Obama's health care plan affect on physician salaries

[VoiceofReason]

this conversation really can't go anywhere.

people like the above poster only think of gestapo tactics and other tyrannical, often violent, abuses of the working class when they think of socialism. then people like the posters even further up think there is no middle ground between unfettered capitalism and total oppressive government control of our lives and wages.

try to separate socialist ideology from it's historical associations for a second

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[bcat85]

The only way everyone can get healthcare is if we actually cut healthcare costs. Either by (a) cutting people off from certain treatments after a certain age (a la European healthcare) or (b) convince them to stop eating/smoking/drugging/drinking/running their cars into trees (see: Talking to a brick wall)

 

[WellWornLad]

Right, using military force against striking workers really is the free market at work! Fail.

Unless you think that military force was a pervasive and significant effector of domestic economic trends, you're playing with straw men. You're not going to find a "pure" example of any economic system, but it's ridiculous to say it wasn't capitalism.

Now, Corporatism it was (as China is now), and with the recent rash of bailouts I'd say that our current government is the most corporatist that it's been in 100 years.

The term "corporatism" is one of those buzzwords undergrads throw around after their first poly-sci course. It has no fixed definition, so maybe you could describe what your particular definition is.

Anyway, my point was that people railing against "socialism" act like we live in a pure capitalist society when in fact we have socialist institutions, such as public schools. You can't make a blanket argument against socialism without arguing against the socialist aspects that already exist in our society, and I'd love to hear why someone thinks that public schools are "destroying America."

 

[JacobSilge]

Unless you think that military force was a pervasive and significant effector of domestic economic trends, you're playing with straw men. You're not going to find a "pure" example of any economic system, but it's ridiculous to say it wasn't capitalism.



The term "corporatism" is one of those buzzwords undergrads throw around after their first poly-sci course. It has no fixed definition, so maybe you could describe what your particular definition is.

Anyway, my point was that people railing against "socialism" act like we live in a pure capitalist society when in fact we have socialist institutions, such as public schools. You can't make a blanket argument against socialism without arguing against the socialist aspects that already exist in our society, and I'd love to hear why someone thinks that public schools are "destroying America."

1) Yes, military force did have a major effect on economic trends by preventing collective bargaining. Labor unions couldn't have been forestalled for so long without government intervention.

2) I am using corporatism to mean government collusion with big business. In our current age of bailouts it is becoming more and more relevant.

3) I don't disagree that we already have a vibrant public sector. I'm more an enemy of false comparisons, namely that the age of the "Robber Barons" was due to lack of government regulation rather than due to the government blatantly favoring those large businesses at the expense of small business.

 

[Optimator]

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[dreamer46]

Hello all! I am new to this site, and this will be my very first post. Hope it's worth while.

A little about me:
I just recently received a BS in Kinesiology, with an emphasis in clinical exercise science. I've been working for 5 years in the orthopedic, sports medicine and rehabilitation field. I'm very interested in learning the ins-and-outs of what it will take to successfully run a private practice. Currently, I've been taking on various positions within a small private practice in CA (25 employees + 1 physiatrist + 1 DC + 2 PT), and most recently, in PT billing and all medical transcriptions *breath*, including records for billing purposes. We are in network with most PPOs, Medicare/Medicaid... yadaayaddayadaah!

About the issue at hand:
Regarding the term "quality" of care for reimbursement and its subjectivity, although it seems new to underline the effectiveness or efficacy of Tx to Dx for payment, our current healthcare system (esp. Medicare) demands that providers clearly define the "medical necessity" of the Tx in question. Basically, change in the level of expertise of your billers, collectors and quality of dictations may deserve a considerable amount of effort, as they always should have. They will pay..but it's going to become much trickier.

And, I'm wondering if anyone knows whether the new NHI is going to limit the number of specialty practices within a geographic region (like some insurers do)? I eventually would like to work as a PA (yes, physician assistant) in aquatic or land-based rehabilitation..ultimately, to own my own practice!... ..

Also, please inform me if there's anything I'm missing with regards to the NHI. I'd really appreciate it!

PRE-Thanks!

 

[dreamer46]

Hi again, on another note, "quality" of care can only be determined after-the-fact or in the "long-term," at least in the way it is described by many of the post-ers. However, doctors and other healthcare providers send out their billing, whether complex procedure or not, usually shortly after an evaluation (with diagnostic testing/manual testing) of their patient by a treating physician, for which there is a documented report/doctor's note.

Therefore, when it comes to questioning the quality of care, so long as those records are made available to the insurers (usually, by your collector), and in light of the fact that claims can always be appealed with documentation that reflects improvement of a patient's condition even in instances where there is a condition/illness that is difficult or not currently possible to treat/diagnose, you need not stress-out. As you know, working with one insurer may be easier than working with hundreds or thousands of private payers, and you will be able to know with a certainty what can/will be paid for. It is rare that insurers pay everything that you bill for, regardless if you meet the current "medical necessity" requirement. Additionally, some patients, whether they have the money to pay or not, actually pay their bills entirely or sometimes, at all.

I'm reading some of the posts, which are at times slightly dramatic to say the least. Doctors get paid what they should, many aren't aware of how billing or collecting works, and so are scared straight that their profits will dramatically decline. But, their ignorance to the payment/collection process is what will drain money from their pocket. They should become more aware of how it works now, in terms of billing, and then evaluate how bad this new NHI really is. It's not THAT bad! Plus, more patient's being "insured" may increase their patient load, which is positively related to their billing opportunity, and ultimately their profit.

Taxing people for 250k+ will help our children's generation deal with our national debt. People are so freakin' greedy! You went to school for 8 years or whatever, you are entitled to a certain pay, you should be paid for exercising your level of expertise, BUT I don't know how else to say it but "it costs to be the boss." Doctors are still profiting at this time, and they are still continuing to layoff experienced, higher-paid people, for less/no experienced grads. Why? To have the increase in their income taxes not affect the PROFIT that they are so used to getting. It's not because they are not making a profit, it's because of GREED. My boss, for example, has me doing the job that they had 2 or 3 full-time, full benefits people doing! Yes, I got a raise, but $1 for working like a freaking race horse isn't cool either. I do it for experience. You'd be surprised to see what some of these procedures cost. While some procedures are painstakingly long surgeries, some series injections take a whopping 5 minutes, and a LOT of $$ is made.

