nobody will work for you. So you pay them in cash and bribe the officials to let you keep operating. As a result national services are underfunded and in disarray. Great system.

More fake news.

https://www.cnn.com/travel/article/world-happiest-countries-2023-wellness/index.html

For the sixth year in a row, Finland is the world’s happiest country, according to World Happiness Report rankings based largely on life evaluations from the Gallup World Poll.

The Nordic country and its neighbors Denmark, Iceland, Sweden and Norway all score very well on the measures the report uses to explain its findings: healthy life expectancy, GDP per capita, social support, low corruption, generosity in a community where people look after each other and freedom to make key life decisions.

 

[deleted1168505]

More fake news.

https://www.cnn.com/travel/article/world-happiest-countries-2023-wellness/index.html

For the sixth year in a row, Finland is the world’s happiest country, according to World Happiness Report rankings based largely on life evaluations from the Gallup World Poll.

The Nordic country and its neighbors Denmark, Iceland, Sweden and Norway all score very well on the measures the report uses to explain its findings: healthy life expectancy, GDP per capita, social support, low corruption, generosity in a community where people look after each other and freedom to make key life decisions.

I wasn't talking about Finland (which is unique in that it has a very homogeneous population and culture). This is a strawman. I was referring to places like Greece. Numerous Latin American failed states offer even more compelling evidence.
Norway is unique in that it has a massive sovereign oil fund. Like entropy, Earth does not fall into disarray as the 2nd law would predict but instead becomes more ordered because it is not a closed system, but rather powered by the sun. It is helpful to have a 1.3 trillion dollar oil fund powering whatever policies you want.

 

[Lamount]

It was not capilalistic principles that led to the death of small business in America and physician owned practice in medicine.

Minimum wage was mentioned. That's a good one. What do you think happens when the federal govt implements a $15 minimum wage. $15 in Nebraska is very different than $15 in SF. So when the 20 year old at your hardware store in rural NE comes to you and says he can't work for you anymore because the Amazon warehouse is paying $15 and you're only paying $11, what do you think happens? Your only option is to pay more to keep your doors open, which means you have to raise prices, which are already higher than Amazon's to begin with. People can afford to buy less with their increased wages due to inflation/more dollars in the system, so what good did that really do except consolidate power in a few mega corporations that drove the small guys out of business.

These things are always more complicated than feel good bumper sticker slogans.
So, I'm not surprised Amazon is coming after highly compensated doctors because they want a piece of that pie, in far-from-free market where the rules benefit them. Totally predictable.

I would argue that if one cannot pay a full-time employee enough to be above the poverty line, one needs to rethink one's business model. Even in rural NE, it's hard to imagine you can afford rent on <2k/month gross income.

 

[communitydoc13]

hat's the thing about socialism: an evil philosophy that preys on the decency of well-meaning people.

Oh jeez. You are so effing smart but so willing to stick to a simple narrative here. Markets do not themselves solve complicated problems with large populations where everyone is not harvesting or hunting their own food in an environment that appears infinite in scale relative to the human population. Cash is not the only capital out there. Most resources are by definition collective (space, water, weather).

Have you spent extensive time in Europe? Is the QOL of the average European so bad? Do their cities suck? Does their welfare system not provide some security even for the professional class? Are they not taking vacations? Do they not have better paternity leave policies?

All this by the way, with a population density that dwarfs the U.S.

There are even poor places where people are happier than the US.

I'm meh on the happiness index. A little neuroticism, a little concern with ethics and next thing you know you are less happy than your neighbor who ascribes to the prosperity gospel.

I am not arguing that there cannot be excessive regulatory burden. Of course there can be, and the culture of government can easily fall into one where regulation production is equated to professional productivity. This is bad.

But markets alone lead to consolidation, exploitation and environmental hazard. This is not new.

In our own system, an enormous fraction of our GDP is consolidated in a few elite metros where they produce almost nothing. Kinda interesting.

I'm pro small business. They should also pay their employees and their effing taxes. Do they? Well the single easiest way to move your margin is through tax manipulation (you know this).

My neighbor owned a carpet cleaning business. We live in the same neighborhood. We were discussing retirement and SEP account limits and he was like, "the gvt won't let me put in that much!". I asked him how much personal income he declared (we live in the same neighborhood). He replied, "40k".

