Obama wants to tie doctors pay to quality starting next year

[GUH]

What do you want to "sacrifice the prime of your life" doing exactly? What exactly is it that medical students and doctors have to sacrifice?

Every time I hear this I picture a whiney student wishing they could play another round of CoD instead of learning a new procedure or doing something meaningful with their life

I'm guessing you went straight from undergrad to medical school.

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[RJGOP]

Honestly a normal job sucks just as much.... In fact it's probably worse. "Congrats you graduated undergrad, now go work a desk job for 40 years." Seriously.... 2 years in and I know without a shadow year of a doubt I am willing to give up 10 years of my life to avoid this crap. At least I will be growing and feeling like I am actually doing something with my life.

What your saying is very subjective (although I happen to agree with you) but you're missing the point. The point is that, if nothing else, physician reimbursment does not reciprocate the amount of sacrifice and hard work doctors make compared to most others. At least at a desk job you're gauramteed a consistent 9-5 with holidays and weekends off, plus no obligations to return to work after work hours.

 

[Beargryllz]

I'm guessing you went straight from undergrad to medical school.

No. I sold some stuff for Verizon for a while. Then I went to nursing school and worked as a phleb for a while to pay it off. Then I did the RN thing for a little while until I got the accept.

Trust me buddy, the alternatives are just crap.

You're making my life out to be this incredibly glamorous thing that I enjoyed. It wasn't that great. Medicine is sooooooooooooooo much more fulfilling.

 

[GUH]

Honestly a normal job sucks just as much.... In fact it's probably worse. "Congrats you graduated undergrad, now go work a desk job for 40 years." Seriously.... 2 years in and I know without a shadow year of a doubt I am willing to give up 10 years of my life to avoid this crap. At least I will be growing and feeling like I am actually doing something with my life.

A normal job does not suck as much as being in school in terms of lifestyle. 9-5 and then go home to your friends or family, relax, exercise, cook, go out, make new friends, learn a new skill, read a book other than Harrison's or FA... do whatever you want because it's your life. Not to mention actually making money rather than hemorrhaging it out. My time in the workforce was wonderful and that was even while I was taking premed classes at night.
I am glad to be in school but am amazed that anyone here would think that we are not making any sacrifice to become physicians.

 

[GUH]

No. I sold some stuff for Verizon for a while. Then I went to nursing school and worked as a phleb for a while to pay it off. Then I did the RN thing for a little while until I got the accept.

Trust me buddy, the alternatives are just crap.

So, what did you do when you got off work, or on weekends? I'm curious.

EDIT: I agree that medicine can be very fulfilling. It's why I was willing to make these sacrifices. But at least for me, there were sacrifices. Not that my life is bad right now or anything but there are a lot of things that my working friends do that I would like to do but cannot. Whether that means buying a new car or house or getting married and starting a family or even just being able to relax at night.

 

[EParker37]

No. I sold some stuff for Verizon for a while. Then I went to nursing school and worked as a phleb for a while to pay it off. Then I did the RN thing for a little while until I got the accept.

Trust me buddy, the alternatives are just crap.

You're making my life out to be this incredibly glamorous thing that I enjoyed. It wasn't that great. Medicine is sooooooooooooooo much more fulfilling.

So then why do you think fair compensation is such a bad idea? You know exactly how much different physician education is from the rest of the medical field.

 

[vokey588]

While PFP isn't necessarily the best alternative, stories like these make a good case for moving away from fee for service: http://mobile.nytimes.com/2015/02/0...se-as-retirees-winter-in-south.html?referrer=

 

[midweststudent1]

While PFP isn't necessarily the best alternative, stories like these make a good case for moving away from fee for service: http://mobile.nytimes.com/2015/02/0...se-as-retirees-winter-in-south.html?referrer=

No they don't. Just because there's voter fraud, does the mean we should get rid of elections?

 

[NeuroMaster316]

Yea.... working in the US doesn't seem too lucrative anymore......

 

[calvnandhobbs68]

Happens to ER docs all the time.

I might get paid for the shift as a whole... but I see plenty of patients that I never get paid for.
And I'm required by law to see them. And I'm liable for things that happen during that visit.