It's all about balance.

 

[circulus vitios]

Taxing people for 250k+ will help our children's generation deal with our national debt. People are so freakin' greedy! You went to school for 8 years or whatever, you are entitled to a certain pay, you should be paid for exercising your level of expertise, BUT I don't know how else to say it but "it costs to be the boss." Doctors are still profiting at this time, and they are still continuing to layoff experienced, higher-paid people, for less/no experienced grads. Why? To have the increase in their income taxes not affect the PROFIT that they are so used to getting. It's not because they are not making a profit, it's because of GREED. My boss, for example, has me doing the job that they had 2 or 3 full-time, full benefits people doing! Yes, I got a raise, but $1 for working like a freaking race horse isn't cool either. I do it for experience.You'd be surprised to see what some of these procedures cost. While some procedures are painstakingly long surgeries, some series injections take a whopping 5 minutes, and a LOT of $$ is made.

It's all about balance.

http://online.wsj.com/article/SB123561551065378405.html

Read the article.

You like being used and abused, that's your problem. I deserve the money I earn. Why is it my responsibility to pay for Sally McTrailertrash's 6 bastard children? How is punishing me for working hard and earning more money even close to being fair?

SOME procedures pay less than SOME injections. You don't say. Have you thought that maybe there's a reason for it? Removing an appendix is routine. Developing a new drug for a very specific niche costs millions of dollars.

 

[dreamer46]

You like being used and abused, that's your problem. I deserve the money I earn. Why is it my responsibility to pay for Sally McTrailertrash's 6 bastard children? How is punishing me for working hard and earning more money even close to being fair?

SOME procedures pay less than SOME injections. You don't say. Have you thought that maybe there's a reason for it? Removing an appendix is routine. Developing a new drug for a very specific niche costs millions of dollars.

I'm sorry if I've offended you or anyone else, but just to get a few things clear - I was not trying to imply that you nor anyone else do not deserve reimbursement for hard work, education, experience, your "niche," etc..

Actually, I was attempting to offer a different perspective, especially to those who may not be aware of how reimbursement works in our current healthcare system. My posts are based on my experience in billing and collecting. From that standpoint, if you can offer any input regarding how this new plan will reimburse physicians other than what has already been said, then please do.

I also never said that I "like being used and abused" either. I was simply pointing out that the current state of the economy is leaving many people to pickup any loose ends left by employees who have been laid-off, and that my employer is frankly doing quite well, as 85-90% of his patient's are MEDICARE, which has very strict rules to follow if you want to get paid. Medicare is a very tricky, and I may be comparing apples and oranges, but I was thinking that if the new NHI is anything like Medicare, then doctors may be able to be more at ease.

 

[dreamer46]

You like being used and abused, that's your problem. I deserve the money I earn. Why is it my responsibility to pay for Sally McTrailertrash's 6 bastard children? How is punishing me for working hard and earning more money even close to being fair?

SOME procedures pay less than SOME injections. You don't say. Have you thought that maybe there's a reason for it? Removing an appendix is routine. Developing a new drug for a very specific niche costs millions of dollars.

I'm sorry if I've offended you or anyone else, but just to get a few things clear - I was not trying to imply that you nor anyone else do not deserve reimbursement for hard work, education, experience, your "niche," etc..

Actually, I was attempting to offer a different perspective, especially to those who may not be aware of how reimbursement works in our current healthcare system. My posts are based on my experience in billing and collecting. From that standpoint, if you can offer any input regarding how this new plan will reimburse physicians other than what has already been said, then please do.

I also never said that I "like being used and abused" either. I was simply pointing out that the current state of the economy is leaving many people to pickup any loose ends left by employees who have been laid-off, and that my employer is frankly doing quite well, as 85-90% of his patient's are MEDICARE, which has very strict rules to follow if you want to get paid. Medicare is a very tricky, and I may be comparing apples and oranges, but I was thinking that if the new NHI is anything like Medicare, then doctors may be able to be more at ease.

 

[soonereng]

No, he doesn't have a clue. I'm betting he thinks the "free market" would lower prices if insurance companies didn't pay for physician fees for some reason.

In the real world we all know that physician fees are already charged separately from hospital fees, so his solution doesn't really make any sense unless shouting "FREE MARKET" enough times appeals to you.

I didn't read the remainder of the thread, so please forgive me if this was discussed. You obviously have no idea how a market actually works or how physicians bill if you don't think that prices would go down from what is currently billed if physician fees were no longer allowed to be covered by insurance.

Yes I do know that physician fees are charged separately from hospital fees (believe me, I've paid my fair share). The fact is that the charged physician fees are almost randomly chosen to be any number above what an insurance company will reimburse for a given code. This is not the market price. The market price is what the physician is willing to accept for that service. This is the price negotiated with the insurance companies.

Under my idea, I don't think that physician's billed fees would go down from what the lowest insurance company pays and would actually probably be higher than that number (an average of the negotiated insurance prices), but the price transparency is good for both the physician and patient in this system. You no longer have these randomly high charges based on the assumption that the pts insurance company will just knock it down to a fair value. Now pts no longer think docs are just greedy bastards with these artificially high charges (especially those without insurance who get the full charge), and the docs might actually collect more in the long run as patients would no longer expect their "Hospital Insurance" to cover physician's fees and these fees are reasonable for those without insurance.

 

[play274]

This is a nice thread and I thought that I would revive it. It's evident that Obama will push forward with the health care plan, and, as physicians, we need to adapt.

If financial rewards are what you wish for, then the answer is simple: see more patients and work faster in a low-overhead private practice setting with the help of a nurse/nurses and appropriate technicians. However, one should keep in mind that they will need to work fast and efficiently, while ensuring that their referral base is strong (hopefully limitless). Work can become brutal, as there is no free lunch (no matter what people say/lie to you about).

