More $%#@ing pay cuts!

[SteadyEddy]

Hello colleagues. I know that I've been a little quiet over the past year, but I've grown quite tired of hearing about pay cuts, additional tests (Step II clinical skills), and the like. I have essentially had enough and will no longer be silent when it comes to pay cuts...not for doctors...and not for surgeons. I'm not going to rant about how long I've been in school etc, because those of you that are in General Surgery Training know the routine. I refuse to stand for those out there that take advantage of my desire to take care for patients by continuing to make pay cuts/freezes. I am currently a resident member of the ACS. Attached below is a copy of what I received from Dr. Russell (if you don't know who he is...you should). I hope that you will join me in helping to take a stand...if not for us, then for those that will follow in our footsteps. Sorry for the rant, but I'm just pissed!

Dear Resident Member,

We need your help with the critical effort to stop 15 percent cuts that are scheduled for Medicare physician payments over the next two years (10 percent cut in 2008 and 5 percent cut in 2009).

In the coming days, the Senate will begin acting on its Medicare bill. The intelligence that our Washington Office is gathering says that the physician payment provisions of the Senate bill may include only a one year freeze (2008) that will be paid for by imposing larger cuts (15 percent) on physicians in 2009. This bill stands in stark contrast to one that the House passed in August that would stop the cuts for 2008 and 2009, provide small positive updates in both years, and minimize the cuts that are needed in future years to pay for the bill.

It is imperative that your Senators in Washington hear from you about the effect that the cuts in Medicare payments will have on your ability to care for your surgical patients.

As soon as possible, please call:

Senator George V. Voinovich at (202) 224-3353

and Senator Sherrod Brown at (202) 224-2315

When you call, you will ask the person who answers the phone to deliver the following message to the Senator:

* Before leaving for the year, the Senate needs to stop the Medicare physician payment cuts and provide at least a small increase (emphasize increase) for the next two years (emphasize two years). The Senate Finance Committee is currently working on drafting legislation.
* Any scheme that imposes "balloon payment" financing on physicians will just make matters worse and must be opposed.

After calling the Senators, please reply to this email ([email protected]) and let us know that you made the call. The replies to this email will go directly to the American College of Surgeons Washington Office. This knowledge will help in the lobbying efforts on our behalf.

Finally, I want to stress how important it is that you call your Senators. At this point in the legislative year, emails and letters will not be received in time. Phone calls are the only method of getting Congress to act. That is why virtually all physician specialty societies are joining forces in this telephone campaign.

Please join me today in taking just a few minutes of time to call your Senators. Not making this phone call could cost you thousands!

Thomas Russell, MD, FACS
Executive Director
American College of Surgeons

---

Members don't see this ad.

 

[Castro Viejo]

Hello colleagues. I know that I've been a little quiet over the past year, but I've grown quite tired of hearing about pay cuts, additional tests (Step II clinical skills), and the like. I have essentially had enough and will no longer be silent when it comes to pay cuts...not for doctors...and not for surgeons. I'm not going to rant about how long I've been in school etc, because those of you that are in General Surgery Training know the routine. I refuse to stand for those out there that take advantage of my desire to take care for patients by continuing to make pay cuts/freezes. I am currently a resident member of the ACS. Attached below is a copy of what I received from Dr. Russell (if you don't know who he is...you should). I hope that you will join me in helping to take a stand...if not for us, then for those that will follow in our footsteps. Sorry for the rant, but I'm just pissed!

I know how you feel.

I called my State Senators per Dr. Russell's email.

If the cuts continue, I might just go and join friends on Wall Street.

 

[DrDawg]

The Email Dr. Russel sent varies by State. The OP was in OH so those numbers are okay if you are trying to contact them.
Here is a link that takes you to the ACS wbsite with info on the bill ect.

http://www.capitolconnect.com/acspa/alert_detail.aspx?AlertID=60

 

[Playmakur42]

.

 

[Enough]

I just called Senator George V. Voinovich and Senator Sherrod Brown.

My interpretation of all these cuts is to destroy Health care as we know it and then "rebuild" with those doctor left around as socialized health care.

 

[rgarrig]

asas

 

[Castro Viejo]

I am a medical student at Stanford and I wish you would come to my school and tell all of my pinko colleagues that the nationalization of the health care industry is a horrible, horrible idea.

Ah, yes, "Northern California Values," as they say. Did I hear right that in California, "MediCal" or something, taxes physicians' earnings 2% to pay for their grand plan to cover every Californian, including the millions of undocumented workers and illegals?

It's not much better in New York, but this is home to the likes of Hillary Clinton.

People talk of the 40+ million uninsured all the time here.

I saw a patient in the General Surgery "charity" clinic that I staff every other week who had an inguinal hernia that should be electively repaired. Most of the patients I see in the clinic are Medicaid patients, the forgotten ones, who are too poor to have a "private" see them, so the faculty at the institutiopn does. Anyway, we also see our share of "self pays," patients who don't qualify for Medicaid or Medicare and who have to pay their own way through everything (usually at a reduced rate because it's "charity," but the majority of them NEVER pay -- I think the institution writes it off or something). "How about next week?" I asked. We had an opening the following week on the schedule. "Oh, I can't. I'm going away."

"Going away? May I ask where?"

"Cancun as an early Christmas present for my husband because he just bought me a brand new Lexus. Isn't that exciting?"