Either allow me to refuse to see people without money up front (would be very bad for the emergency system)
Or give me some liability shield for seeing people for free

Terrible, absolutely awful analogy. You get paid for seeing those patients because you're getting paid for the shift. Nobody has ever said to you "well sorry, this patient doesn't have insurance so we're dropping your pay for this shift". It doesn't matter to you, it matters to the hospital, since in this case they actually are the one taking on the risk by hoping their proportion of paying patients to non-paying patients covers your salary and the rest of the operating costs.

Your liability is tied the fact that you are still getting paid for seeing them whether they are paying or not. If you'd like to not get paid but be in a situation the resolves you of liability, go work in a free clinic where you actually "won't get paid" but won't have any liability either under good samaritan laws in most states.

 

[Psai]

They're paying for your shift by giving you the money that you earned from seeing patients. Hospitals make money off of doctors, not the other way around.

 

[NickNaylor]

They're paying for your shift by giving you the money that you earned from seeing patients. Hospitals make money off of doctors, not the other way around.

Yes, but presumably the hospital is still making a net "profit" in the aggregate even taking into account patients for which they receive no payment. Otherwise that ED isn't going to remain open for too long, or revenue from other departments in the hospital are going to be used to keep the department running.

 

[notbobtrustme]

What your saying is very subjective (although I happen to agree with you) but you're missing the point. The point is that, if nothing else, physician reimbursment does not reciprocate the amount of sacrifice and hard work doctors make compared to most others. At least at a desk job you're gauramteed a consistent 9-5 with holidays and weekends off, plus no obligations to return to work after work hours.

ya and if you want to be stuck in the same job or get "let go" for being a poor performer (eg managers rate everyone 1 to 5, only 80% of the workforce can get 5s, 4s, 3s, 2s. anyone with two consecutive 1s is automatically let go), go ahead and work just 9-5, no weekends, no holidays. Go ahead, go home before your boss. See how well that goes for your career.

If you want anything more than a middle class lifestyle, you're going to be putting in the hours, the days and the stress that comes with better pay. Outside of a few outliers, most people making 6 figures are putting in 50-80 hour weeks, working weekends, working holidays.

 

[Psai]

Yes, but presumably the hospital is still making a net "profit" in the aggregate even taking into account patients for which they receive no payment. Otherwise that ED isn't going to remain open for too long, or revenue from other departments in the hospital are going to be used to keep the department running.

Of course the hospital is making a net profit, the ED is where they get most of their patients and the operating rooms are where they get most of their money. The point is that even though the ED physician is getting paid a salary, they see plenty of patients that are seen for without payment while still being liable for any mistakes or bad outcomes. They are also being evaluated by these patients. The pay would presumably be higher if there wasn't a government mandate to see everyone regardless of financial capability and the liability and stress would be less. There are plenty of patients in the waiting room without being forced to see compulsory charity cases

 

[ciruji]

Some people live in welfare but somehow they have money enough money to buy the last Jordan sneakers, etc.

Now lets give a basketball player a 200 million contract http://www.si.com/nba/2015/01/30/kevin-durant-thunder-200-million for 5 years of his time, not even counting his side venues (sneakers, ads, etc.) .... Guess what? Nobody complains

I sincerely wish I was taller

 

[PL198]

Some people live in welfare but somehow they have money enough money to buy the last Jordan sneakers, etc.

Now lets give a basketball player a 200 million contract http://www.si.com/nba/2015/01/30/kevin-durant-thunder-200-million for 5 years of his time, not even counting his side venues (sneakers, ads, etc.) .... Guess what? Nobody complains

I sincerely wish I was taller

and here we go with the athletes. kevin durant is more skilled than any surgeon in the history of the world. thats hard for everyone to swallow, but its the case.

 

[PL198]

can't wait till the doctors superiority complex comes out and how athletes should get paid like 50k a year comes out.

 

[RJGOP]

ya and if you want to be stuck in the same job or get "let go" for being a poor performer (eg managers rate everyone 1 to 5, only 80% of the workforce can get 5s, 4s, 3s, 2s. anyone with two consecutive 1s is automatically let go), go ahead and work just 9-5, no weekends, no holidays. Go ahead, go home before your boss. See how well that goes for your career.

If you want anything more than a middle class lifestyle, you're going to be putting in the hours, the days and the stress that comes with better pay. Outside of a few outliers, most people making 6 figures are putting in 50-80 hour weeks, working weekends, working holidays.