If $90-145k is sufficient (and it for many), then employed positions (teaching, hospitalist, etc) will be fine.

-

A. Want cash = work fast and have a great support staff at a low overhead, but work hard.
B. Want lifestyle = rewards may lower a bit and look for the protection of a larger entity (9-5 worker).

Just my likely flawed 2 cents ... with that said, I wish you all the best in your vocational pursuits and keep your eyes open(-minded)! Best regards to SDN.

 

[Frunkey]

"effect" With an E.

That is all for now, I'll be back after I read this thread.

 

[Taliesinrk]

After reading this, I can see why our current political leaders continue to have jobs. The ideas being shared in this thread are the only explanation as to how a President/administration whose ideas/policies are truly anti-American can be elected. I certainly hope that this is not how my future colleagues will think.

 

[RGMSU]

There's a lot of talking around in circles on this website, but I can tell you what happens to physicians' salaries when the government gets involved - they plummet. Medicare reimbursement cuts have been declining every few years for the past decade and a half. I was reading this morning about physician pay in Germany being quite poor compared to the US. I guess it looks like we can catch up with them pretty soon - looks like we're probably ultimately heading in the direction of the European model. All the CEOs and lawyers will continue to make what they want, but anyone trying to make a living helping people - ie, doctors - will probably wind up getting screwed in our society. You rack up $200,000 in debt, study for 12 years plus, work 60 hours a week when you get done, have peoples' lives in your hands, and the ungrateful bastards still think you get paid too much. Classic case of "king of the hill" - there's always somebody waiting to knock you off when you're up top. Negative appraisal, yes - but that's the way I see it shaping up. Younger folks had better wake up and do it fast. They think socialism and liberalism are so cool right now because they're not in the income bracket getting taxed 37% of their income. In a few years when some of you dudes are done with school and you are making a little money, you won't like writing that big ass check to Uncle Sam every year and watching them give it away wastefully by the billions and trillions. Freedom has made this country great. Not government control.

 

[Taliesinrk]

There's a lot of talking around in circles on this website, but I can tell you what happens to physicians' salaries when the government gets involved - they plummet. Medicare reimbursement cuts have been declining every few years for the past decade and a half. I was reading this morning about physician pay in Germany being quite poor compared to the US. I guess it looks like we can catch up with them pretty soon - looks like we're probably ultimately heading in the direction of the European model. All the CEOs and lawyers will continue to make what they want, but anyone trying to make a living helping people - ie, doctors - will probably wind up getting screwed in our society. You rack up $200,000 in debt, study for 12 years plus, work 60 hours a week when you get done, have peoples' lives in your hands, and the ungrateful bastards still think you get paid too much. Classic case of "king of the hill" - there's always somebody waiting to knock you off when you're up top. Negative appraisal, yes - but that's the way I see it shaping up. Younger folks had better wake up and do it fast. They think socialism and liberalism are so cool right now because they're not in the income bracket getting taxed 37% of their income. In a few years when some of you dudes are done with school and you are making a little money, you won't like writing that big ass check to Uncle Sam every year and watching them give it away wastefully by the billions and trillions. Freedom has made this country great. Not government control.

 

[Steve Threet]

There's a lot of talking around in circles on this website, but I can tell you what happens to physicians' salaries when the government gets involved - they plummet. Medicare reimbursement cuts have been declining every few years for the past decade and a half. I was reading this morning about physician pay in Germany being quite poor compared to the US. I guess it looks like we can catch up with them pretty soon - looks like we're probably ultimately heading in the direction of the European model. All the CEOs and lawyers will continue to make what they want, but anyone trying to make a living helping people - ie, doctors - will probably wind up getting screwed in our society. You rack up $200,000 in debt, study for 12 years plus, work 60 hours a week when you get done, have peoples' lives in your hands, and the ungrateful bastards still think you get paid too much. Classic case of "king of the hill" - there's always somebody waiting to knock you off when you're up top. Negative appraisal, yes - but that's the way I see it shaping up. Younger folks had better wake up and do it fast. They think socialism and liberalism are so cool right now because they're not in the income bracket getting taxed 37% of their income. In a few years when some of you dudes are done with school and you are making a little money, you won't like writing that big ass check to Uncle Sam every year and watching them give it away wastefully by the billions and trillions. Freedom has made this country great. Not government control.

 

[D0CT0R]

There's a lot of talking around in circles on this website, but I can tell you what happens to physicians' salaries when the government gets involved - they plummet. Medicare reimbursement cuts have been declining every few years for the past decade and a half. I was reading this morning about physician pay in Germany being quite poor compared to the US. I guess it looks like we can catch up with them pretty soon - looks like we're probably ultimately heading in the direction of the European model. All the CEOs and lawyers will continue to make what they want, but anyone trying to make a living helping people - ie, doctors - will probably wind up getting screwed in our society. You rack up $200,000 in debt, study for 12 years plus, work 60 hours a week when you get done, have peoples' lives in your hands, and the ungrateful bastards still think you get paid too much. Classic case of "king of the hill" - there's always somebody waiting to knock you off when you're up top. Negative appraisal, yes - but that's the way I see it shaping up. Younger folks had better wake up and do it fast. They think socialism and liberalism are so cool right now because they're not in the income bracket getting taxed 37% of their income. In a few years when some of you dudes are done with school and you are making a little money, you won't like writing that big ass check to Uncle Sam every year and watching them give it away wastefully by the billions and trillions. Freedom has made this country great. Not government control.

Actually, you're wrong. The correct answer is that we don't know what will happen to physician salaries in the United States.

Current physician salaries in the U.S. are made possible by the great inefficiency in our healthcare system. Preventative medicine is cheaper, but 50 million Americans are uninsured. We spend the most in the world on health, but are ranked 37th in the world. So are current salaries really justified? Everyone agrees that physicians should be one of the highest paid members of society; even in countries with a universal health care system, they still are. What you're really advocating is for the inefficiency to stay.