(Thinking of the 1992 Toyota Corolla that I drive around in with rust eating away at the driver's side rear door, and trying to contain my disdain for this type of nonsense...) "That's amazing. OK, how about the following week?"



I don't have data on this, but I feel that the majority of those uninsured in this country have made the choice that healthcare is free to them and they can continue taxing the system in this similar way.

 

[Celiac Plexus]

http://www.usatoday.com/sports/college/football/2007-12-04-coaches-pay_N.htm

I especially enjoyed the following:

"It ranges from some days when I'm embarrassed about the amount of money I make to other days that you say, 'Listen, what's my market value? These are my earning years, and I've got to make sure I get the dollars I deserve,' " Cincinnati's Brian Kelly says.

and

"I go back to professional baseball and Alex Rodriguez making $25 million a year. Or to Julia Roberts and $20 million for one movie," Bertman says. "Are those people worth it? Of course not. But if that's what the marketplace is and enough people are willing to watch Alex play or Julia Roberts in a movie, they have a right to get that.

and

"There was a time when we were content to be 4-4 in the SEC and win three other games and go to a bowl," LSU athletics director Skip Bertman says. "But evidently, we're not content to do that anymore. And we have to pay. I think people here understand that."

Nothing against people earning whatever they can, but it makes one think...

 

[jubb]

I don't have data on this, but I feel that the majority of those uninsured in this country have made the choice that healthcare is free to them and they can continue taxing the system in this similar way.

Oh yeah, get them talking and you'll find out most of them have TV nicer than that one you still have from a garage sale in college, a better cable/satellite package, and that their life is pretty much superior to yours in everyway except when it comes to what you are allowed to do with sharp objects.

I hate when people talk about the millions of uninsured in our healthcare system as if they aren't getting care. I've never seen anyone turned away for not having insurance. I've seen tons of people get operations and not pay a dime for them. Of course you may not get a liver transplant or bone marrow transplant without insurance, but those are pretty rare.


The only real difference between access to care now and access to care with nationalized healthcare will be a feeling of entitlement to the care. And that 10% of people that are grateful for the free care they get will turn into whiners like the rest.

 

[gasnewby]

there's an acl thread in the ortho forum about a professional skier who is on medicare because he doesn't have insurance. he skis in chile for kicks. his grandmother supposedly finances his career. guy sounds like a jerk, to boot.

 

[Castro Viejo]

Nothing against people earning whatever they can, but it makes one think...

Agreed. I don't have a problem with A-Rod making about $28 million a year now with his new contract with my beloved New York Yankees, but I have a big problem with the people who screw my profession and me because they think what we provide (healthcare) is a right because this is the United States of America, and no one should be without healthcare.

Unfortunately this is the prevailing attitude. I've worked at several different hospitals as a medical student and resident, spanning the socioeconomic ladder from ultra urban poor and indigent to brand spanking new, affluent suburbs, and the attitude is the similar everywhere. The urban poor are actually a hell of a lot more appreciative of what you can do for them, and I think some of them feel guilty about taxing the system -- I don't mind them. I like them and it's a pleasure to help them in any way I can, but it's the bastards who drive the Bimmers to the charity clinic whining about this and that and essentially telling you that you are in THEIR service that drives me nuts.

 

[gasnewby]

it's the bastards who drive the Bimmers to the charity clinic whining about this and that and essentially telling you that you are in THEIR service that drives me nuts.

if i hear "i'm the consumer" one more time from a patient who's trying to dictate their health car, i'm going to shove my customer service foot up their consumer ass

 

[Castro Viejo]

if i hear "i'm the consumer" one more time from a patient who's trying to dictate their health car, i'm going to shove my customer service foot up their consumer ass

My hospital put up a bunch of flyers in the physician lounges about "service excellence" and referred to patients as "our customers."

Feeling annoyed one evening I sought out each poster and crossed out "customer" and wrote "patient."

The day we unanimously consider patients as "customers" or "clients" is the day I quit.

 

[Winged Scapula]

My hospital put up a bunch of flyers in the physician lounges about "service excellence" and referred to patients as "our customers."

Feeling annoyed one evening I sought out each poster and crossed out "customer" and wrote "patient."

Great!

The day we unanimously consider patients as "customers" or "clients" is the day I quit.

Have you noticed that many physicians in fields like PRS refer to their patients as clients? Makes some sort of sense if you are doing purely aesthetic work.

 

[Faebinder]

Great!



Have you noticed that many physicians in fields like PRS refer to their patients as clients? Makes some sort of sense if you are doing purely aesthetic work.

Hey if they want us to treat them like "clients" and "customers" then they better start paying instead of letting medicare/medicaid handle it.

 

[Castro Viejo]

Have you noticed that many physicians in fields like PRS refer to their patients as clients? Makes some sort of sense if you are doing purely aesthetic work.

Perhaps. Maybe the distinction between "client/customer" and "patient" should be if someone truly has a pathology and comes to you for help, he/she is a "patient."

If someone comes to you for a non-recognized pathology, such as those people seen by the Aesthetic Surgeons and people who run "medispas," they are "clients" rather than "patients."

I dunno. It just burns me up that a HOSPITAL, a place for the ruptured, crippled, and infirm would refer to people who are truly in need as "customers," thereby engendering this "the customer's always right" belief in practice. That drives me nuts.