 

[deleted1168505]

Have you spent extensive time in Europe? Is the QOL of the average European so bad? Do their cities suck? Does their welfare system not provide some security even for the professional class? Are they not taking vacations? Do they not have better paternity leave policies?

Yes.

With a few exceptions like Hungary it is rapidly deteriorating. I recently received healthcare there and it was affordable and excellent. The streets are not littered with homeless people and I could walk home at night without concern. It was quite nice. The racial tensions in France is basically a non-solvable problem at this point. Young girls are raped on a daily basis and it is not reported in the news and the police are powerless to stop it. The UK's health system is a national embarrassment. Free speech is not protected. Corruption abounds even in more developed places like Italy. Wealth is increasingly consolidated in Western Europe. Overt anti-semetism and white nationalism is rife in places like Poland and Ukraine. At this point, you are safer on the streets at night in places like Budapest instead of Paris.

Exceptions to the disarray include a few naturally wealthy Nordic countries and Switzerland with homogeneous populations and strict immigration policies.

It baffles me that so many young people in America look at Western Europe and think we are so terrible and should strive to be more like them. It is the result of ignorance and indoctrination at university by faculty that hate the founding principles of America.

 

[communitydoc13]

At this point, you are safer on the streets at night in places like Budapest instead of Paris.

I don't know, and hard for me to know what you know. We are drifting. Not my experience at all. While economic policy is pertinent to our conversation regarding physician pay, this is not.

 

[deleted1168505]

I don't know, and hard for me to know what you know. We are drifting. Not my experience at all. While economic policy is pertinent to our conversation regarding physician pay, this is not.

I have very good friends that live in France. I have spent extensive time in Germany (who have totally screwed themselves with their energy policy). It's changing rapidly. I could go on for a long time. I was responding to the question you asked. We could talk about physician pay in Germany if you want (you won't like it!).

For your next European holiday, try Budapest, Split, or Zurich. Maybe avoid Paris and London.

 

[Mandelin Rain]

Yes.

With a few exceptions like Hungary it is rapidly deteriorating. I recently received healthcare there and it was affordable and excellent. The streets are not littered with homeless people and I could walk home at night without concern. It was quite nice. The racial tensions in France is basically a non-solvable problem at this point. Young girls are raped on a daily basis and it is not reported in the news and the police are powerless to stop it. The UK's health system is a national embarrassment. Free speech is not protected. Corruption abounds even in more developed places like Italy. Wealth is increasingly consolidated in Western Europe. Overt anti-semetism and white nationalism is rife in places like Poland and Ukraine. At this point, you are safer on the streets at night in places like Budapest instead of Paris.

Exceptions to the disarray include a few naturally wealthy Nordic countries and Switzerland with homogeneous populations and strict immigration policies.

It baffles me that so many young people in America look at Western Europe and think we are so terrible and should strive to be more like them. It is the result of ignorance and indoctrination at university by faculty that hate the founding principles of America.

Like, apparently we have all the cherry picked examples of how bad western europe is rolled into one dysfunctional country.

 

[communitydoc13]

I have very good friends that live in France. I have spent extensive time in Germany (who have totally screwed themselves with their energy policy). It's changing rapidly. I could go on for a long time. I was responding to the question you asked. We could talk about physician pay in Germany if you want (you won't like it!).

For your next European holiday, try Budapest, Split, or Zurich. Maybe avoid Paris and London.

I don't care if this post gets pulled. This is bogus AF. Recently spent time in Paris, took metro from CDG to 4th arrondissement in AM as is typical. My family (brown, mixed race) and me (middle aged white guy). No problems on a train filled with black Parisiennes. Food still good. Went out at night all the time. Very diverse and lovely city.

Racism in eastern Europe? Well I can't speak from personal experience, but my younger cousin definitely felt some shade there.

That this thread would devolve like this is bad. I know I contributed to this. That there is a consistent confluence of free market ideology (not bad at all) and narratives that are strictly social and play well on Fox news alerts is very concerning to me.

Best.

 

[Lamount]

Yes.