Also, you're ignoring the fact that there will be different effects for primary care physicians vs specialists. In our current system, primary care physicians are one of the least paid out of all the physicians. Why? Because they are the ones most closely tied to HMOs which need to operate on almost ludicrous cost-cutting regulations due to the ever-increasing cost of medicine. In a universal health care system, there is a greater opportunity for preventative care because everyone is insured, thus demand will increase and primary care physicians will be paid more.

The reason why pay for specialists would theoretically go down is because in a universal healthcare system, more people can go to the doctor before their health spirals out of control and it becomes necessary for more advanced care. Is this a bad thing? Primary care physicians are one of the most important people in medical care, but currently are paid much less than specialists and what they are worth-where is your outcry for this?

The money for health-care reform needs to come from somewhere, it is not about "knocking off those at the top". The cost of medicine has increased **40-fold** since the 1960s. Health care reform is not a liberal issue. Most health-care policy experts agree that the term "socialized medicine" is meaningless. Your concern about healthcare becoming controlled by government bureacrats is unfounded because it's already being controlled by bureaucrats at insurance companies.

 

[gstrub]

Actually, you're wrong. The correct answer is that we don't know what will happen to physician salaries in the United States.

Current physician salaries in the U.S. are made possible by the great inefficiency in our healthcare system. We spend the most in the world on health, but are ranked 37th in the world. So are current salaries really justified? Everyone agrees that physicians should be one of the highest paid members of society, but what you're really advocating is for the inefficiency to stay.

Also, you're ignoring the fact that there will be different effects for primary care physicians vs specialists. In our current system, primary care physicians are one of the least paid out of all the physicians. Why? Because they are the ones most closely tied to HMOs which need to operate on almost ludicrous cost-cutting regulations due to the ever-increasing cost of medicine. In a universal health care system, there is a greater opportunity for preventative care because everyone is insured, thus demand will increase and primary care physicians will be paid more.
The reason why pay for specialists would theoretically go down is because in a universal healthcare system, more people can go to the doctor before their health spirals out of control and it becomes necessary to visit a specialist. Is this a bad thing? Primary care physicians are one of the most important people in medical care, but currently are paid much less than specialists and what they are worth-where is your outcry for this?

The money for health-care reform needs to come from somewhere, it is not about "knocking off those at the top". The cost of medicine has increased **40-fold** since the 1960s. Health care reform is not a liberal issue. Most health-care policy experts agree that the term "socialized medicine" is meaningless. Your concern about healthcare becoming controlled by government bureacrats is unfounded because it's already being controlled by bureaucrats at insurance companies.

This post made me vomit a little.

Here are the counterpoints:

Inefficiency: tort reform to end defensive medical practice
Increase of cost since 1960: CT, MRI, major advances in drug design, etc.
Primary care vs specialist pay difference: more training required, invasive/high risk procedures/higher insurance cost/less #'s of them

The real point is that there ARE places we can focus on to reduce the cost of medicine, but they shouldn't start with MY paycheck. They want me to take out $300K in loans at 6.8%, train for 10+ yrs at the pay rate of an indentured servant, then pay extraordinarily high taxes on my take home pay once I make decent money, force me to see patients with an insurance plan that will only reimburse me for a fraction of the cost of providing services, and "used evidence based approaches" and "reward quality of care not quantity" which is just a way of saying we will punish you if your patients don't comply with treatment.

 

[D0CT0R]

This post made me vomit a little.

Here are the counterpoints:

Inefficiency: tort reform to end defensive medical practice
Increase of cost since 1960: CT, MRI, major advances in drug design, etc.
Primary care vs specialist pay difference: more training required, invasive/high risk procedures/higher insurance cost/less #'s of them

The real point is that there ARE places we can focus on to reduce the cost of medicine, but they shouldn't start with MY paycheck. They want me to take out $300K in loans at 6.8%, train for 10+ yrs at the pay rate of an indentured servant, then pay extraordinarily high taxes on my take home pay once I make decent money, force me to see patients with an insurance plan that will only reimburse me for a fraction of the cost of providing services, and "used evidence based approaches" and "reward quality of care not quantity" which is just a way of saying we will punish you if your patients don't comply with treatment.

"This post made me vomit a little" Could've stopped reading there, but decided to see what you have to say.

Honestly, you think the 40-fold increased cost of medicine per person has to do with medical advances? Why does open-heart surgery in India cost 1/10th that of the united states, even though it's just as effective (adjusted for spending power)?

As for "more training required, invasive/high risk procedures/higher insurance cost/less #'s of them" true, but this point does not counter my argument. I don't think you really read what I wrote.

 

[gstrub]

What does it cost to go to medical school in India? Next to nothing. What does a CT surgeon make in India? Next to nothing. And are you suggesting the quality of care for open heart surgery is the same in the US as in India? Have you seen the inside of an Indian hospital? Why do you think thousands of Indians come here to practice medicine and not the other way around?

Look, I just want to be appropriately compensated for my efforts. If medicine is to draw the top minds, incentives other than pure altruism must be present. I'm sorry, but 4yrs college + 4 yrs medical school + 4-7 years residency + fellowship + 300K debt, no life for years, etc, is NOT worth $100,000/year. I'm sorry, but for me, that's just not worth it. Especially when it would be government intervention, and not market forces, that would be dictating what I can and cannot do. Physicians are NOT overpaid. I agree that primary care doctors are UNDERPAID! Politically, the idea that doctors are undercompensated is a non-starter, which is at the heart of the problem. If they try to cover EVERYONE, the money will come from US. And we'll get it on both ends...one with up front cuts in reimbursements and two with increased taxes on what we take home.

 

[D0CT0R]

What does it cost to go to medical school in India? Next to nothing. What does a CT surgeon make in India? Next to nothing. And are you suggesting the quality of care for open heart surgery is the same in the US as in India? Have you seen the inside of an Indian hospital? Why do you think thousands of Indians come here to practice medicine and not the other way around?

