Article Source: msnbc.com
from:msnbc.comDoctors have steadily cut their work hours over the past decade, a new study finds, something that experts say may only worsen the health care situation.
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Childhood obesity is a crisis in the United States.We have the greatest healthcare system in the world.Either one is true and the other false.Or they both are flat out lies. Larry Batek
Why would anyone go into medicine, especially primary care?
As a retired, and now returning to practice because our state is hemorrhaging doctors, familty physician I understand the huge problem this is becoming. Prior to retirement I was working over 60 hours a week, seeing 45-50 patients a day. Starting at 6 am to do rounds in the hospital and then going to the office to see patients was finally too much. I worked in a group practice owned by the local hospital. When we owned the practice we made a decent living and employed over 25 support staff, we had 6 providers (doctors and PA's). After we joined the hospital, you HAVE to be affiliated with a hospital participating in your managed care insurances, our support staff increased 20%. Once with the hospital we started to make less and less as the hospitals expenses kept going up. But their solution was,,,,,see more patients.
Most people don't understand the huge amount of paperwork involved in medicine nowadays. From charts, to prescription renewals, to referrals, to lab results needing to be checked, the list goes on and on. We had receptionists, MA's, a nurse, chart reviewers and purgers, referral specialists, accountants, lab personnel and an office manager. And then we had patients. Lots and lots of patients. Being in Michigan where the auto industry took a huge number of employed workers down when they collapsed this put a bigger strain on the patients ability to afford seeing the doctor. I can't tell you the number of times I PC'd (professional courtesy) patients charges because I knew they couldn't pay. Then the straw that broke the camels back was when the hospital wouldn't allow us to PC anyone any longer. Understandably they needed to maintain revenues. That's when I retired.
The problem with medicine today is that it's no longer run by doctors. It's run by bureaucrats. Hospital, insurance and government bureaucrats. Most of them are very book smart regarding the business cycle, but they lack one thing. Compassion. Patient compassion. Especially the government. Regulation after regulation is imposed on the system in the name of "patient concern". Many are acceptable but most are just ridiculous.
Now add to the doctors usual day the constant and unrelenting threat that if something happens, even if everything was done correctly, you can and WILL get sued. When I was a resident an old physician preceptor once told me the most powerful weapon a physician carries is,,,,a pen. And he was right. Not using the pen as a weapon, but rather as an instrument to order things. Prescriptions, tests, procedures, referrals, all these things can result in harm to the patient.
The romanticized carreer of doctors is quickly coming to an end. It is still the greatest profession on the planet. Nothing can compare to helping another person get better. The problem is the bureaucracy. And as this health reform goes on it will get much worse. Not many qualified people will go into this great profession when they can make as much without as much concern in other carreers.
That's why this health care reform has to be more than just the money. The government will TELL you they're concerned with your care, but all they're really concerned about is the money.
Buyers beware.
They need to give the hospitals free electricity, this would cut down on a lot for a sick person. But that is only if they pass on the savings ... (But with the greed today I doubt it). I can remember way back, when Doctor's really cared, and it was about helping people, not about the money... But as USA Rogue said, today it is run by bureaucrats, and all for the money... Just look at the report that was done on Walter Reed Hospital, where the Politicians and Vet's go. The side for the Politicians was clean, and everything was up to date, but the side for Vet's, was run down, the roof was leaking, paint was peeling off the walls, nothing was up to date... These bureaucrats think they are better then the rest of us... They think they are above us... Again, it is all about the money...
my god... you are an idiot. Do try and talk about the topic.
USARogue, you are absolutely right. I couldn't have said it better.
And I am one of that army of hospital "bureaucrats" who has to constantly dance on that tight wire of complying with state and federal regulations all while doctors think the only thing we care about is the bottom line. :-)
As far as the article was concerned, I wasn't too sure what the study focused on - actual hours worked (regardless of location) or standard office hours.
My experience is that while some docs/PAs/NPs/CNMs may be cutting back on office hours, they are not actually working less hours. Because of the introduction of electronic medical records systems, many docs now take their work home with them and work weekends to complete progress notes and other charting requirements. Less office hours does mean less access for patients, but I don't know that it actually translates into less hours worked per week.
