I wasn't going to respond to this thread until I read one of the stupidest and most insulting comments I read in the last 3 months (thanks JS80). Please refer to my post
here as SD for more info.
Originally posted by: Gonad the Barbarian
Please, malpractice insurance is as much of a scam on the doctors as health insurance is on us plebes. All docs need to do to protect themselves from those evil trial lawyers is not screw up.
No offense - but you don't really have a true feel for how bad it is to feel the pinch of malpractice. Without going into detail, one of the worst patients I ever had to deal with was a 96 year old man who I admitted who should have been put on hospice and I got "lucky" admitting him for 2 months to my hospital (BTW - I didn't make a single penny on the case since he was uninsured). The wife wanted to do everything basically because previous docs and staff didn't tell the wife how bad the husband was after having a debilitating stroke. I knew the day I admitted him I was probably going to have to deal with legal crap and maybe even a lawsuit. I walked on eggshells around the woman - who to this day the chaplain says was the hardest family member he ever dealt with. I spent over 1 hour each day talking to family - one day I spent 5 hours in a family conference. I stayed with her for 3.5 hours on my birthday and missed a surprise party for myself because I tried to plead with her to put her hubby on hospice. 2 years later I got the subpoena and the circus of calling my malpractice started. I was listed as a witness to the fact. I never had to go into court, and I got to charge $400/hr (much more than the $80-90/hr I make as a hospitalist physician) for the 1.5 hours of deposition - and I HATED every minute of it. I didn't do a single thing wrong in the case - in fact the plaintiff's side said they never saw documentation like mine (no shit - 5 hours days with the family - I had no wife or life for that matter at the time). Point is - from 30 seconds after seeing the patient I knew I was "in-trouble".
It may be easy to say as you say "just don't screw up". No shit. CYA - Cover your ass. The problem is not physicians making mistakes - hell over 20% of the choices most hospitalists make are mistakes - duh - hindsight tells you the Vancomycin didn't work on the MRSA (even though it's SUPPOSED to) so you switch to Dobra - is this considered a mistake? I see it as a mistake. It is a mistake. Only person who could have seen that coming is God (whatever one(s) you want). The problem is negligence and or fraud. Nobody needs to preach to me about them - I've already reported 7 docs to the state board and I've only been out for 4 years! The problem is lawyers like former presidential candidate Edwards who make a living out of convincing jurors that a medical mistake (whatever form it may be) was true negligence.
If you think you are more apt to survive a 60-mph collision (I assume one car is stationary) than an admission to the hospital then you don't know anything about trauma. Aortic rupture and/or hepatic laceration are always fun Yes I agree that 50K people dead from mistakes is 50K too many, but probably more than 1/2 of those are not because of the physician (you'd be surprised what the pharmacy and night-float nursing staff can do to you). If you want to single handedly cut that 50k down - push for EMR. Can't say you can't read doctor's handwriting or dosage if it's plain Courier 12 point. Can't have know fatal drug interaction if the computer prevents giving 2 meds.
Originally posted by: ohnoes
Originally posted by: thegimp03
I'd say yes. They put many more years and hard work into school than most other people so they deserve to get paid well. Med school isn't cheap, MCATs, ridiculous hours when on call, and always having the possibility of getting sued for malpractice - they deserve everything they can get.
Lawyers & bschool grads work just as hard, and generally don't get paid as much as Dr's. If school costs, bar/gmat exams, and long hours are the rationales for making $$$, then they should also be making $200K. But they're not...
Not from my personal experience. My sister is a lawyer and one of my best friends is business (NYC). I've spent enough time around both those groups of people. I never heard of either of those groups putting anywhere near the time a general surgery resident puts in. While some medical residencies are a joke and only need a 40hr week most of my legal/business friends have way more free time on their hand - and none of them wake up at 3AM for pages - just for babies. The starting pay for a physician is usually is higher when training is done, but the lowest training is 3 years and people like cardiothoracic typically have close to 10 years of training after medical school where they make between 30-75k. I made $33K W2 (including benefits) per year in SoCal working an average of 101 hr week (52 weeks) during my internship. I made less than an illegal farm hand :disgust: I have no problem with trained professionals making money if they put the time into training - but nobody short of NASA space cowboys have more training than physicians hence the higher starting pay. Note from the thread I linked above (my rant at SD) that my W2 after my 1st full year of incorporation was 30k! My break even point with EE/ME is about 55 years of age
Originally posted by: JS80
Originally posted by: Brainonska511
Originally posted by: JS80
Doctors do indeed have a monopoly in practicing medicine in this country.
Lawyers have a monopoly on practicing law in this country. Are they a monopoly too?
There is no monopoly because doctors are individual entities. They are not some conglomerate that work out overall prices with one another.