I remember an encounter with a patient who needed a hernia repair for an incarceration and I informed her that she was on the "add-on" schedule, which meant she'd get the first available room after the scheduled cases for the day.

"But why? I demand to have this operation now. I'm a paying customer, you know!"

She wasn't (she's self pay), but that's the other thread... As a resident you learn to bite your tongue. I suppose an attending might not have said anything either, for customer's service sake, but this is the patient culture that's been created by feel-good physician groups.

 

[rgarrig]

Ah, yes, "Northern California Values," as they say. Did I hear right that in California, "MediCal" or something, taxes physicians' earnings 2% to pay for their grand plan to cover every Californian, including the millions of undocumented workers and illegals?

This was proposed buy the Governator, but I am not sure where things stand right now. There was a little discussion about this on our listserv, but since most students can't admit that financial security and proportional compensation for their work are legitimate issues to be concerned with, the discussion mostly consisted of me telling everyone how stupid charging DOCTORS for their "SERVICE" is.

It's not much better in New York, but this is home to the likes of Hillary Clinton.

People talk of the 40+ million uninsured all the time here.

I saw a patient in the General Surgery "charity" clinic that I staff every other week who had an inguinal hernia that should be electively repaired. Most of the patients I see in the clinic are Medicaid patients, the forgotten ones, who are too poor to have a "private" see them, so the faculty at the institutiopn does. Anyway, we also see our share of "self pays," patients who don't qualify for Medicaid or Medicare and who have to pay their own way through everything (usually at a reduced rate because it's "charity," but the majority of them NEVER pay -- I think the institution writes it off or something). "How about next week?" I asked. We had an opening the following week on the schedule. "Oh, I can't. I'm going away."

"Going away? May I ask where?"

"Cancun as an early Christmas present for my husband because he just bought me a brand new Lexus. Isn't that exciting?"

(Thinking of the 1992 Toyota Corolla that I drive around in with rust eating away at the driver's side rear door, and trying to contain my disdain for this type of nonsense...) "That's amazing. OK, how about the following week?"



I don't have data on this, but I feel that the majority of those uninsured in this country have made the choice that healthcare is free to them and they can continue taxing the system in this similar way.

Sickening. When I graduated college, I worked as an independent contractor in the IT industry; you can be damned sure that I paid my $80/month for health insurance. Yes, I was poor and the plan itself had high premiums, but I just wanted to be covered in case I was run over by a car or stabbed in the throat by a communist trying to re-distribute my wealth (I owned a really "nice" 15 year old Cavalier - while driving, you could actually look down and see the highway - but no doubt some poorer, out-of-work under-served baby-daddy needed it more than me.)

 

[Blade28]

Have you noticed that many physicians in fields like PRS refer to their patients as clients? Makes some sort of sense if you are doing purely aesthetic work.

One of my pet peeves...

They're patients, not "clients" or "customers."

We're physicians/surgeons, not "healthcare providers," "providers," "clinicians," etc.

 

[Castro Viejo]

This was proposed buy the Governator, but I am not sure where things stand right now. There was a little discussion about this on our listserv, but since most students can't admit that financial security and proportional compensation for their work are legitimate issues to be concerned with, the discussion mostly consisted of me telling everyone how stupid charging DOCTORS for their "SERVICE" is.

They all feel like this now. Everyone I went to medical school with felt the same way too. But remember, this is before they'll graduate with an M.D. and about $160,000 or more in debt. Debt that'll be subjected to an interest rate that will be way higher than what I pay in interest (3.5%) after consolidating my nearly $150,000 worth of loans.

Then they'll struggle throughout residency with little sleep and mountains of compounded interest that'll balloon their $160,000 to way more than they had ever anticipated. And guess what? They'll be looking at the presidential candidates and instead of voting for Obama, Clinton, or any other Democrony, they'll be looking to the new generation of Republican candidates. Romney, Huckabee, McCain, or dare I say, Giuliani.

Sickening. When I graduated college, I worked as an independent contractor in the IT industry; you can be damned sure that I paid my $80/month for health insurance. Yes, I was poor and the plan itself had high premiums, but I just wanted to be covered in case I was run over by a car or stabbed in the throat by a communist trying to re-distribute my wealth (I owned a really "nice" 15 year old Cavalier - while driving, you could actually look down and see the highway - but no doubt some poorer, out-of-work under-served baby-daddy needed it more than me.)

Democrony = Communist.

I know the majority of you guys out there are going to say, "What about the war, man?" The war's an important issue to me too, but I'll keep my personal beliefs and convictions regarding that private. What I'm still more concerned with, unfortunately as it may seem, is where my profession and my colleagues in medicine are going to get screwed. And the writing's on the wall. These types of plans in California aren't new. They're being proposed in more than a few other places too. I thought I heard Michigan from someone as well. Soon they're going to charge you just to practice medicine and make your $50 off Medicaid for an inguinal hernia repair.

Explain that to your family when you're living in a trailer park in the middle of Wahoo, TX trying to pay off your $200,000 in medical school and college debt on a $90,000 a year salary (pre-tax) as a General Surgeon. And it'll be tough getting to the hospital in the middle of the night to do another $75 appendectomy because the buses won't be running at that hour.