It is sad. We need reform so desperately, but we need to make informed decisions and we just don't really have much time to explain to the public how this all really works. Healthcare reform is very much like playing pin the tail on the donkey. You are blind to the landscape and you (we) are just hoping we insert the pin in the right place.
Michele--- You must have lots and lots of money to throw away huh? I guess you don't mind being over taxed and over priced ??? Did you know that the courts ok an electric rate hike, just because they want it for lobbyist. A true story, in the newspaper... You actually pay over 1700% more for your electricity then what it costs to produce it and maintain it... (that includes all employees pays) Etc... It looks like your all for the money and not for human life ?????? Very sad... Hey you may as well tell people that, whats the sense of living, if you can't afford to live ??? A.H
As the doctor said - it's because of the waste of time because of Government Bureaucracy and Paperwork. And the Government Takeover of the Healthcare/Insurance Industry will only make it much worse. My sister is a nurse, and she said the same thing.
Rule of Thumb - the Government Kills Everything it Touches.
Bottom line-- It's all about the money... How many millions did the insurance companies give out in bonuses again ??? And how many Doctors and Hospitals get kick backs from the Pharm Companies for giving out prescriptions from their company??? Thats why Doctors and Hospitals don't say too much when it comes down to a medicine not working, or very bad side effects-like the case Tens of thousands of other individuals are physically or neurologically damaged for months, years or permanently from Levaquin, Cipro, Avelox and other fluoroquinolone antibiotics. But yet the FDA still approves of them, cause they are getting a lot of money from these companies as well... Just look it up... It has been in the news for years... And once again, It's all for the money.
One time I needed antibiotics , I could afford the $20.00 prescription , but I could not afford the $100.00 Doctor visit...And I can not afford the $1200.00 E.R. visit... I can not afford health insurance either, and they tell me that I make too much to get assistance...(yet I am just barley making ends meet) It was a good thing that a friend had an extra bottle of antibiotics...
This is the hidden side of the health insurance debate. If an additional 31 million people start seeing a doctor on a regular basis, what will happen to the quality of care - not to mention the doctor burnout factor?
I'll bet the doctors can't wait for the $500 Billion in cuts for Medicare reimbursements to take effect - along with the $240 Billion in the "doctor fix" that's scheduled.
Good point Roy: that's why we need reform, the faster the better, they cant start fast enough to start training nurses, and giving students incentives to become doctors, to be able to keep up with the ageing population and the growing population not to mention the people who stay away until the last minute, if they double the workers in hospitals, they would just be at par, on that issue, they really need to make these decisions based on whats good for the country, and future, not just money if we are to remain, a great Nation, if these workers do not get some relief it will get worse over time when they really get burnt out!!!
dale this health care plan is simular to medi-cal. Average 11 per patient. Not much incentive there is it? Doctors will make more going into pharmacy then patient care.
It would be nice if the study broke it down into hours spent with patients and hours spent on paperwork. I would not be surprised if the hours spent on paperwork has increased significantly over the years. Which is bound to happen when the doctor to patient relationship also includes third parties, whether they be private insurers, government bureaucrats or both.
My doctor told me that he knows of several colleagues that are planning to retire if the Obama monstrosity passes. He himself is not accepting new patients and is cutting back his hours dramatically to improve his quality of life.
Boo, Google the letters FQHC for your state. You should get a list of just FQHCs or a combined list of Community Health Centers (CHCs), FQHCs, and Rural Health Centers (RHCs).
For at least a decade, the federal government has been funding federally qualified health centers (FQHC) so that people such as yourself can get the care you need REGARDLESS OF YOUR ABILITY TO PAY.
The FQHCs also participate in the 340 drug program. Another federally funded (your tax dollars at work) program that provides you low to no cost prescription drugs through their own, in-office pharmacy.
They are not free clinics, per se. They are required by the federal government to review your tax return (if you become a regular patient), not unlike Medicaid, and determine based on federal poverty guidelines if you can pay anything towards your care. They have a huge sliding scale so some people pay flat fees, say $20 for a visit. Some people qualify for percentage discounts, say 50% off of the fees generated for that visit. And many people I saw pass through the doors of the one I used to work at get all of their care for FREE.
You do not have to go to the ER, but you certainly have to be proactive in and take responsibility for your own care by choosing one of these clinics as your medical care provider.
Good Luck!