Look, I just want to be appropriately compensated for my efforts. If medicine is to draw the top minds, incentives other than pure altruism must be present. I'm sorry, but 4yrs college + 4 yrs medical school + 4-7 years residency + fellowship + 300K debt, no life for years, etc, is NOT worth $100,000/year. I'm sorry, but for me, that's just not worth it. Especially when it would be government intervention, and not market forces, that would be dictating what I can and cannot do. Physicians are NOT overpaid. I agree that primary care doctors are UNDERPAID! Politically, the idea that doctors are undercompensated is a non-starter, which is at the heart of the problem. If they try to cover EVERYONE, the money will come from US. And we'll get it on both ends...one with up front cuts in reimbursements and two with increased taxes on what we take home.

Your comments about India are just plain ignorant. Also, where did you pull out "100,000/yr" from? Nobody is forcing you to be a doctor. Most doctors agree that we need health-care reform: only 32 percent of physicians oppose health-care reform (http://newsinfo.iu.edu/tips/page/normal/11178.html#3).

 

[atengnr]

There's a lot of talking around in circles on this website, but I can tell you what happens to physicians' salaries when the government gets involved - they plummet. Medicare reimbursement cuts have been declining every few years for the past decade and a half. I was reading this morning about physician pay in Germany being quite poor compared to the US. I guess it looks like we can catch up with them pretty soon - looks like we're probably ultimately heading in the direction of the European model. All the CEOs and lawyers will continue to make what they want, but anyone trying to make a living helping people - ie, doctors - will probably wind up getting screwed in our society. You rack up $200,000 in debt, study for 12 years plus, work 60 hours a week when you get done, have peoples' lives in your hands, and the ungrateful bastards still think you get paid too much. Classic case of "king of the hill" - there's always somebody waiting to knock you off when you're up top. Negative appraisal, yes - but that's the way I see it shaping up. Younger folks had better wake up and do it fast. They think socialism and liberalism are so cool right now because they're not in the income bracket getting taxed 37% of their income. In a few years when some of you dudes are done with school and you are making a little money, you won't like writing that big ass check to Uncle Sam every year and watching them give it away wastefully by the billions and trillions. Freedom has made this country great. Not government control.

I agree with this thinking, but I certainly hope were wrong.

 

[Instatewaiter]

"This post made me vomit a little" Could've stopped reading there, but decided to see what you have to say.

Honestly, you think the 40-fold increased cost of medicine per person has to do with medical advances? Why does open-heart surgery in India cost 1/10th that of the united states, even though it's just as effective (adjusted for spending power)?

As for "more training required, invasive/high risk procedures/higher insurance cost/less #'s of them" true, but this point does not counter my argument. I don't think you really read what I wrote.

The 40 fold increased cost is not coming from doctors salaries and I dont think it is actually adjusted for inflation. Adjusted for inflation it would be 5 fold. That could be explained at least in part expensive tests like MRIs, CTs, Caths that have become standard of care.

While you say health care costs are drastically rising, physician salaries have actually gone DOWN. Instead of sticking it to the actual work horses of the health care industry, why not just cut down on all the administrative BS that has to be done.

Gov't involvement is just going to add that much more paperwork to the system. It is not going to make it more efficient.

 

[D0CT0R]

The 40 fold increased cost is not coming from doctors salaries. Physician salaries have actually gone DOWN. Instead of sticking it to the actual work horses of the health care industry, why not just cut down on all the administrative BS that has to be done.

Gov't involvement is just going to add that much more paperwork to the system. It is not going to make it more efficient.

Right, I never said it's coming from doctor's salaries. It's coming from lack of preventative care (lack of health insurance=treating a health problem only after it requires more advanced care), unnecessary tests, malpractice lawsuits, and a whole host of other reasons that only health-care policy experts and not knee-jerk reactionists (like most people on this forum) understand.

Everyone complains about government involvement, but what about insurance company involvement? Because our current health system is currently controlled by insurance-company bureaucrats.

 

[Instatewaiter]

Your comments about India are just plain ignorant. Also, where did you pull out "100,000/yr" from? Nobody is forcing you to be a doctor. Most doctors agree that we need health-care reform: only 32 percent of physicians oppose health-care reform (http://newsinfo.iu.edu/tips/page/normal/11178.html#3).

Cost of living, education etc are next to nothing in india. Physician salaries in India demonstrate this. A family doc in india after 5-9 years experience makes around $6,000. A General surgeon makes around $10,000

Doctors supporting health care reform is not the same thing as them supporting everything Obama is planning. It just means that they are not satisfied with the current system, and why would they be. They spend hours on needless paperwork instead of spending that time seeing patients.

Have you ever been to a hospital in india?

 

[gstrub]

Your comments about India are just plain ignorant. Also, where did you pull out "100,000/yr" from? Nobody is forcing you to be a doctor. Most doctors agree that we need health-care reform: only 32 percent of physicians oppose health-care reform (http://newsinfo.iu.edu/tips/page/normal/11178.html#3).

Agree with InstateWaiter 100%. And that study includes retired physicians and physicians who are in their latter years of practice who enjoyed big $$ and were able to pay off their loans. I'd like to see them poll residents and junior attendings...I bet it would be the exact opposite.

And I know no one is forcing me to be a doctor. But that doesn't mean when I made the decision to pursue this field that I hadn't evaluated the risk/reward ratio. Now that I get to the "reward" part I feel a bait-and-switch coming, and I don't like it.

 

[DrJD]

Agree with InstateWaiter 100%. And that study includes retired physicians and physicians who are in their latter years of practice who enjoyed big $$ and were able to pay off their loans. I'd like to see them poll residents and junior attendings...I bet it would be the exact opposite.

And I know no one is forcing me to be a doctor. But that doesn't mean when I made the decision to pursue this field that I hadn't evaluated the risk/reward ratio. Now that I get to the "reward" part I feel a bait-and-switch coming, and I don't like it.

Gstrub, I agree with everything you're saying... While I was reading D0ctor's post I vomited a little as well, haha My internal monolouge was something like, "No wonder the government is going to bend doctors over, we're asking for it!!"

Thanks for saying what I thought. I'm really hoping the ol' bait and switch doesn't get pulled on us, gah....