I understand that, but there's no point in diminishing the effort required to make 6 digits, and not remain in the middle class. If the people working 9-5 who risk losing their job and not being able to find a new one don't like their situation, they should have done something else. The person most responsible for your outcome is you, (it's a given the government is trying to screw you) so there's not point in making that argument. If you don't want to be in the middle class or have less-than-stellar job security, then work harder. If you don't want to work as hard, then you risk the aformentioned consequences. It's that simple.

 

[vokey588]

No they don't. Just because there's voter fraud, does the mean we should get rid of elections?

No one is saying that everything described in the article is outright fraud. I would say fraud is billing for things you didn't do. This is irresponsible and excessive use of resources.

Even besides the fact that excessive testing certainly harms patients, billions of taxpayer dollars are spent on provider practice patterns like these.

 

[maxxor]

Terrible, absolutely awful analogy. You get paid for seeing those patients because you're getting paid for the shift. Nobody has ever said to you "well sorry, this patient doesn't have insurance so we're dropping your pay for this shift". It doesn't matter to you, it matters to the hospital, since in this case they actually are the one taking on the risk by hoping their proportion of paying patients to non-paying patients covers your salary and the rest of the operating costs.

Get out of the academic employee mindset. There are groups of ER physicians that staff hospital ERs and bill patients directly, much like there are private practice radiology, anesthesia, and pathology groups. You don't have to be an employee to work in those fields, though employment is becoming more common. If you are a private practice ER physician, see a patient, bill them/their insurance, and they don't pay, you didn't get paid for seeing them. BUT you are still on the hook for any and all liability that may arise from their care. The same goes for anesthesia, path, rads, etc.

Your liability is tied the fact that you are still getting paid for seeing them whether they are paying or not. If you'd like to not get paid but be in a situation the resolves you of liability, go work in a free clinic where you actually "won't get paid" but won't have any liability either under good samaritan laws in most states.

What are you rambling about here? Your liability is established by you establishing a physician-patient relationship. Providing care "for free" does not absolve you of liability. Free clinic physicians still carry malpractice; it's just usually paid for by the free clinic.

 

[Doctor Bob]

Terrible, absolutely awful analogy. You get paid for seeing those patients because you're getting paid for the shift. Nobody has ever said to you "well sorry, this patient doesn't have insurance so we're dropping your pay for this shift". It doesn't matter to you, it matters to the hospital, since in this case they actually are the one taking on the risk by hoping their proportion of paying patients to non-paying patients covers your salary and the rest of the operating costs.

Your liability is tied the fact that you are still getting paid for seeing them whether they are paying or not. If you'd like to not get paid but be in a situation the resolves you of liability, go work in a free clinic where you actually "won't get paid" but won't have any liability either under good samaritan laws in most states.

Well I was going to give an explanatory reply to this... but @maxxor said it for me... so I will just add...

I have worked at hospitals where my paycheck is a direct result of the billing for that shift. Usually it's a 2 month lag time (so in March I get paid for the patients I saw in January). At those sorts of jobs there is wild fluctuation in the paycheck from month to month based somewhat on patient flow, somewhat on acuity, but affected the most by payor mix. I'd usually run 20-30% unpaid or unreceivable bills in a month. I had a (thankfully) anomalous month where over 50% of the bills generated didn't get returned. But despite the sudden drop off in income I still had the same bills at home, the same malpractice insurance costs, the same lost-time with my kids... but wasn't getting paid for the entirety of the work I did.

So yes... someone has said to me "well sorry, this patient doesn't have insurance so we're dropping your pay for this shift". They just didn't use those exact words but the end result was the same.

 

[PL198]

Well I was going to give an explanatory reply to this... but @maxxor said it for me... so I will just add...

I have worked at hospitals where my paycheck is a direct result of the billing for that shift. Usually it's a 2 month lag time (so in March I get paid for the patients I saw in January). At those sorts of jobs there is wild fluctuation in the paycheck from month to month based somewhat on patient flow, somewhat on acuity, but affected the most by payor mix. I'd usually run 20-30% unpaid or unreceivable bills in a month. I had a (thankfully) anomalous month where over 50% of the bills generated didn't get returned. But despite the sudden drop off in income I still had the same bills at home, the same malpractice insurance costs, the same lost-time with my kids... but wasn't getting paid for the entirety of the work I did.