I've yet to talk to a doctor in favor of Obamacare. All indications that the problems discussed in the story will just get worse. There's a reason that other countries have a shortage of doctors. With all the work involved, are you being compensated enough to make it worthwhile? More and more doctors are deciding that the answer is no. All that paperwork that is required is not just insurance companies, it's also governments. Should the system be reformed. Sure. But not in the way being proposed. Tort reform would be a great start. There is a definite problem with our society wanting doctors to guarantors of their health. Mistakes are made, but that shouldn't lead to liability. Only gross negligence or intentional actions should lead to liability. Unfortunately, medical malpractice lawsuits are the great crap table of the legal profession. Since all doctors are in PYA mode, that adds to the cost of care. Always better to order to many tests than miss the one that a lawyer can hang his hat on.
I suppose tort reform may happen when Obama and the libs force all medical people to be employeed by the government and then there can be governmental immunity for all. It sure looks like where they are wanting to get us. And the trial lawyers are trying to milk it while they can.
As reported by the doctors themselves. This is like the executive who says they work 80 hours a week. How about we do an honest audit and see how many of those hours are truly work? I've seen enough of both to know that's largely a bunch of hooey.
Secondly, the idea that someone has to go through 8+ years of college to prescribe antibiotics, order strep tests and bandage sprained ankles as a primary care physician is absurd. The level of care provided by the typical general practitioner, including those at CareNow, PrimaCare or some other doc in a box should require a bachelor's degree at the most.
You require 10s or 100s of thousands of dollars plus 8+ years of schooling to treat tummy aches and bumps and bruises then are shocked that no one wants to do it?
Somehow, Republicons will spin this as a good thing.
free healthcare will make sure that no one wants to be a doctor...eat that Brandon
Brandon - it's Obama and the Libs who want to make the whole situation worse with less pay for doctors and more Government Bureaucracy and Paperwork, which consumes their time. And it's the Republicans who want more Tort Reform, which will help the doctors because they pay most of the salary in fees for Insurance to Lawyers.
Just like it's Obama and the Libs who want to make sure Americans pay more for Insurance, not less.
Brandon; I need to correct one thing in your comment! . [ some blind Republicans will spin this as A good thing ]
No dale some libreal who has no clue how even health care runs and thinks the goverment is doing this for THEM, instead of special interest will spin this.
As a Physician (PCP) I'm not opposed to free heath care done well. There are plenty of models in other countries. The problem is Ins., drug co. and countless other will loss a lot. So to expect free heath care done well: It's not going to happen because no one in Washington has the balls to stand up and do what is in the interest of the little man. So you and so many other can keep bickering, and I'll keep shuffling paperwork and patients until I can't take it anymore.
Yes my hours to see patients are down a lot. Many reasons. Mostly because of paperwork.
LOL...you say this as if Reagan, and Bush I and Bush II didn't lower Medicare and Medicaid reimbursments to doctors and hospitals.
I've been in this business for well over 20 years. I have yet to see a President who didn't want to lower payment rates, republican or democrat.
If they did suggest higher rates of pay, they came back 3 years later and did audits on rules that didn't exist 3 years earlier to justify supposed fraud and ended up taking that money right back anyway.
You are WAAAAYYY off base on this one.
I'm a family practice doctor and I'm one of those that have cut back my work hours significantly. I left a private group practice where I worked 60+ hours per week to work at a university student health center. After several years of working longer hours and seeing more patients in order to bring home less money, I decided that private practice primary care medicine is a losing battle.
More overhead every year in order to keep up with insurance company or government bureaucracy. Declining reimbursement from for-profit insurance company oligopolies that squeeze every last penny from physicians (who have no ability to negotiate fees with insurers). The yearly threat of a 20-30% decrease in Medicare reimbursement because Congress fails to act to correct underlying problems with Medicare funding. It all adds up to an unsustainable business model. This country should be prepared for an overwhelming shortage of primary care physicians in the coming years. There is no reason to enter the field under the current system.
Physicians may not always be great businessmen/women but we're not stupid. If working 10+ hours more per week adds very little to the bottom line we're smart enough to spend that time with our friends & families... instead of beating our heads against an ever bigger and harder wall.