 

[gida]

These payment cuts are just ridiculous...do you know any other field where they just cut your pay by 10% in the face of inflation and increased overhead? Imagine what the congressmen would say if they just got their salary cut by 10%? How is this possibly deemed acceptable?

I did several months in Canada doing endoscopic ultrasound training...the socialized medicine they have is terrible. "Oh, you have a pancreatic mass found on CT....we can get you in for the EUS in 6 weeks."
Sure 'everybody can get care' but not everybody can get ACCESS to the care. PCPs are so busy they don't take new patients. You can't get to a specialist unless you have a PCP send you to one....

With the internet and email, it seems that doctors should be able to unite to some degree and take a real stand for themselves....

4 years of college, 4 years of med school, 3 of residency, 3 of fellowship....student loan debt, delayed start on retirement saving, and the US government now wants to cut reimbursement???

Healthcare is not a right, do you see it in the Bill of Rights?

 

[rgarrig]

Healthcare is not a right, do you see it in the Bill of Rights?

WRONG!

Healthcare IS a right - a BASIC HUMAN RIGHT. At least, that's what the UN says, and as we learned with Iraq, the UN is THE world legal authority and to act without their permission is to engage in illegal activities, e.g. engaing in an illegal war.

[/BEING A DIP$HIT]

I agree, healthcare is not a human right. If all medical students suddenly dropped out of school to take up more lucrative careers, could we be jailed for Crimes Against Humanity? After all, we would all be guilty of denying someone their basic human right! If a company doesn't give away drugs and technology for free - even if they invested billions developing it - are they, too, guilty of crimes against humanity?

The reason so many people, patients, and medical students think healthcare is a basic right is because that idea has been slyly drilled into our heads over the last few decades by sinister people who knew exactly what they were doing. That's why your patient in the OR, who you are seeing at the tail end of a 36 hour shift, has the balls to think (or not think, once anesthsia gets here) that YOU are under THEIR service, that YOU owe THEM, and not the other way around.

...

I'm just going to stop this post right here because (1) it takes too much time and effort to articulate these and related points well, and at best I'm preaching to the choir, and (2) whenever you intend on robbing Peter to pay Paul, you can always count on the help of Paul, so us (future) physicians are fighting an up-hill battle that we are almost sure to lose.

 

[paintballdoc]

I have had similar experiences to Medicaid patients in the past as Castro Viejo. I had a patient come into clinic to get a cyst removed and needed it done that day. He had to had it off before he went to Scotland to play on the St. Andrew's golf course. He was planning on being there for a few weeks!!

 

[Faebinder]

Question:

Can you actually report such a patient to medicaid? I mean seriously.... you hear the patient is going to scotland to play golf. That definitely is enough money to pay for many medical services, yet he is being funded by medicaid to pay for this cyst.

Why should you not be able to report this GOVERNMENT system abuse and the government do something about it like kick him out of that program or at least investigate kicking him out? I hear they are very good at denying medicaid to people... why shouldn't the physician be able to help?

Indirectly, you can argue that this person is causing harm to others by taking away money others on medicaid might be granted to care for their health.

 

[Faebinder]

Like this website. Can you actually report them there?

 

[Castro Viejo]

With the internet and email, it seems that doctors should be able to unite to some degree and take a real stand for themselves....

What the public sees in such an action is the big, bad, rich doctor, oozing with cash, getting all up in arms about their reimbursements and how they won't be able to afford next month's country home payment or how they are going to afford the new wheels for their Jag. At least that's how the liberal media will portray physicians and attempt to fling mud at our plight.

And then there's the AMA, to whom I've contributed $45 annually since earning an M.D., who belly aches over the 48 million people who are uninsured but can't seem to do one damn thing about legislation aimed at fixing the reimbursement issues in this country. How un-frickin' believable is that? And then there's this country's 18,000 medical students who hold "candlelight vigils" for the uninsured but don't seem to give a crap about their own professional viability. That's probably because the majority of them will be just salary men and women, working in EDs as ER docs, thinking that they're immune. Sorry. Once the well dries up with these payment cuts, you'll be working a hell of a lot more than "three 12 hours shifts a week" for that $160,000 a year.

We live in too PC a world and are part of a profession where money is taboo. I personally don't think there's anything wrong with earning what we deserve. If we can afford to live a better life than most, so be it -- I wouldn't apologize for it. We all worked our butts off for it. We all continue to work our butts off for it. But, hell, I'm not going to take any emergency or trauma call if I'm being paid just a little better than a public school teacher (and they get 2-3 months of paid vacation a year). I'll just go get an MBA and make bank on the Street.

 

[gida]

What the public sees in such an action is the big, bad, rich doctor, oozing with cash, getting all up in arms about their reimbursements and how they won't be able to afford next month's country home payment or how they are going to afford the new wheels for their Jag. At least that's how the liberal media will portray physicians and attempt to fling mud at our plight.

And then there's the AMA, to whom I've contributed $45 annually since earning an M.D., who belly aches over the 48 million people who are uninsured but can't seem to do one damn thing about legislation aimed at fixing the reimbursement issues in this country. How un-frickin' believable is that? And then there's this country's 18,000 medical students who hold "candlelight vigils" for the uninsured but don't seem to give a crap about their own professional viability. That's probably because the majority of them will be just salary men and women, working in EDs as ER docs, thinking that they're immune. Sorry. Once the well dries up with these payment cuts, you'll be working a hell of a lot more than "three 12 hours shifts a week" for that $160,000 a year.