So yes... someone has said to me "well sorry, this patient doesn't have insurance so we're dropping your pay for this shift". They just didn't use those exact words but the end result was the same.

healthcare is totally a right though, amirite

 

[notbobtrustme]

healthcare is totally a right though, amirite

If we had a sensible system, these sorts of problems wouldn't exist.

For example, Canadian physicians make as much or more than US physicians, work less, have less paperwork and don't have these kinds of headaches regarding insurance.

 

[Baller MD]

If we had a sensible system, these sorts of problems wouldn't exist.

For example, Canadian physicians make as much or more than US physicians, work less, have less paperwork and don't have these kinds of headaches regarding insurance.

You forget that they don't have lawyers breathing down their necks either. Going to single payer will not fix this issue.

 

[PL198]

If we had a sensible system, these sorts of problems wouldn't exist.

For example, Canadian physicians make as much or more than US physicians, work less, have less paperwork and don't have these kinds of headaches regarding insurance.

how so?

I think you can break it down to a fundamental issue:

At some point, people won't be able to pay. So if you say everyone has a right to care, then someone else besides that person is going to be responsible for paying the person administering the care. Now, people don't usually like paying for others, so the reimbursement won't be what it normally is. So you're asking physicians to accept less, just because of some made-up right that people are supposed to have. When does that happen in any other field?

 

[NickNaylor]

how so?

I think you can break it down to a fundamental issue:

At some point, people won't be able to pay. So if you say everyone has a right to care, then someone else besides that person is going to be responsible for paying the person administering the care. Now, people don't usually like paying for others, so the reimbursement won't be what it normally is. So you're asking physicians to accept less, just because of some made-up right that people are supposed to have. When does that happen in any other field?

You're making a few assumptions there, and nothing dictates that your description of the situation is what must be.

 

[KnuxNole]

More taxes. Less payment. More bureaucracy. Ahhh... it's lovely to be at the top 1%

Are we ready to bend over and take it?

I don't think I'll ever know what it feels like to be the 1%. But that's ok, cause if I wanted to feel that, I wouldn't have chose medicine of all things as a career haha

 

[KnuxNole]

Some people live in welfare but somehow they have money enough money to buy the last Jordan sneakers, etc.

Now lets give a basketball player a 200 million contract http://www.si.com/nba/2015/01/30/kevin-durant-thunder-200-million for 5 years of his time, not even counting his side venues (sneakers, ads, etc.) .... Guess what? Nobody complains

I sincerely wish I was taller

99% of people who play basketball can never make the NBA, no matter how much they exercised and trained. They get paid to produce their talent. I think athletes are paid a fair amount, in fact I think some should get paid more.

Nobody reading this topic would be good enough for the D league anyway

 

[KnuxNole]

how so?

I think you can break it down to a fundamental issue:

At some point, people won't be able to pay. So if you say everyone has a right to care, then someone else besides that person is going to be responsible for paying the person administering the care. Now, people don't usually like paying for others, so the reimbursement won't be what it normally is. So you're asking physicians to accept less, just because of some made-up right that people are supposed to have. When does that happen in any other field?

That is way I usually don't like to go to the doctors. No way in HELL I can pay for a decent amount of stuff. In med school, one of my classmates did try to apply for medicaid, and he was successful.

 

[WhippleWhileWeWork]

At what point does it become uncool to whine about a non-issue?

When you lose your job? ERs can't run on unicorn farts and rainbows, after enough years in the red, they will close the doors.
Here's one example of how it can go down.

“We’ve left no stone unturned as we’ve sought solutions that would allow us to keep the Mid City ER open,” said Baton Rouge General President and CEO Mark Slyter.
The General’s board of directors had voted last August to close the emergency room in November, a casualty of growing red ink associated with uninsured patients entering its doors."

 

[WhippleWhileWeWork]

seriously I just shut it down if anyone says the word strawman, it's like calling someone racist for not liking obama or sexist for criticizing any female. it's this blanket get out of jail statement that more and more people make.

Hahaha. Alright.

it's pathetic and it's a joke.

Sounds like you're describing internet debates in general, if I'm honest.