Completely understandable. Also, the medicare reimbursement cuts of 21% come into effect Feb. 28. Older, more experienced doctors will begin to retire or cut back even more hours just like yourself. Younger doctors who are in $100,000's dollars in debt will attempt to see more patients but spend less time with each of them.
and not one single remark by the democratics attempting to destroy further the medical profession in the united states.the immoral concept of decreasing payments for services that become a financial liability for the doctor because said doctor tried to work with the government to treat people who are medicade/medicare enrollees when the government then tries to put the blame on doctors for turning away patients enrolled in both programs-ONLY BECAUSE THE COST FOR PROVIDING SUCH PROCEDURES IS BEING PUT ON THE DOCTOR DUE TO THE REDUCED COMPENSATION THE GOVERNMENT IS WILLING TO PROVIDE.
unless the idiots who are pushing this garbage legislation are too stupid to sense the majority of americans are not supporting their vision for health care reform the only reasonable reason is that they believe that they are superior in intellect to the american population that they are at odds with.
whatever the belief system that supporters of this monstrosity employ the majority of their opposition have spoken out loud and clear against their view of reform.the real problem now lies with the unwanted ideaology that is being regurgitated daily.apparently the premise that clarification of the message was all that was needed...........the reality is that the defiance is coming from those who are pushing this rejected agenda despite being shown overwhelming evidence that nobody is buying their brand of reform.
insanity is defined as trying something over and over and expecting a different result........isn't 12 months of this enough already?
Dr. jd,
Well put. I don't believe it is only the insurance company's causing this massive problem. There has been a shortage of primary doctor's for years. No one is pushing for more medical schools to produce more doctors. What a shame. I have asked how is it that insurance company's became so powerful to dictate what doctors and their patients pay? Is it any wonder, no one has to look far to see how insurance company's have ruined our economy.
you could always become a 'MDVIP'. Several years ago, our doctor joined that organization to be rid of medicare patients. If we wanted to stay with him, it would cost $15k a year! What a miserable SOB. Many years ago a Dr. got into that line of work to help people. Now they are into it only for the money.
It won't matter how many medical schools end up being built. If the primary doctors continue to be compensated poorly, then there will be a continue of primary doctor shortages years to come.
The doctor said -
It's the Government Bureaucracy that Imposes Mandates and Regulations on the Insurance Companies that cause all the Red Tape and Restrictions and PAPERWORK, that is driving doctors away.
cost factor to Jeania. Medi-Cal averages 11 dollar per patient and they spend that in paper work. Otherwise your health care reform is nothing but a medi-cal system that will just tip the medical system on the edge unless Obama plans on making the doctors see so many goverment patients and then they'll just go into pharmacy or some other field.
Doctors do work pretty hard. I guess we'll just have to start paying doctors what they deserve. Fine by me.
Doctors should be paid for their services just like other professionals. They should also be held ACCOUNTABLE for their mistakes, just like other professionals.
Not being held accountable because;
It is a common mistake.
It was caused by a side-effect of the medication, they had prescribed.
Another Doctor will not testify against them.
Or a Lawyer will not bring suit, because it is not financially viable......
Just remember your oath, "Primum non nocere" - (First, do no harm). You will be held accountable and hiding behind HIPAA will only just delay the consequences.......
What does your comment have to do with anything this article is talking about?
"It's just too many patients to take care of," Bodenheimer said. "And you don't make that much money for each visit. It's really exhausting. It's extremely hard work."
In other words, PAY ME MORE and I will work harder. Or more money = better care...
I say, stop making MISTAKES and you will have less patients........ Git rid of those that keep making the mistakes...... Just like other professions......
Or like another MSNBC article titled, 'Hospital infections killed 48,000, report shows' - due to inadequate infection control by staff.........
Or 'Health workers often decline TB care' - 22 of 53 infected health-care workers declined treatment.......
Not many professionals ARE held accountable for their mistakes. I seem to remember huge piles of OUR money going to incompetent executives running failed companies. What was that?
LAWYERS are the ones most in need of being punished for disobeying "first do no harm".
You have been believing too much of the conjecture presented to you via the press.
Mistakes are NOT the reason patients have to keep coming back to the doctor.
There are a myriad of reasons, but one of the largest ones is that we don't really have a system that supports good preventative care and long term chronic disease management. 3 out of the hundreds of chronic diseases, diabetes, asthma, and blood clotting disorders (coumadin patients), have seen some recent advances in care because of standardization of primary care. The vast majority of other diseases are still in study on what should be an appropriate guideline to follow.