With a few exceptions like Hungary it is rapidly deteriorating. I recently received healthcare there and it was affordable and excellent. The streets are not littered with homeless people and I could walk home at night without concern. It was quite nice. The racial tensions in France is basically a non-solvable problem at this point. Young girls are raped on a daily basis and it is not reported in the news and the police are powerless to stop it. The UK's health system is a national embarrassment. Free speech is not protected. Corruption abounds even in more developed places like Italy. Wealth is increasingly consolidated in Western Europe. Overt anti-semetism and white nationalism is rife in places like Poland and Ukraine. At this point, you are safer on the streets at night in places like Budapest instead of Paris.

Exceptions to the disarray include a few naturally wealthy Nordic countries and Switzerland with homogeneous populations and strict immigration policies.

It baffles me that so many young people in America look at Western Europe and think we are so terrible and should strive to be more like them. It is the result of ignorance and indoctrination at university by faculty that hate the founding principles of America.

Since we are making comparisons… are Americans healthier than Europeans with socialized medicine? Does our market-driven healthcare system result in lower healthcare costs?

 

[deleted1168505]

I don't care if this post gets pulled. This is bogus AF. Recently spent time in Paris, took metro from CDG to 4th arrondissement in AM as is typical. My family (brown, mixed race) and me (middle aged white guy). No problems on a train filled with black Parisiennes. Food still good. Went out at night all the time. Very diverse and lovely city.

Racism in eastern Europe? Well I can't speak from personal experience, but my younger cousin definitely felt some shade there.

That this thread would devolve like this is bad. I know I contributed to this. That there is a consistent confluence of free market ideology (not bad at all) and narratives that are strictly social and play well on Fox news alerts is very concerning to me.

Best.

You are free to disagree. I don't know why you are bothered that some who have different social perspectives share free market ideological principles. I would argue that this is a good thing. The Fox News jab is an ad hominem, though. I do not doubt that your experience as a wealthy American tourist in France wasn't terrible. The racial tensions in France involve Arab immigrants, not "black Parisiennes"

Since we are making comparisons… are Americans healthier than Europeans with socialized medicine? Does our market-driven healthcare system result in lower healthcare costs?

As noted above this actually is rolling "western europe into one dysfunctional country." It's different in each location and multi-factorial including the differences in the population base and culture. It is not simply a matter of spending and access. It is no secret that healthcare costs multiples for near equivalent outcomes. This is not simply due to the fact that there is not a single payor system but rather multiple inefficiencies driving up prices. I have visited an ED in Switzerland before. It was affordable to pay cash, even as a non-citizen (although it was clear that I would be denied care if I was unable to pay at the time of service, which I thought was... interesting given the narratives). Paying the sticker price for an ED visit in the US is just insane. Yes, I agree it is a very broken system, but it's not due to the simple fact the US is not single payor. Many European systems are not either, with both public and private options. Some work better than others.

Without a doubt, at least in my opinion, the largest driving factor are obesity rates in the US. The downstream effects of this cannot be overstated. This is a cultural phenomenon that a place, like say Finland, doesn't have (you can look at why Covid outcomes weren't all that different in Sweden even though they never locked down or enforced mitigation policies like the US did -- the virus killed obese and chronically ill people preferentially, and Sweden well isn't that). This is also observed in Mexico, which is even more obese than the US. You could also look at a place like Russia for another example of this. Health outcomes are driven largely by staggering rates of alcoholism and drug abuse.

 

[communitydoc13]

The Fox News jab is an ad hominem, though.

I apologize.

My experience is so radically different from recent in person travel to France, UK, Greece and Italy that my response was visceral. I would not discourage travel to any of these countries. I have good friends from some of these places. I have also heard the narrative of "Europe is crumbling" many times. In my experience, the correlation between this narrative and other political positions has been remarkable (but not uniform).

Europe is of course becoming more diverse racially and culturally. Not a bad thing in my opinion. I'm sure you are familiar with the long history of France and North Africa. There are tensions of course, this is normal.

I know what European physician pay is in general. Not uniform, but a rough calculation of a 50% pay cut is not far off for many of us in the middle. Much more for some of us. I know an outstanding former US academic (European by birth and early training) who opted to return to Europe for cultural reasons. He told me his pay went down 50% but his QOL went up. (One of the countries you mentioned). To each his own.