 

[Charles_Carmichael]

Your comments about India are just plain ignorant. Also, where did you pull out "100,000/yr" from? Nobody is forcing you to be a doctor. Most doctors agree that we need health-care reform: only 32 percent of physicians oppose health-care reform (http://newsinfo.iu.edu/tips/page/normal/11178.html#3).

gstrub's comments about India are not ignorant. I'm Indian; I've lived in India for half my life and I spent a considerable amount of time in several hospitals there when my grandma was hospitalized. The quality of care there, for most hospitals, is nowhere near the level of that in the US. Sure, the top hospitals in India might be comparable to US hospitals, but the majority of the hospitals there are not that great.

And physician incomes in India are considerably lower than in the US. I will say this though: a lot of things are cheaper in India and you don't need a ton of rupees (Indian currency) to live comfortably there.

 

[D0CT0R]

gstrub's comments about India are not ignorant. I'm Indian; I've lived in India for half my life and I spent a considerable amount of time in several hospitals there when my grandma was hospitalized. The quality of care there, for most hospitals, is nowhere near the level of that in the US. Sure, the top hospitals in India might be comparable to US hospitals, but the majority of the hospitals there are not that great.

And physician incomes in India are considerably lower than in the US. I will say this though: a lot of things are cheaper in India and you don't need a ton of rupees (Indian currency) to live comfortably there.

You're right that Indian healthcare is not very good, but I took issue with the implication that the U.S. has the best doctors. Anyways, my main point was that we spend a lot on health care but don't have as much to show for it as we think we do.

"750,000 Americans leave the United States every year to go abroad for life-saving operations. Why? Mainly because of cost. It can be up to a tenth of the cost in some of these countries such as India, such as Singapore. King: Open-heart surgery in India might be one-tenth of what it costs here?
Gupta: One-tenth. Hip surgery, neurosurgery. All -- a lot of these various operations. And the real question, and I think it's a question worth exploring, is why? How can they do it so much cheaper?
How can they offer good-quality care? I saw it. It is good-quality care. I saw that with my own eyes. What do we have to learn? And how can we use this to help reform our health care system?
King: Is there an assumption that we have the best doctors, that we do it better than anybody else, that's an American assumption?
Gupta: Yes. And I think, you know, we do provide very good health care for people who have access to it.

http://www.cnn.com/2009/POLITICS/03/05/gupta.larry.king.live/index.html

 

[Charles_Carmichael]

You're right that Indian healthcare is not very good, but I took issue with the implication that the U.S. has the best doctors. Anyways, my main point was that we spend a lot on health care but don't have as much to show for it as we think we do.

"750,000 Americans leave the United States every year to go abroad for life-saving operations. Why? Mainly because of cost. It can be up to a tenth of the cost in some of these countries such as India, such as Singapore. King: Open-heart surgery in India might be one-tenth of what it costs here?
Gupta: One-tenth. Hip surgery, neurosurgery. All -- a lot of these various operations. And the real question, and I think it's a question worth exploring, is why? How can they do it so much cheaper?
How can they offer good-quality care? I saw it. It is good-quality care. I saw that with my own eyes. What do we have to learn? And how can we use this to help reform our health care system?
King: Is there an assumption that we have the best doctors, that we do it better than anybody else, that's an American assumption?
Gupta: Yes. And I think, you know, we do provide very good health care for people who have access to it.

http://www.cnn.com/2009/POLITICS/03/05/gupta.larry.king.live/index.html

That good quality care was most likely at one of the top hospitals. Like I said previously, I'm sure there are some hospitals in India that are comparable in quality to US hospitals, but the majority are not. I don't think anyone mentioned that US doctors are the best or that doctors trained in other countries are inferior (I think you changed your post regarding something about people implying Indian doctors are inferior?). There are good and bad doctors everywhere; I've heard of some great doctors in India that have found creative ways to get around lack of equipment, etc. and I've also seen many horrible doctors who wouldn't tell you what was going on or what the treatment plan was.

Anyways, I guess we should stop sidetracking the thread now.

 

[NewmansOwn]

You're right that Indian healthcare is not very good, but I took issue with the implication that the U.S. has the best doctors. Anyways, my main point was that we spend a lot on health care but don't have as much to show for it as we think we do.

"750,000 Americans leave the United States every year to go abroad for life-saving operations. Why? Mainly because of cost. It can be up to a tenth of the cost in some of these countries such as India, such as Singapore. King: Open-heart surgery in India might be one-tenth of what it costs here?
Gupta: One-tenth. Hip surgery, neurosurgery. All -- a lot of these various operations. And the real question, and I think it's a question worth exploring, is why? How can they do it so much cheaper?
How can they offer good-quality care? I saw it. It is good-quality care. I saw that with my own eyes. What do we have to learn? And how can we use this to help reform our health care system?
King: Is there an assumption that we have the best doctors, that we do it better than anybody else, that's an American assumption?
Gupta: Yes. And I think, you know, we do provide very good health care for people who have access to it.

http://www.cnn.com/2009/POLITICS/03/05/gupta.larry.king.live/index.html

Well done. I was waiting for you to cite the skyrocketing popularity of medical tourism.

 

[Daddywarbucks]

So I was wondering, does India and other European countries have the same battle with malpractice cases. For someone who has been paying the bills for medical care for 30 plus years. It makes since to me that Dr's. are required the run every test possible just trying to cover their a** and not get sued. I agree with the prior post saying cutting administration, and capping malpractice settlement amounts as per the degree of negligence, not my scar didn't heal right. It is my understanding that admin. often dictate which tests are ordered through there protocal. Just the opinion of an old country boy, a single parent of two, one college and one medical student.

 

[RGMSU]

Actually, you're wrong. The correct answer is that we don't know what will happen to physician salaries in the United States.