The second largest reason: patient non-compliance. I cannot tell you how hard it is to get some diabetes patients to just come in to have blood drawn every 3 months. Many of them wait until they have mind-numbing pain in a limb that at that point can only be amputated or they end up in the ER in a coma all while doctors are practically begging them to just show up once in a while and start a healthier diet/lifestyle.
You do have docs who are cutting back hours because of costs and pay, but in a rural area like ours, those doctors only make $65K to $120K per year. You are not talking about people who are highly compensated as primary care physicians. Hell I make more than some of the doctors in our community, and I get to go home at the end of my shift and no one expects me to work in the off hours or on weekends.
Truly, the system is more complicated than you can imagine. Sweeping statements and regurgitating empty media sound bites don't help one bit.
BS. You need to ask yourself what is the definition of healthcare worker here.
Nurses and docs are NOT allowed to work with active TB. Period.
A hospital housekeeper or a janitor, ok maybe. MAYBE. But that hospital would end up with some serious violations if anyone found active TB employees working in or around patients.
Again, this is really more complicated than you think.
Imagine that. Pay doctors less and they will go home earlier and take fewer patients. I can't wait until ObamaCare. It's not just doctors as the article suggested. More and more people are turning down overtime when offered in order to avoid slipping into the next tax bracket. Why work overtime when each hour worked beyond 40 is taxed at 50%?
The ones that really need to be taken to task in health care reform are the gluttonous insurance companies. They are making billions in profits every year and they are accountable to no one. They decide how much to pay doctors, what they will pay for, who they will pay for , and who can get insurance. In other words, who lives and who dies. And no one has any power over them. If the Republicans want to help the citizens of this country they need to get off their stubborn child like asses and start trying to become a part of the solution for this problem. And saying they don't want to regulate anybody is not the answer. If they don't like Obama's plan then come up with something of their own. Oh yeah I forgot Republicans are owned by the big insurance companies.
BHO wants to cap the Insurance companies profits at 10%. This will double their present profit margins........
BHO wants to force you to buy health-insurance or pay fines and go to Jail....
BHO wants to GIVE health-care to ILLEGALS...... I'm sorry they will not verify who is receiving the health-care...... IMO - Same thing......
BHO wants to cut the Medicare cost by 500+Billion.... But it will not reduce the health-care available...... Ha! Ha!
BHO wants to TAX cadillac health-care policies, but UNIONS are exempt......
The Republicans want to make universal Tort Laws to lower insurance cost for the Doctors.....
The Republicans want to restrict health-care to ILLEGALS.....
The Republicans want to ENFORCE the cost-cutting measures now in effect......
The Republicans were forced out of the final writing of the Bills and their attempts at writting changes were blocken... Democrats - Reid & Pelosi, wrote the final bills behind closed-doors......
How is this "don't want to regulate"??????? or Restricting health-care to US Citizens??????
Remember that the Democrats had a super majority for 12+months. They did not need the Republicans to pass anything they wanted..... And they still could not do it.....
Judy, it is not as simple as insurance companies "decide how much to pay doctors." In reality, Medicare acts as the price leader (similar to what happens in oligopolies when one company has a marginal cost advantage over another). For example, on Feb. 28, Medicare will cut reimbursment rates by 21%. Insurance companies will then follow suit with their own cuts.
Medicare sets the rate on office visits, various procedures, etc, and insurance companies then decide to pay a certain percentage of that rate, for example 166% of the Medicare rate. The problem is the Medicare rate does not reflect the true cost of providing these services. Sometimes it pays way too little, sometimes way too much.