Big, bad, rich doctor?....I just finished fellowship and look at what one has to go through:
1) sacrificing a lot of holidays, weddings, parties etc. in my 20's
2) doing the same as a fellow
3) basically no retirement savings at age 33---missed out on all that compounding
4) SIX figure student loan debt and now the interest is no longer tax deductible
5) I still drive a 1996 toyota with 160,000 miles on it

After working my balls off from age 18 to 33....now they wanna cut our salaries. If I worked this hard in any other field I'd be insanely successful. In all honesty I just wanna make as much as possible as quickly as possible, invest it, and then when the system goes to crap which it invariably will, I can leave medicine or do it part time on my terms!!!

The AMA is a joke as are many of the subspecialty "A's"
To my knowledge they do very little to help prevent the cuts. They take your money and just do some overly academic worthless garbage with it!
I have not been an AMA member since 2nd year of residency.

I'll just go get an MBA and make bank on the Street.

I wish I would have done that. I will discourage my kids from going to med school!!

 

[Leforte]

Had someone come in the other day to the free clinic at the county hospital.

Has had this thyroid mass for years and decided to have it checked out. Due to the size, will likely need to be removed regardless of the FNA (> 4 cm). Has no money for the surgery, etc, of course.

Anyway, when doing her H&P I ask about previous surgeries.

Her: "I had a breast augmentation"
Me: "When was that"
Her: "3 months ago"
Me: "Bet that set you back a it"
Her: "Yeah, about $6,000, but I was wanting them for a long time"

So - can afford the $$$ for the plastic surgeon, but now demands free care for her thyroid.

Amazing.

I tell you, it would be interesting if 20/20 or some other show actually investigated this crap. I think it would open some peoples eyes to the situation.

Sure I believe that people are entitled to health care - but I mean, come on - known thyroid mass and instead goes for plastic surgery. This is not unique, as any resident can tell you, and people pay for things they want, not what they really need.

So now, the tax payers get to pay for this surgery and work-up.

 

[Castro Viejo]

So now, the tax payers get to pay for this surgery and work-up.

Yay! Just like the patient with the acute appendicitis I just took to the OR a couple of hours ago, who came to the ED as "self pay, no insurance" and was wearing some watch with lots of bling (a la hip hop rapper man style) and a face that's bigger than my knee cap, and signed the consent form with this Cartier fountain pen (which I've seen in the Cartier boutique for, like, $5,000).

I know what you're thinking... He's so rich, he'll pay all cash for the operation.

Yeah right. That guy will stiff us on the surgeon's fee and it's yet another charity write off for the hospital. If my poor attending actually had to waste time on this case instead of dictating and catching up on his paper work over in the physician's lounge, that'd be even more of a shame.

 

[Faebinder]

Several attendings where I am expressed refusal to take call cause it paid less than they would get paid moonlighting at another institution!

 

[JosephFaecesMD]

Had someone come in the other day to the free clinic at the county hospital.

Has had this thyroid mass for years and decided to have it checked out. Due to the size, will likely need to be removed regardless of the FNA (> 4 cm). Has no money for the surgery, etc, of course.

Anyway, when doing her H&P I ask about previous surgeries.

Her: "I had a breast augmentation"
Me: "When was that"
Her: "3 months ago"
Me: "Bet that set you back a it"
Her: "Yeah, about $6,000, but I was wanting them for a long time"

So - can afford the $$$ for the plastic surgeon, but now demands free care for her thyroid.

Thats the american dream, boss

 

[Castro Viejo]

Several attendings where I am expressed refusal to take call cause it paid less than they would get paid moonlighting at another institution!

Perhaps they can work out a thing with another institution's group of surgeons, who I'm sure are getting screwed taking call, and moonlight at each other's hospitals so that everyone can make the moonlighting money.

That's a way to win one for the little man!

Honestly, if it wasn't for the joy I get outta cutting and sometimes just being a total badass (at least in my opinion), I'd have probably quit about three and a half years ago.

 

[Miami_med]

What the public sees in such an action is the big, bad, rich doctor, oozing with cash, getting all up in arms about their reimbursements and how they won't be able to afford next month's country home payment or how they are going to afford the new wheels for their Jag. At least that's how the liberal media will portray physicians and attempt to fling mud at our plight.

And then there's the AMA, to whom I've contributed $45 annually since earning an M.D., who belly aches over the 48 million people who are uninsured but can't seem to do one damn thing about legislation aimed at fixing the reimbursement issues in this country. How un-frickin' believable is that? And then there's this country's 18,000 medical students who hold "candlelight vigils" for the uninsured but don't seem to give a crap about their own professional viability. That's probably because the majority of them will be just salary men and women, working in EDs as ER docs, thinking that they're immune. Sorry. Once the well dries up with these payment cuts, you'll be working a hell of a lot more than "three 12 hours shifts a week" for that $160,000 a year.

We live in too PC a world and are part of a profession where money is taboo. I personally don't think there's anything wrong with earning what we deserve. If we can afford to live a better life than most, so be it -- I wouldn't apologize for it. We all worked our butts off for it. We all continue to work our butts off for it. But, hell, I'm not going to take any emergency or trauma call if I'm being paid just a little better than a public school teacher (and they get 2-3 months of paid vacation a year). I'll just go get an MBA and make bank on the Street.