You think there will be fewer cost-cutting measurements with universal health care versus HMOs? I beg to differ - especially if the government plays a significant role. I hate to break it to you, but the great increase in health care costs has occurred on the watch of insurance bureaucracy, not because of doctors. And, you're advocating more bureaucracy? How exactly will that decrease costs when increased bureaucracy in the past has produced the opposite effect? Primary care physicians are apparently not smart enough to figure out that they will not be king of the hill again by accepting these changes. No, primary care physicians will likely be slowly replaced by NPs and PAs because they are cheaper. This is, after all, all about saving money, remember? And how exactly is that going to help the focus on preventive medicine by placing someone less qualified in the position of overseeing it? Not every disease process is going to be stopped by preventive care. That's only in an "Alice in Wonderland" story. Do you have the magic pill to give to all family practice docs so that nobody will need to see an orthopedist for a knee replacement later in life? Do you have the magic serum to disperse to every family nurse practicioner to stop all cancer so that noone will need an oncologist? And all these fat folks who eat at McDonald's everyday are going to magically stop doing it because you and the government say so, right? When everybody starts living like little nutritional princes and princesses, we won't need any more cardiologists either I guess. We're all just going to hold hands and all the medical problems of the world will disappear because everybody has health insurance. For the record, I don't like control by insurance bureaucrats any more than control by the government, but it's too entrenched. My fear is making things worse. Things are already bad, I submit. Yes, people at the top will be taxed to pay for this. Who else will pay for it? The thing that amazes me is that people who are or will be in upper income brackets - ie, physicians and medical students - are so glib about giving their earnings or future earnings away so that government and insurance bureaucrats can line their pockets with more pork barrel money and profits, respectively. And don't start comparing things over here to India. Last time I saw, about 90% of their folks in the lower castes are still crapping in outdoor pits out on the street. Thankfully, we developed indoor plumbing quite some time ago. Maybe little details like that are why things cost less in India instead of the big, bad, greedy American doctors.

 

[Concubine]

I object to paying for my obese neighbor's hypertension/diabetes anymore than I already am.

 

[gstrub]

And I just heard one of the "concessions" congress is considering in keeping this healthcare plan to ONLY $1,000,000,000,000 is to "put on hold" the scheduled increases coming for medicare reimbursement. See what I mean? Our dollars go first...

 

[jwrigh69]

I'm a little troubled by your idea of physician "control." You make it sound like if a physician needed a little more money, he/she could just whip up a few more procedures to perform. That does happen, but I don't think it's a policy we should be defending.

I haven't read the entire thread yet and don't know if anyone has mentioned this but I think you have the wrong idea. It's not that people are arguing for physicians rights to do any procedure at anytime and drive up healthcare costs and ultimaty salaries.. It's the fear that limits will be put in place restricting certain procedures when they may be absolutely necessary for the care of an individual. Imagine as an emergency room physician being restricted on certain scans or lab work for a patient presenting chest pains and shortness of breath. Scary.

 

[Pianoman32]

Current physician salaries in the U.S. are made possible by the great inefficiency in our healthcare system. We spend the most in the world on health, but are ranked 37th in the world. So are current salaries really justified?

Albeit humorous, your views on health care are almost appalling, and clearly ignorant. Your justification of physician salaries has no merit. We are not ranked 37th in the word in medical care; we are ranked 37th in the world in health care. Please try and understand the difference between the two before you post again. Medical care makes up only 10% of health care and of this 10%, we are number 1 in the world by a long shot. Medical care is more expensive in this country because we have the best physicians and hospitals in the world; there is a reason you don't see people going to Europe for better medical care and why people from all over the world come to the US for the most competent doctors. Please explain why current salaries aren't justified?

I will now clarify why we are ranked 37th in the world in healthcare since you clearly think this is still tied to our medical care. The united states has some of the highest rates of murder, drug abuse, and obesity. Oh, and lets not forget the 46 million uninsured, most of whom will gladly spend 3g on a new stereo system and subwoffers and the newest Iphone, but come time to spend 3grand on an insurance policy......."I think I'll pass." All of these things drive down the life expectancy and this is why we are ranked 23.

Also, in another one of your posts you had said that preventive care will lower the cost of healthcare. Once again, you are wrong. Preventive "healthcare" could lower the cost of healthcare, but preventive "medical care" in which a PMD is involved actually raises the cost of "healthcare" in the long run. Preventive healthcare would involve finding a solution to get Americans to stop eating at McDonalds, to exercise more and to stop smoking (note however, that individuals who smoke actually lower the cost of healthcare.....I'm guessing I'll need to explain this though, cause you will probably argue). Nonetheless, Americans are lazy and generally don't care about their health, so this will likely never happen.

On the other hand, preventive medical care, will raise the cost of healthcare. Yes there are instances where preventive medical care lowers the cost of healthcare for the country, asthma inhalers, vaccinatsions, etc., but by and large, preventive medical care will raise the cost of healthcare. "Screening the entire population for high blood pressure and treating huge numbers of patients with drugs for their entire lives is very expensive. Even assuming the treatment prevents strokes and heart attacks, the patient lives just long enough to get another expensive disease that can't be prevented, like pancreatic cancer" (From the book Health Care Half-Truths).

Now I'm not saying preventive medical care is wrong, because it isn't and it truly is something that our country needs. However, please don't buy into the liberal lies that state that preventive care will lower the cost of healthcare, because in reality, it won't.

 

[TRuSchool]

lol. DOCTOR reminds me of stupid college undergrads who blindly follow obama because everyone else does. They see his platform on the website and beat off to it without even bothering to see how poorly efficient it really is. There's a reason why the AMA booed when he proposed the plan last week. I'm glad I didnt need to write a long sermon about how wrong and poltically inclined obama is, and thankful others already did.

In conclusion, I've kind of changed the subject to Obama bashing. I apologize. He's a good guy, his policies are just dumb. He's from a school of Chicagoan thought that basically mirrors socialism. Cant really blame him.

 

[TRuSchool]

and then there's the people that say Obama is just fixing 'that idiot Bush's' problems. Bush didnt fail the economy. Stupid poor people who tried to buy a $300k home with a $60k income and the banks that gave them loans to do it ruined the economy.

 

[physasst]

And I just heard one of the "concessions" congress is considering in keeping this healthcare plan to ONLY $1,000,000,000,000 is to "put on hold" the scheduled increases coming for medicare reimbursement. See what I mean? Our dollars go first...

Umm,

Medicare wasn't scheduled for any increases this year, in fact, the SGR was supposed to be a 21% CUT in Medicare payments, and it goes in effect in December. There was some discussion about "fixing" that this year, but now there is talk about letting it stand.