Whatever the driving reasons for physicians to spend less hours plying their trade...it is a GOOD thing. The unrealistic time demands placed on physicians begins in their internship/residency years...they are overscheduled duty hours for weeks on end...trying to make life impacting decisions about critical treatment of patients while exhausted and in a constant state of sleep deprivation... essentially absent from the home front, and sometimes through desperation, lapsing into artificial means to keep trudging. Entering private practice then now face huge financial debt for both their education and the cost of setting up a practice, long hours in which they face an increasingly older population with time demanding multiple complex disorders, but with decreasing fee reimbursement, the costs of malpractice insurance soaring, they are faced with patients with unreasonable expectations based on the barrage of drug company ads and scathing publicity about alleged physician misdeeds. The reasonable person choosing medicine knows they face all these challenges and the reasonable person would decide to adhere to a schedule that permits normal life activities and adequate time for regenerative rest. Trading the quality of your life for long hours, increasing technological demands, and the constant threat of financially crippling legal suits, makes no sense at all, let alone when you face the reality of decreasing reimbursement after spending years of your life preparing for this incredibly demanding role. Are there money hungry physicians? Absolutely. Are there bad physicians? Yes...in all fields there are the money mongerers and the poorly performing...it is not a universally held state for the majority. As the patient, we all want the best and look to the physician to be the provider of that level of attention and care...it is difficult not to do so when we realize we are placing our welfare and lives in their hands...our country has come to the point of crisis in finding a balance for the patient and the physician...the question is whether that is even possible.
I agree completely with this. However, the next generation of doctors are facing increasing medical education costs, increasing malpractice premiums, more demanding patients with ridiculous expectations, and lower salaries. They will have no choice but to work longer and longer hours.
I want my doctor to be well rested and alert when he sees me. I know how much working too many hours takes out of a person. I nearly died because of my workaholic ways. A doctor told me to cut back or face premature death. I say the same thing applies to doctors.
Problem is there are NOT enough doctors to keep up the pace.
My best friend from high school is a doctor, and after 30 years, he tells his kids not to go into medicine because it's too much work. I think it is great that doctors are working less. I like the idea of having a well rested and less stressed doctor. Of course, they might make less money, but I think they will have a better life. And maybe we will get less materialistic doctors who enjoy serving people if they can also have a life.
As a general pediatrician, I have read this article and the associated posts with a great deal of interest.
Financial issues are an important part of the problem mentioned in the article, but this goes beyond mere money. There is a great disillusionment in medicine in general, and primary care in particular, because of a number of different factors. The general public has absolutely no clue about the degree to which the malpractice crisis has poisoned the waters as far as the relationship between patients and physicians is concerned. (This is also true for nurses, respiratory therapists, technicians and other personnel, by the way.) We cannot help our patients without playing "mother, may I" games with government agencies or insurance companies. We cannot help some of the sickest people we see without being concerned that we will bankrupt them or their families in order to save their health or their lives. We have become the public lightning rods for the average American's outrage over problems in our health care system, even though our ability to influence that system dwindles every day.
Medicine has its share of bad apples, but most of us are decent and hard-working people. We never went to medical school to become enmired in such a mess. As I look back over a career of more than twenty years, I cannot believe how tragically the practice of medicine has changed for the worse in this country. Not only have physicians lost, but our patients have lost. I personally am sustained by the belief that I have been a positive influence in the lives of many children during my lifetime, but I also realize that the detractions of the current situation may someday outweigh the positives. Many of my colleagues feel the same way, and are turning to pursuits outside of medicine that they find more personally rewarding. In a perverse and sad way, this may be what the payors really want. After all, to their way of thinking, fewer doctors equals lower costs.
I see the ground work being laid for a more socialized medical system.
Well said...Tifton
Get that Libs -The doctor said -
And Lib/Dems want to Takeover the Healthcare/Insurance Industry completely.
Good comment Tifton.
Good post, but if 'The Majority of doctors' care about their patients.
Then why are they conducting a "Work Slow-Down"??????? The same tactic used when someone is not being paid enough...... The Police use it and it is called 'The Blue Flu', other public service professionals use it, and the UNIONS have used this tactic for decades........
But YOU Doctors call it a 'Quality of Life' issue...... We have to work so hard.... Ha! Ha!
YOU are the 'Lightning Rod' because you preform multiple procedures to cover your A$$. And the patients are waking-up and realizing WHO the problem is....
Tell it to the US Military (deployment after deployment) and the US Citizens who have no jobs and are bankrupt because of medical expenses.....
The best EXCUSE - I no longer work in OB/GYN, because the insurance cost too much.............. Simple - STOP injuring patients and babies......
Or the other EXCUSE - As a GP, I have to work so many hours and the pay is not high enough............ I can make MORE money as a specialist........
You stated "you worry about health care cost bankrupting them or their family"...... But you charge three different rates.......... Medicare/Medicaid gets the lowest bill, Regular insurance companies get another bill, and the people without insurance are charged the HIGHEST............ And many doctor refuse to take Medicare patients
Sounds like you care about your pocket-book/money - NOT the patients.....