 

[Castro Viejo]

You know, it's kind of interesting.

Usually right about now there'd be some tree-huggin' pinko from the Bay Area or Massachusetts (and almost always one of those Harvard, Stanford types whose parents paid their way through everything in life) who's so up-in-arms about what I've just said, that they'll stage a hunger strike to protest or start telling me what a Nazi I am for thinking of my colleagues and myself instead of the "poor" schmoe who goes to the charity clinic because he's a victim of society. You know, the usual Hollywood celebrity whining bullcrap.

Either I've found the most hard core base of people who actually care about the profession and not about free-loaders in the country, or all the liberals are hiding behind their trees.

I know you're there. You might as well contribute your Michael Moore-inspired viewpoint and get this thing going!

 

[TrabNY]

haha, ok, just to keep you going... I'm a French resident (done in 4 month... Haha), my father is a GP. I'm saying all that just to let you know that I know what I'm talking about!
Everyone knows that wa have a "super" social medecine system in France (have a look at my previous post!) compare to what you have in the States.
And we are facing the same amount of crap as you do guys! Let me give you an example: in France we've got a social insurance for the "paupers", meaning the people who don't have a decent enough salary on a certain period of time (meaning an unemployed young lawyer as well as an homeless guy... yes you read that correctly!)... This state insurance is called CMU (stands for Universal Medical Coverage).
When you are CMU, you don't pay for ANYTHING (medically wise and for other things as well...). And guess who's consuming medical care more than anyone else?? Hmmm? Go on, guess! Yeah, you are right... They are!
Just an example: I was a resident in pediatrics ER, at 11pm (yes 11 pm), this guy is coming with his 3 kids because they were sneezing and he couldn't sleep... He asked me to do something cause he couldn't deal with it anymore... Needless to say that I went rampage. SO he came, I had to see the three kids, the hospital billed 3 nights consultations (around 150 dollars)... And who payed? Well, me and the 40 other percent of French workers paying taxes...

All that to say that you haven't yet reach our stage of social crap... Fight not to go that far!!!

I'm going to the States, I hope the French socialized medecine won't follow me there!

 

[Kikaku21]

Here is something to make everyone feel a little better.

http://www.nejmjobs.org/career-resources/physician-compensation-trends.aspx

 

[Castro Viejo]

All that to say that you haven't yet reach our stage of social crap... Fight not to go that far!!!

I'm going to the States, I hope the French socialized medecine won't follow me there!

Wow, man... You've really changed my opinion of the French.

Are you really French or are you a "stupid American capitalist" in French clothing?

Good for you. Welcome to the United States of America. Make sure you don't vote for a Democrat.

But you're another person who sides with me. Where are you people? The people who think we should work for next to nothing and care for people for free! The people who think "Patch Adams" was a great and inspiring movie. I vomited when I watched that. (Just kidding...) It's way too late (in New York City at least) to be out on one of your candlelight vigils with the hobos in the park. Come out, come out, wherever you are...

 

[Castro Viejo]

Here is something to make everyone feel a little better.

http://www.nejmjobs.org/career-resources/physician-compensation-trends.aspx

Ahem... Considering this was published in April 2007 when CMS' proposed cuts were staved off yet another year (and in 2005 and 2006), what do you think the outlook will be like if CMS gets its 15% cut over the next two years? 10% for 2008. 5% for 2009. This makes up for all the smaller cuts they wanted over the last 5-10 years but were stopped by legislators.

The system's broken and I don't know what the fix is. I don't think anyone does.

Anyone know how to register for the GMAT?

 

[ufgrad00]

I know you're there. You might as well contribute your Michael Moore-inspired viewpoint and get this thing going!

I am currently an applicant and have been interviewing in a few schools, and what you are talking about with the cuts has come up in every interview I have had. First off, I currently work at a large practice, that operates a few locations, but one location in particular will prolly be closed because of these cuts. That location serves a population of 80K and 60-70% of that practice's patients are on medicare, and the real reason it will prolly be closed is because something is changing in medicare where medicaid will no longer pay for treatment.

The physicians are talking that the practice will possibly lose up to a million a month by covering the unpaid treatments most of which are located in that one location. As well, the practice still has to pay the salaries of the staff and pharmacists. Anyways, most of the interviewers I have talked to have told me its this type of legislation and policy that got them into academia and away from practice.

 

[ufgrad00]

I am glad you brought up Michael Moore; that loser made me so sick when he took those people to a Cuban hospital.

I have family in Cuba and I lost two family members in recent years because of a lack of care. My cousin died because there aren't any antibiotics available after being diagnosed with sepsis, and another family member died after being in a vehicle accident and was allowed to bleed out at a very $hitty hospital.

Wealthy tourists, like Maradona or Danny Glover (It is ironic that Castro wanted a Spanish Surgeon), have access to the best care available, but Cuban citizens would get better care if they went to a Veterinarian in the US. Castro has purposefully located modern and well provisioned hospitals in the tourist districts some of which could be compared to spas, also these are where Cubans aren't allowed to go unless they are either prostitutes or work there,

Yet, because M&M went to Cuba and declared it as having better health care than the US, now Castro and his cronies believe they can get away even more attrocities. This is all because there are enough Hollywood and Washington losers who will be around to defend them while trying to find a way to bash this administration.