There might be a monopoly in the way that the AMA runs med schools, but that's not doctors. Plus, you can always go for D.O. degree, which isn't granted via the AMA.
Law doesn't have pricing problem because they accept anyone who is willing to pay to become a lawyer. The AMA purposefully keeps the supply of doctors low to preserve their profession through their med school shenanigans. That's an effective monopoly. That is unconscionable for a profession that is supposed to save lives. They are not even pretending to try to keep up with population and demand. AMA = doctors.
And who the hell respects DOs?
Ahh, the post that made me respond. Well let me start off by saying I'm a DO. I think of myself better than the average MD and DO because I listen to my patients - not because I got 2 stupid letters in my title. Hell if I wanted letters I could take 1 more anthro class and double major, or 2 more physio classes and have a masters. After going to UCLA and seeing people go "wow" at a school that I thought was utter crap for undergrad I choose to pick the school that worked best for me - the DO school here in Pomona, CA even though I got more than enough interviews in good out-of-state MD schools. Your ignorance on this matter is disgusting. Care to see who's leads the care for military personel - and you know those IED wounds aren't like simple Stage I ulcers.
The fact you think medicine is a monopoly is laughable. I'll be honest with you - more than 1/2 of all docs wouldn't wish their kids to go to med school - some elite club huh? I guess lawyers have a monopoly too!?! Yes it was hard getting in, and yes there are a limited number of seats, but you give the AMA too much credit. BTW I think the AMA can pound sand - the way the whore themselves out to lobbyists is disgusting. You complain about not enough physicians and then you mock a group of physicians that has opened about 20 new schools in the last 12 years. How many new MD schools have you seen?
I trained in Southern California. I met some of the brightest future docs and some of the worst atrocities of admission (as we used to call them). It happens at every school. The worst medical student I ever met to this date came from UCLA (ahh, there's that school again). Now I recognize UCLA should probably be considered in the top 3 in the US (it's where the POTUS goes west of the Mississippi) but that asshole was an unethical bastard who avoided work. Brought a smile to my face when I failed him 10 days into his medicine rotation lol. Then there are the new batch of kids coming from my DO school who make Gump look like Plato. Consider a doc based on their training and their interaction with patients - not their title. For you information - my hospital's nurses respect and love me and voted my "Doc of the Year" in 2008. Not because of my title, but because I returned my pages on-time and didn't punt my paperwork onto them like the lazy older docs.
Originally posted by: 3chordcharlie
Originally posted by: HardcoreRobot
they are worth whatever people will pay for their services. its really not that complicated.
Not a very helpful argument when there is an artificially limited supply of doctors.
The supply of physicians is not easy to explain. Well let's look at it going through the process (since I'm still sane enough to remember my last 10 years). Getting into med school used to be very hard - only the best and brightest supposedly. I know it to be true having sat on interview committees recently that med schools can't be as discriminating as they used to be since the applicant pool is down now. Assuming you make it through, you meet the 1st restriction - residency. This is controlled by Congress. It's not enough to just finish med school - pretty much every place that hires physicians to practice wants to see a formal residency nowadays - so that means 3-10 years of slave labor at teaching hospitals. There are a limited number of spots set up by Congress and they have failed to increase this number for over 10 years. Funny - here I was thinking maybe the baby boomers would need physicians. One of my biggest criticisms of the Obama plan is that is trying to provide access to people when there are no more providers available. Hell I'm in FP/IM - I live on the front lines. Most hospitals, BTW, actually make money off of residents. My hospital gets about $150k/yr for 21 spots and they pay the residents about $35k now. Malpractice group is about $10k per resident - so they're making about $2 million off the residency - only reason our hospital was able to stay afloat for so long after the local county (MLK) closed.
The reality is we don't need more dermatologists. We need primary care. This is why I bailed on anesthesia (even though I knew I could have a cushier life and make more $). Sadly I started regretting it as I discovered what primary care in this country has become and after seeing Obama's solution I'm losing my HOPE.
Now, would an increased supply decrease cost? I don't believe so, but I'm not an expert. I just know since most HMO/PPO are doing a fraction of Medicare reimbursement and since most of insured America is in a plan now (I HATE THIS) there is a set fee. The price won't really go up or down unless Medicare changes - and if you know anything about doc's pay you know the 5% Medicare keeps having to get pushed back by AMA/AOA every year. Pelosi says she won't stop it next yet. The only net effect of increasing # of docs would probably be face time you get to spend with the doc (which is a good thing). Hell I would be happy if the Kaiser docs spent more than 2.3 minutes with my parents per visit but they don't.