AC Robertson, I sense from the nature of many of your posts that you are seriously anti-doctor for some reason. I only hope that it is not because a member of my profession has wronged you or yours in some way.
There are at least 4 new medical schools expected to open in the next 3-4 years.
If States would pre-pay tutition for medical students in exchange for a 10-15 year contract to remain general practicianers (no specializing) and to remain in the State, they could reverse the derth of general practicianers.
There's not shortage of students applying to medical school and most of them worry about the debt load and how they will cover it.
The number of residency spots has not increased, so we will still end up with the same amount of doctors, just fewer will be from other countries. Ironically enough, International Medical Students are the most likely to be primary care physicians and work in under served areas.
Of course, congress could decide to increase the number of primary care residency spots making my first point moot.
Serious, I agree and have been saying this for years.
Of course, with the Government Takeover of the Healthcare/Insurance Industry the Doctors will be Outsouced and the New Doctors will be Insourced more Cheaply than Americans. Sound familiar? That's what happened to my husband in the IT Industry. His salary was cut in half and he had to teach a guy from India his job, so he could be fired and the Indian could take over cheaper.
The new boss Obama is the same as the old boss Bush.
The general public just has no idea what it takes to run a medical office in this day and age. There is no other "business" that could work under the conditions that physicians and their staff have to endure. Even if you just look at the nuts and bolts of surviving financially.................the costs just to keep your doors open, so to speak, rise every single year. Office overhead is on an unlimited rising curve. Insurance payments decrease every single year. New cuts in Medicare payments this year. Medicaid compensation being cut in many many states. So basically, unless you are a plastic surgeon, you face yearly increases in overhead, and yearly decreases in compensation, which will accelerate if Obama has his way.
So what is happening? Docs are deciding that if they cannot change this steady loss of control over their practise, then they might as well get a life before they too have that last heart attack.. There is no sense in working 60-70 hours a week, if you don't get paid....why bother. (I don't know of anyone who works 50 hours/week unless they do not take night call, or they are a pathologist) Many middle aged docs are retiring early, others are changing to concierge care, and others are dropping out of Medicare and Medicaid. Med students are finally seeing what goes on in primary care, and are deciding they can never pay back their $200,000 in med student loans by becoming an internist/primary care physician. All of this will affect the middle class. All of this will get worse.
Finally, and most importantly, the satisfaction that most physicians used to get from their practise is evaporating. Everyone takes their frustrations out on the doctor these days. Insurance companies constantly deny everything, patients get angry because the insurance compnies refuse to pay for their care when in crisis, and somehow everyone see the physicians as the ones who should be able to solve these problems. The doc today has to answer to EVERYONE......patients, patients families, staff, nurses, hospital administrators, insurance reps, hospital committees, pharmacies, you name it...........the physician has to respond to everyone, and everyone expects that their demand on the physicians time is more important than anyone else's need...... And the doc can NEVER make a mistake, like other professionals............ Docs don't have time to spend talking to their patients............they are too busy filling out forms and looking over their shoulders at the latest insurance company audits/letters/denials.....plus insurance companies will not compensate a physician when they need to spend an hour counseling a family for the third time about a patients serious illness..............so if you want to keep your practise open, then you better have the patients lined up in the waiting room like on a conveyor belt..it is a horrible way to practise medicine.., but in many areas of the country it is becoming the only way to survive.
If you know of any intelligent sensitive young people who want to go to medical school, tell them not to go for their own sake. It would be a terrible mistake in this day and age in the US. There are many other ways to earn a living in this country that will not eat at your soul. And they won't have to worry about another $200,000 in medical student loans if they forget about med school. Obama certainly hasn't even tried to deal with that one either.
I don't have the answers, but unless society gets a better handle on how to deal with health care costs, you won't have to worry about your next doctors appointment.............it will take you a year just to get one. People seem to want socialized medical care so that they don't have to be responsible for much of the cost........well, try getting care for cancer and broken hips in Canada and England.....good luck.
Most doctors I work with their kids are either lawyers or pharmacist. (Majority are lawyers)
Doctors can lessen the number of hours they work and have the luxury of lifestyle choices whereas others cannot find work at all - do doctors, therefore earn an over-abundance of money. Just wondering.