Sorry for the ranting, I'll chill and read on

 

[Castro Viejo]

Anyways, most of the interviewers I have talked to have told me its this type of legislation and policy that got them into academia and away from practice.

Yeah, but hiding in the Ivory Towers doesn't necessarily protect you.

As an academic physician/surgeon you may not feel it hit your wallet right away, but once the institution starts losing money because of the reimbursement cuts (i.e., they start collecting less from CMS and other insurance carriers), where do you think they'll be looking to get their money back? That's right. YOUR salary.

These cuts affect all physicians in all practice settings and in all disciplines.

Specialists more so than primary care physicians, but everyone's gonna get screwed.

Do you think the radiologists will still be finding positions that offer three months of vacation in the future? Absolutely not.

 

[Castro Viejo]

Yet, because M&M went to Cuba and declared it as having better health care than the US, now Castro and his cronies believe they can get away even more attrocities. This is all because there are enough Hollywood and Washington losers who will be around to defend them while trying to find a way to bash this administration.

Sorry for the ranting, I'll chill and read on

The same generation that watches and believes Michael Moore's propaganda is the same generation that gets their news off of MTV.

He's pretty much been branded a ***** by most people, I think, except the Hollywood types who think he's "brave" and "courageous" for brining the "truth" out.

 

[sleeping]

The same generation that watches and believes Michael Moore's propaganda is the same generation that gets their news off of MTV.

He's pretty much been branded a ***** by most people, I think, except the Hollywood types who think he's "brave" and "courageous" for brining the "truth" out.

Unfortunately, the problem is like you said; no one has a solution. So, people just take the solution that is offered, i.e. socialized medicine.


The insurance companies are the real idiots, they have the most to lose with this type of medicine after us . If they were a bit less greedy, we would not be in this position.

 

[Castro Viejo]

Unfortunately, the problem is like you said; no one has a solution. So, people just take the solution that is offered, i.e. socialized medicine.


The insurance companies are the real idiots, they have the most to lose with this type of medicine after us . If they were a bit less greedy, we would not be in this position.

No... They're just trying to be profitable businesses.

Physicians are the real idiots. If physicians could ban together and not sell each other out the minute they see an opportunity to, then maybe we could develop an effective lobby like the trial lawyers, the dairy farmers, all these other idiots who flood Washington every year wooing legislators.

You think that email Dr. Tom Russell of the ACS sent out was really taken to heart by the majority of surgeons who got it? No. That's because everyone thinks it's the "other guy's" problem.

Every specialty has its own lobby group, but it's nothing. There's strength in numbers. If you band each and every one of the nearly 650,000 physicians in the country together, then maybe something can happen. Unfortunately the only large group we have, the American Medical Association, is too busy worrying over how the trailer park mom with the BMW parked out front is going to afford preventive care for her six kids by three fathers.

 

[ufgrad00]

The same generation that watches and believes Michael Moore's propaganda is the same generation that gets their news off of MTV.

He's pretty much been branded a ***** by most people, I think, except the Hollywood types who think he's "brave" and "courageous" for brining the "truth" out.

I never brought this up in my interviews, but I really believe many members of congress are trying to create an issue out of health care to have a talking point for future elections. Especially many democrats and some republicans keep calling for universal reform; however, at the same time these very people keep sabotaging the funding of medicare and medicaid in order to create the "crisis" whereby they will have a platform for future elections. It's just my theory and most of which is based on conjecture.

Also, some people I have met keep saying that the funding for medicare and medicaid is going to the war or this or that project, but if our congress members ever gave as much attention or value to the already existing health care projects and programs, as they do for peanut or soybean subsidies, we wouldn't be discussing this issue.

 

[gida]

There are 2 problems really:
1) the medicare cuts that will effect us in 2008 if congress doesn't vote to put them off again for another couple years
2) intiating socialized medicine, which most likely would also reduce physician reimbursement

Addressing
1)...doctors don't have strong PACs...the AMA is garbarge and I quit giving them money long ago...I'm hoping Congress puts the cuts off for a few more years!! But like Castro stated....doctors need to band together!! I really think that we (doctors) should think about unionizing.
Also please go to the websites and check the boxes to send the prefab letters to your congressmen!! It just takes a couple minutes!!

2) even if a Dem gets in in '08 I don't think they will be able to get a nationalized healthcare system in place without a Megafight (hope the powerful insurance companies side with the MDs) but I think it will plant a seed and socialized medicine is about 10 years off....again if we get socialized medicine I definitely think we should UNIONIZE!! I'm not going in at 3am to deal with some bleeder, when I'm only gonna get paid $25 to do it. Sorry to you: you rancid, septic, alcoholic Child class C pile of variceal bleeding trash. However, if you survive, then perhaps between the hours of 8am-3pm we will have time to add you on.

The real plan and what I recommend....join a strong private group with an ASC, work your bag off now, and when it really goes to s--t hopefully you've banked and invested enough to go work part time, retire, or do some other career/hobby. By then you won't even have to pay for your ownhealth insurance!!

 

[Leforte]

There are issues with unions, as has been discussed before.

Check out this interesting article.
http://physiciansnews.com/law/497union.html

In short, as hospital employees, you can unionize and reap the benefits of collective bargaining. In most other practice models, you're screwed and have to take the pittance that the HMO / Medicare / Medicaid contract offers.