 

[D0CT0R]

Medical care makes up only 10% of health care and of this 10%, we are number 1 in the world by a long shot. Medical care is more expensive in this country because we have the best physicians and hospitals in the world;....

...the 46 million uninsured, most of whom will gladly spend 3g on a new stereo system and subwoffers and the newest Iphone, but come time to spend 3grand on an insurance policy......."I think I'll pass." All of these things drive down the life expectancy and this is why we are ranked 23.

...Nonetheless, Americans are lazy and generally don't care about their health, so this will likely never happen.

On the other hand, preventive medical care, will raise the cost of healthcare.

The terms "medical care" and "health care" are often used interchangeably. The distinction you're drawing only pertains to the topic of health care reform if your point is that the U.S. is great at providing advanced care to those who can afford it, but bad at providing it to those who can't. If this is your point, then I agree, and this further illustrates problems in our health system.

Perhaps many people flock here to receive advanced treatment, but many people also leave the country for cheaper treatment. You should read the post about medical tourism I provided above.

I'm pretty sure I never said that all types of preventative care will cut costs. Some will and some won't. Missing from your discussion of preventative care is the suffering that uninsured people have to go through. Your comments on why many Americans are uninsured are uninformed; I suggest you read the following link on why many Americans are uninsured: http://www.nahu.org/legislative/uninsured_updated_final.pdf ... ""75% of the uninsured in these working families did not have access to insurance through their employer""

 

[MOHS_01]

Actually, you're wrong. The correct answer is that we don't know what will happen to physician salaries in the United States.

Current physician salaries in the U.S. are made possible by the great inefficiency in our healthcare system. Preventative medicine is cheaper, but 50 million Americans are uninsured. We spend the most in the world on health, but are ranked 37th in the world. So are current salaries really justified? Everyone agrees that physicians should be one of the highest paid members of society; even in countries with a universal health care system, they still are. What you're really advocating is for the inefficiency to stay.

Also, you're ignoring the fact that there will be different effects for primary care physicians vs specialists. In our current system, primary care physicians are one of the least paid out of all the physicians. Why? Because they are the ones most closely tied to HMOs which need to operate on almost ludicrous cost-cutting regulations due to the ever-increasing cost of medicine. In a universal health care system, there is a greater opportunity for preventative care because everyone is insured, thus demand will increase and primary care physicians will be paid more.

The reason why pay for specialists would theoretically go down is because in a universal healthcare system, more people can go to the doctor before their health spirals out of control and it becomes necessary for more advanced care. Is this a bad thing? Primary care physicians are one of the most important people in medical care, but currently are paid much less than specialists and what they are worth-where is your outcry for this?

The money for health-care reform needs to come from somewhere, it is not about "knocking off those at the top". The cost of medicine has increased **40-fold** since the 1960s. Health care reform is not a liberal issue. Most health-care policy experts agree that the term "socialized medicine" is meaningless. Your concern about healthcare becoming controlled by government bureacrats is unfounded because it's already being controlled by bureaucrats at insurance companies.

Monumental fail. What in the bloody blue hell does any of that rambling on today's hot liberal talking points have to do with the effects of the proposed changes on physician earning power? Hint -- nothing. Learn something on healthcare financing, business operations, and practice cost and revenue structures and then you may be able to add something to the discussion. Until then keep the ignorant card in the hole......

 

[RGMSU]

Umm,

Medicare wasn't scheduled for any increases this year, in fact, the SGR was supposed to be a 21% CUT in Medicare payments, and it goes in effect in December. There was some discussion about "fixing" that this year, but now there is talk about letting it stand.

On the one hand, I am resistant toward changes because I do believe it will place the physician over a barrel in being forced to accept virtually any conditions placed upon them. However, there is a very real problem with Medicare that cannot go unnoticed - namely, the ever-present reimbursement cuts and the looming insolvency. Like it or not, all of us will have waiting rooms full of old Baby-Boomers over the next couple of decades. What will we do with all these people if Medicare goes bust?

Honestly, though, as soon as the position of insurance companies and the government are strengthened with the new plans being discussed by Congress, they will be able to make reimbursement cuts whenever they damn well please. Unless it gets so bad that docs get the gumption to go on strike.

 

[efex101]

Why oh why do not these bleeding hearts move to Europe with their government run healthcare? has anyone that touts this move as the best thing since sliced bread EVER LIVED in Europe? (and no, being there for vacation does not count)....because those of US that have clearly know what lies ahead.

 

[RGMSU]

We're definitely heading in the direction of Europe - in every way possible. I don't like it, but in 30 years our country will look like Europe does right now. Nothing against Europe, but I don't believe we will be better off for it either. Fine place to vacation, but I wouldn't want to live there.

 

[radslooking]

Oh, and my personal belief is that "paying for excellence" is a bit unfounded term. Physicians, as a general rule, are well trained. There are a few outliers who are terrible, but by and large, most practitioners are pretty good. I think you make a mistake by trying to parse out who's providing great care or not. I think you make the systems around the physicians better and you'll get more for your money. Don't piss off the very people who are trying to provide you good care. Don't press them to do better, make the systems around them better so they fail less.

 

[tibor75]

The only way everyone can get healthcare is if we actually cut healthcare costs. Either by (a) cutting people off from certain treatments after a certain age (a la European healthcare) or (b) convince them to stop eating/smoking/drugging/drinking/running their cars into trees (see: Talking to a brick wall)

Or c) if doctors stop ordering procedure after procedure in order to buy yet another BMW or vacation home.

 

[tibor75]

and then there's the people that say Obama is just fixing 'that idiot Bush's' problems. Bush didnt fail the economy. Stupid poor people who tried to buy a $300k home with a $60k income and the banks that gave them loans to do it ruined the economy.

Poor people make 60k? Uh, that's middle class.

Come back when you understand the basics of American society.

 

[Instatewaiter]

If i as a PCP order an Echo, or a CT, or a Thyroid U/S or a host of tests, how is that going to buy me a BMW? I'm not making money off of those tests.