The European example is not going to help us defend our pay.

Without a doubt, at least in my opinion, the largest driving factor are obesity rates in the US.

It's a factor, but I think it will be hard to prove this is the greatest factor. For cost per capita, a place like NZ has close to our obesity rate, 1/3 cost per capita on health care and slightly better life expectancy.

As others have said, it's the prices.

 

[deleted1168505]

It's a factor, but I think it will be hard to prove this is the greatest factor. For cost per capita, a place like NZ has close to our obesity rate, 1/3 cost per capita on health care and slightly better life expectancy.

As others have said, it's the prices.

Yes, but again if you have been to New Zealand, you will again notice an overall healthy, homogeneous population and a culture that values these things. Obesity rates in New Zealand are largely driven by the native population as is common in other Polynesian nations, which is not to say that is not a serious problem. America has devolved into a disturbing trend of trying to normalize obesity (as well as other negative physical and mental health behaviors) and censor criticism of it as a serious health issue.

"Life expectancy at birth was 73.4 years for Māori males in 2017–2019 (up 3.1 years from 2005–2007), and 77.1 years for Māori females (up 2.0 years from 2005–2007). In comparison, non-Māori males are expected to live to 80.9 years, while non-Māori females are expected to live to 84.4 years"

Also interesting, since you bring up New Zealand and physician pay in America, they often advertise for American rad oncs since we can practice there. I believe the pay is around $200k/year.

 

[communitydoc13]

(as well as other negative physical and mental health behaviors)

like what?

 

[communitydoc13]

"Life expectancy at birth was 73.4 years for Māori males in 2017–2019 (up 3.1 years from 2005–2007), and 77.1 years for Māori females (up 2.0 years from 2005–2007). In comparison, non-Māori males are expected to live to 80.9 years, while non-Māori females are expected to live to 84.4 years"

17% of population. Their health outcomes folded in. Not sure how this supports the notion that obesity is the main driver of health care costs.

Also, like what?

 

[deleted1168505]

17% of population. Their health outcomes folded in. Not sure how this supports the notion that obesity is the main driver of health care costs.

Also, like what?

My point was that it is not a good faith argument to argue that New Zealand has comparable rates of obesity but equivalent life expectancy to the US when these rates are driven by a small minority of the population who, not unexpectedly, have lower life expectancy as a subgroup.

I suppose if we made all physicians in America government employees and also paid us $200k/year also that there would be savings. I have suspicions that these savings would get passed on to the patients/taxpayers.

When you say "it's the prices" what exactly do you mean? Is it physician pay? To what extent?
I mean, there was the famous Forbes article from 2012 "It's physician pay stupid" so it's not a novel idea. And physician pay has been reigned in a lot since then, how much better are things? It's Physician Pay, Stupid!

 

[fiji128]

Correct. When the system is rigged such that regulatory compliance (among many other inefficiencies) can no longer be met by small business and retain a positive operating margin.
The federal minimum wage is $7.25, correct. This is $7.25 too high. States can figure out what/if any wage requirements work best for them.

In my neck of the woods no one is hiring anyone for anything close to $7.25/hour (even though that the technical legal minimum). As far as I can tell the starting no skills but can show up on time and follow instructions wage starts around $17/hour and I am not in an urban or even suburban area.

 

[communitydoc13]

When you say "it's the prices" what exactly do you mean? Is it physician pay? To what extent?

Even the posted article supports that physician pay is a small factor regarding total expenditures. The math here is easy.

I am not advocating for European style pay in the absence of European style med school or pension plans. That would suck.

I do think physicians are targeted for being relatively affluent for multiple reasons. Some of which are anti-elitist notions about credentialism. I am not eager to take a pay cut.

The prices are what is charged (and the 25-40% that is paid on those charges) for medications, hospital stays, blood draws, diagnostic studies....basically everything. The professional fees of the physicians are a small fraction of this (and not necessarily correlated well with the amount spent on the physician).

Most pressing for us is how our leadership interface with the gvt and other specialties to achieve sustainability and availability of quality care. I would argue that they are losing track of the importance of scale and supporting low value interventions only offered by large systems. A mistake IMO. (maybe you agree).

Also, like what....own it.