What I think will happen, is if socialized medicine comes around, physicians will slowly increase their practice to private pay models, where you pay up from for your service and then the patient can collect the $$$ from the government. This type of reimbursement is seen in many countries that do have a socialized medicine model (Australia comes to mind). People end up getting private insurance anyway to pay the "Gap" between the physician charge and the government reimbursement.

Also, just because there is a socialized system, doesn't mean that the pay goes down. Physicians in socialized medicine countries do well - they just have a private clinic and a public clinic.

You need your hernia repaired? I can do it under the public system next year, or if you want to pay me $1000 and the anesthesiologist $1000 as a private patient (and you can get the $400 reimbursement from the government) we can do it next week.

What does change, however, is the pharmaceutical industry and ancillary systems (including radiology). No longer is everyone getting Nexium or Prevacid for GERD. Instead, you're stuck on ranitidine for 6 months to see if there is any benefit - and only a specialist can prescribe a PPI - good luck getting into their clinic as a public patient. That knee pain you have? 2-view plain films instead of the MRI everyone now demands for osteoarthritis.

Remember, just because there is a universal system, doesn't mean that all physicians/surgeons have to fill their practice with it. There will still be private insurance companies, because people won't wait a year for their elective operation.

Again, back to Australia. I've been told the highest paid surgeons are opthalmologists - close to a Mil a year - because nearly everything is elective and grandpa doesn't want to wait 5-years on the public list to get his cataracts fixed and will pay the $2k to have it done next week. On the other hand, the lowest paid surgeon is.....

Neurosurgeons! All crani cases need to be done ASAP and ortho does elective spine. I've heard that NS pull in ~150k in Oz and they can't fill their residencies (or specialist registrar positions if you want to be technical).

So, I hear a lot of colleagues really worried about socialized care - the bottom line is that it is going to happen within our careers. I agree with most others to save, save, save when you get done with residency and live well below your means (which, for some reason is hard for us physicians) until it all works itself out.

 

[rgarrig]

I am glad you brought up Michael Moore; that loser made me so sick when he took those people to a Cuban hospital.

I have family in Cuba and I lost two family members in recent years because of a lack of care. My cousin died because there aren't any antibiotics available after being diagnosed with sepsis, and another family member died after being in a vehicle accident and was allowed to bleed out at a very $hitty hospital.

Wealthy tourists, like Maradona or Danny Glover (It is ironic that Castro wanted a Spanish Surgeon), have access to the best care available, but Cuban citizens would get better care if they went to a Veterinarian in the US. Castro has purposefully located modern and well provisioned hospitals in the tourist districts some of which could be compared to spas, also these are where Cubans aren't allowed to go unless they are either prostitutes or work there,

Yet, because M&M went to Cuba and declared it as having better health care than the US, now Castro and his cronies believe they can get away even more attrocities. This is all because there are enough Hollywood and Washington losers who will be around to defend them while trying to find a way to bash this administration.

Sorry for the ranting, I'll chill and read on

Thanks for sharing that; the students at my medical school get together to watch Sicko on a regular basis, and they freakin love communism and socialized medicine. Makes me sick.

 

[Castro Viejo]

Thanks for sharing that; the students at my medical school get together to watch Sicko on a regular basis, and they freakin love communism and socialized medicine. Makes me sick.

And I'm sure they're watching it on an environmentally unfriendly plasma or LCD screen television while consuming fossil fuels and increasing their carbon footprints because of the Hummers they drive around Palo Alto in. Kind of reminds me of Al Gore who flew around the country in a private jet to promote his "Inconvenient Truth." I know, I know... A lot of you guys probably adore Al Gore. I think he's a smart guy too, but he's every bit of a publicity hound and, thus, a celebrity and NOT an activist as these Hollywood types are.

Just why the hell do I care what Kanye West has to say about global warming?

Bastards. I don't like hypocrites.

 

[Castro Viejo]

So, I hear a lot of colleagues really worried about socialized care - the bottom line is that it is going to happen within our careers. I agree with most others to save, save, save when you get done with residency and live well below your means (which, for some reason is hard for us physicians) until it all works itself out.

I'm not so sure that socialized systems of medical care are as rosy as you paint it. The Canadian system, which is sort of a hybrid as well (you have the option of private insurance in addition to government-sponsored healthcare to cover "gaps"), seems to screw their physicians all the time. Average salaries for Canadian physicians are, for the most part, lower than for Americans. Perhaps they take more home since their overhead may not be as ludicrous as ours (50% overhead in a practice is considered "pretty good" according to most practice management literature), I dunno.

I think everyone's hitting the nail on the head.

Get in. Make your bank. Re-invest it in something that'll make you some real money. And let this M.D. thing become more of a hobby/weekend thing, just to kill some time while your Maserati is being detailed.

But what if I want to go into academics? Sigh...

 

[sleeping]

Doctors in private are so overworked, esp surgeons I've seen, I don't think they even have the time to write letters. They all know the b.s. thats coming down the pipeline. And this is why we have governing bodies like the ama to protect us, not screw us.

Its really a shame we don't have a real lobby group. If the ACS/AMA whoever started doing something real. I can bet every last MD would pay whatever they asked for.

Get in. Make your bank.

Thats about the way I am seeing it also, but it takes time to make money, like at least 10 years.