To give you an idea of where medicine is at - look at this example. An old nephrologist I work with said he made $10k/yr as in intern about 35 years ago. He said you could buy an above average house in SoCal for $20k. So with 2 years of intern/resident salary saved you could buy a house. The median SoCal home has gone up proportionately with that of the nation give or take 10%. That same $20k house in SoCal now costs about $600k. Mind you a $300k/yr salary is easier to save than a $10k/yr salary, but an intern would need to make about $250k/yr to buy a house in 2-3 years.
So what did I do - I married an older orthodontist Problem solved - got me a sugar momma. She straightens teeth and makes $200/hr sometimes. I code a person every week or so, do rectal exams and far worse procedures and make about $80-90/hr. Now for those of you about to pop your mouths open and say that I don't know what I'm doing - mind this fact. I posted a thread about 2 years ago when I was fed up with a cash patient. A 22 year old woman who was worried that her hospital admission was going to delay her trip to Vegas. She had $ to stay at the Bellagio but couldn't spend the $130 a month for basic health insurance - she was found to have cancer and died. I bitched about how little I made in that thread and how the cash patients (AKA uninsured/illegals) didn't pay and I got about 5 PMs and 10 replies that I suck as a business man and people told me to move my area of practice. These are fellow members of this board who told me to move! Both know repubs and dems! So much for altruism! So much for the nobililty instead of the pay!
I stuck it out 1 more year (doing free work for those uninsured and see all kinds of riff-raff - yeah I don't know what else to call the 2 pimps I hospitalized lol). Finally I gave up after too many threats of violence and lawsuits from those patients. It's amazing how Medical patients think I'm making money by seeing them and I'm keeping them there to get rich. Stupid state doesn't pay me! I'm seeing their entitled ass for free and putting my license on the line. Well I was young and stupid.
I now only cover other private docs and make less than $60k but am happy to not have to deal with the entitled culture of the Medical patient or the ungratefulness of the uninsured. I did not move since I work at a community hospital and still want to support the community but I refuse to see all the public sector garbage the County/State dumped on our little non-profit hospital that finally went bankrupt last month (burned through $100 million in endowment in 6 years due to bad management and insurance companies leeching us).
I know a lot of people who when into anesthesia/derm/optho for the $. I had the grades for it and matched. But I bailed because my parents raised me to want to help others. Having done that for 3 years and saying I can't handle it - I can't imagine what those less morally inclined (and there are a lot nowadays in medical school) will do to make money. Bill fake patient visits/procedures? Skip seeing patients but still write and bill for hospital visits (shady older docs do this all the time). Insurance scams?
I don't know - when regret sets in for all those recent grads like me - will we just quit or will transform into something more malicious? After all my friends from HS all have houses and kids. My life was set back 10 years and my body paid for it (you can't do a 36 hour shift 14 times in a month and not expect to get week).
Well that's my rant for now. I'm in the process of selling my first home as a realtor and I must it's a lot easier money than medicine - and a lot less stressful :frown:
Wanted to add on one more fallacy:
Originally posted by: bobcpg
Originally posted by: KB
Doctors have to get years of expensive schooling and deal with expensive insurance costs. This is a case of supply and demand where there is great demand for doctors but not a large supply. We can also ask should football players be paid so much?
Problem here is that I can choose to watch/buy-into football. I cant choose if I need life saving spine surgery.
By choosing to watch football you are making a choice between enjoyment and working/studying/volunteering etc. There are risks/benefits for that choice. Hell you could work-out at the gym and exercise you heart, but that has the risk of getting a community infection and getting into an easily survivable 60mph crash en-route.
You can always CHOOSE to have life saving surgery - and you can choose not to have it. Hell cancer patients choose all the time to not have chemo that would prolong life - perhaps even cure them. How do you know the surgery can't kill you!?! We had a 46 year old ER doc die on a table getting a breast biopsy because she was given a "free body CT scan" as a birthday present. NO SURGERY IS WITHOUT RISK!!! Hell nothing in medicine is without risk. Question is whether the risk outweighs the benefit. If the benefit is you having the rest of your life, then you ask yourself what is my life worth.
Don't people always say "well at least you have your health"? If some schmuck wants to do the back surgeries for $200k/yr he probably could - but in Mexico. I see them all the time. I can email you pictures of what some Mexican "doc" thought was a tummy tuck - it would be considered torture/disfigurement by LAPD lol.
If you want competency you have to pay. If you want lower prices you face the business climate of "I save $ if I skip this step". True you should be able to shop around, but if the back surgery is that important do you have time/capability? I guess that's the point of this thread. How much to pay for our governmentally deemed level of medically competent care? For me, I paid $3k for LASIK on my eyes (well my dad paid - I'm broke lol) instead of doing those eye-mills that advertise on the radio.