 

[Mandelin Rain]

If he "owns it," it'll certainly cross over to "Dare you to reply" territory, which is likely where we already are.

 

[deleted1111261]

In my neck of the woods no one is hiring anyone for anything close to $7.25/hour (even though that the technical legal minimum). As far as I can tell the starting no skills but can show up on time and follow instructions wage starts around $17/hour and I am not in an urban or even suburban area.

I’d agree that 7.25 for all intents and purposes is ~0

 

[deleted1168505]

Also, like what....own it.

Own what? I'm not sure where you are trying to go with this, but I have a pretty good idea. I have little interest in being goaded into defending traditional virtues by someone behaving with hostility towards me for no reason, especially when you bemoaned shifting the point of discussion away from physician pay and are now harping on this for some reason. Do I think that working from home 3 hours a day, eating junk food, having few outside social connections, and smoking weed and watching porn all the time leads to positive physical and mental health outcomes? No, I sure don't. Yet this is becoming so common and is a real problem in younger populations with declining rates of marriage, birth rates, adults living at home into their 30s, etc. Some of it is economic and not their fault for sure. But to a much larger extent IMO it is cultural.

This is, of course, all a matter of opinion.

 

[sirspamalot]

Nobody "hates" UHC for being rich, but they sure do hate on Doctors making a good living.

You better believe those megacorp's are happy to fuel that notion - the poor fight against the middle class while the rich smile and laugh behind closed doors.

 

[deleted1168505]

I am not advocating for European style pay in the absence of European style med school or pension plans. That would suck.

So if we had med school paid for and a government pension of 50% salary (so, like $100k/year or so), you would?
Now that math really doesn't work.
How much does med school cost? Now knock the average rad onc income down from 572k to 200k over a 30 year career. Does that come out even close? (FYI, in germany employed doctors which is basically all of them make about 100k euro/yr, but yes, school is free (well paid for by taxpayers as nothing is free))

And yes. I do see something perverse about Paul Wallner buying multimillion dollar mansions with 9 bathrooms off his rad onc career while smacking the rest of us down.

 

[deleted1111261]

Nobody "hates" UHC for being rich, but they sure do hate on Doctors making a good living.

You better believe those megacorp's are happy to fuel that notion - the poor fight against the middle class while the rich smile and laugh behind closed doors.

That Optho glaucomfleck has made a career out of hating UHC. I don’t think this line is accurate. Every patient of mine will complain about this.

I had a low-middle income patient excoriating insurance executives today, as we complained about his SBRT being “converted” to VMAT.

 

[Lamount]

As noted above this actually is rolling "western europe into one dysfunctional country." It's different in each location and multi-factorial including the differences in the population base and culture. It is not simply a matter of spending and access. It is no secret that healthcare costs multiples for near equivalent outcomes. This is not simply due to the fact that there is not a single payor system but rather multiple inefficiencies driving up prices. I have visited an ED in Switzerland before. It was affordable to pay cash, even as a non-citizen (although it was clear that I would be denied care if I was unable to pay at the time of service, which I thought was... interesting given the narratives). Paying the sticker price for an ED visit in the US is just insane. Yes, I agree it is a very broken system, but it's not due to the simple fact the US is not single payor. Many European systems are not either, with both public and private options. Some work better than others.

One could argue that Western Europe is no more heterogeneous the US (how much does a person in rural MS have in common with someone from the upper east side of NYC?).

I don't think making US single payer would solve everything overnight... nor am I 100% convinced it is the right thing to do. However, I do think the US healthcare system (much like many other facets of our economy) is accelerating toward disaster. The reason for this is simple... it's not profitable to keep most Americans healthy. US researchers are incentivized to develop cutting edge cancer drugs that cost 200k+/year, but prevention is far less profitable.

Obesity obviously is a MAJOR contributor to the chronic illnesses that plague many Americans. The solution is simple: grow more fruits and vegetables and less corn... but why prevent a problem when you can charge >1k/month for a drug that can treat it?

Free markets are great for building iphones, cars, etc... but are less helpful in sectors where the incentive for profit is decoupled from the well-being of the populace.

 

[sirspamalot]

That Optho glaucomfleck has made a career out of hating UHC. I don’t think this line is accurate. Every patient of mine will complain about this.

I had a low-middle income patient excoriating insurance executives today, as we complained about his SBRT being “converted” to VMAT.

Sure an anectodal experience is nice to hear about.. but the real bile and contempt is reserved for widely published "your doctor makes" articles..

And very few "Your UHC megacorp C-suite guys makes 5-20m while denying your care.. you should be rioting"

 

[deleted1111261]

Sure an anectodal experience is nice to hear about.. but the real bile and contempt is reserved for widely published "your doctor makes" articles..

And very few "Your UHC megacorp C-suite guys makes 5-20m while denying your care.. you should be rioting"

If you think in society than United and insurers are not the villain and physicians are, we live in two very different realities.

There are 100s of articles bemoaning insurance companies, many lawsuits against them, many settlements against them.

This is one albeit major article that says we get paid a lot.

I don't have a victim complex, I suppose. Patients at least where I work lionize us and villainize them.

Maybe your world is different and I can accept that.

 

[deleted1168505]

One could argue that Western Europe is no more heterogeneous the US (how much does a person in rural MS have in common with someone from the upper east side of NYC?).

I don't think making US single payer would solve everything overnight... nor am I 100% convinced it is the right thing to do. However, I do think the US healthcare system (much like many other facets of our economy) is accelerating toward disaster. The reason for this is simple... it's not profitable to keep most Americans healthy. US researchers are incentivized to develop cutting edge cancer drugs that cost 200k+/year, but prevention is far less profitable.

Obesity obviously is a MAJOR contributor to the chronic illnesses that plague many Americans. The solution is simple: grow more fruits and vegetables and less corn... but why prevent a problem when you can charge >1k/month for a drug that can treat it?

Free markets are great for building iphones, cars, etc... but are less helpful in sectors where the incentive for profit is decoupled from the well-being of the populace.

I basically agree with all of this. Medicare is headed towards insolvency... rapidly. We have a broken system and no good way to fix it except to print more money. We have 31 Trillion in national debt. Our leaders are addicted to spending to remain in power. This will not end well, the only question is when.

I think we are all on the same page about pharma, especially being in onc and seeing the waste that goes on in the medical side at enormous cost for minimally improved outcomes.

With regards to the heterogeneity of the US, what I meant is that the US is a massive melting pot (in addition to being enormous with large populations in regional areas far bigger than most european countries). Vs a place like Norway where most people are, well, Norwegian. We also have a major problem with millions coming through an open border with no reasonable path to obtaining legal status and accessing healthcare and legitimate work opportunities. I have treated patients trafficked across the border into sex slavery pro bono. It is an enormous problem objectively regardless of your politics. Norwegians have the same culture for the most part and strict immigration standards. I would love to live in Norway and eat fresh fish all the time. Try getting that in Salina!

 

[Mandelin Rain]

When in doubt, blame the immigrants. Oh, wait. White people here ARE the immigrants.

[green font] At least, immigrating Europeans have made Native American lives better through capitalism. [green font]

 

[deleted1168505]

When in doubt, blame the immigrants. Oh, wait. White people here ARE the immigrants.

[green font] At least, immigrating Europeans have made Native American lives better through capitalism. [green font]

I literally said that America is a "melting pot." A nation of immigrants. What in the world are you talking about? Are you trying to say that the millions of unauthorized border crossings, human trafficking, and these people flooding into our country filling EDs because they have nowhere else to go is not a major problem? Or that it isn't real? I guess I just have to disagree with that.

If you want to advocate for physician pay but also for open borders, you are going to put yourself in quite the conundrum because you will either have to deny care to the sick or be taking care of increasing numbers of people without even a driver's license who have no way to pay you anything for your services. Both situations are suboptimal.

 

[medgator]

If you want to advocate for physician pay but also for open borders, you are going to put yourself in quite the conundrum because you will either have to deny care to the sick or be taking care of increasing numbers of people without even a driver's license who have no way to pay you anything for your services. Both situations are suboptimal.

Open borders?

We have such a labor shortage it's ridiculous yet one side just loves to throw that buzzword around while acting like an ostrich in the sand when it comes to immigration reform.

Family guy nailed RW ideology on immigration over a decade ago