Nope. 4 years undergrad, 4 years medical school, 3+ years residency to become a trained physician. An individual who is equally hard working can make as much as a family doctor in a 40 hour week by managing a warehouse or giving financial advice; and those jobs after 4 years of college.
It is unfortunate that folks who have no higher education cannot get jobs working construction or driving trucks right now. But Anne said it above, $200,000 in medical school debt and a 60 hour work week, after at least 11 years of training really deserves to be paid well.
Justin,
A Chemical/Bio Engineer has to go to school for 5+years, then they take a test for their limited license. They then work in their chosen field for another 4 to 6 years, to receive the needed job experience and training and then have to take another certification test..
At a State University the cost for tuition/books is $25+K a year, plus housing/food expenses. Prior to receiving their engineering certification the employers pay 50% of the going wages..... I know because I just finished paying for my daughters engr degree.
Doctors are just like any other professional, EXCEPT they are exempt from being held ACCOUNTABLE.... Unless they cut the wrong leg or arm off...... Ask any lawyer and you will find that the worries of Medical Malpractice and being sued for almost anything is BS..........
You mean tuition at a PRIVATE UNIVERSITY is $25K each year, a state school will cost between $5-10K each year. If you go to a private university and rack up $200K in debt you better have a wealthy parent (which it sounds like your daughter does) or you need to aim for a job that will pay you enough to repay your debt. The kicker is that if you go to private school for undergrad, and then go to med school you could really be screwed with double that figure owing upwards of $400-500K...OUCH!!!
I don't understand why you think doctors wouldn't be held accountable for mistakes. If a mistake is made that causes an injury to a patient, a doctor can certainly be sued and should lose. Earlier you comment that sometimes lawyers will not take a case if it is not financially viable; this happens in many cases outside of health care as well, it is not unique to medicine. You also say that doctors are not held accountable for side effects caused by medications. All medications have side effects for some people. When you get a prescription filled, you get documentation explaining all the possible known side effects of a medication. At that point it is really up to the patient to decide if the benefit outweighs the risk, and if you have more questions, just call your doctor to discuss it.
And if an Engineer makes a mistake, the company gets sued, not the individual. The engineer may get fired, but they don't lose their house.
About 70% of OBs have been sued at least once nationwide:
http://www.manhattan-institute.org/html/cjm_21.htm
92% of OBs in New York have claimed to have been sued at least once:
http://commongood.org/healthcare-reading-cgpubs-factsheets-16.html
Doctors order unnecessary tests all the time. Unnecessary tests do not help in a diagnosis, so why do doctors ask for them? They do so they don't get sued, i.e. they order them because the lawyers say they do.
Doctor sued for medical malpractice, dragged on 4.5 years before spent $150,000 of his own money on court fees, lawyer etc. Day of the trail, the plaintiff's lawyer told the family they would not win, case dropped. Link below and I really hope you see a problem with this...
http://www.nytimes.com/2009/12/29/health/views/29case.html?_r=1
If doctors can not be sued for almost anything, then why is there a much higher rate of lawsuits in the U.S. then in other industrialized nations? If they can't be sued for anything, why do they practice defensive medicine? If they can't be sued for almost anything, how do you explain the fact that 2/3 of OBs have been sued nationwide?
Need to add more. "Today, the American doctor has a greater chance of being sued than any otherprofessional in the United States, or any other doctor in the world. In 1989,there were approximately 900 malpractice complaints brought before Americandoctors every day. And the United States in the only country in the world where anything like this situation exists. The rate in which doctors were sued in Canada in 1989 was 10 times less than in the U.S., and in Great Britain only 3 or 4 out of 1000 physicians could expect to be sued (while some 43 percent of all obstetrician-gynecologists in New York State had been sued 3 or moretimes)."
http://www.faqs.org/health/topics/25/Medical-malpractice.html
Justin,
You need to check you education cost. A private Liberal Arts college can cost over $45K a year. And I know what the NC State rates are, I paid for it.....
You need to talk to a lawyer about medical malpractice..... You will be surprised.....
You are incorrect about the liability that engineers assume when they sign and stamp a process or building, Their carrier is on the line and they can lose everything and their ability to work as a engineer.....
Obstetricians and gynecologists are also a dying breed. Many are retiring or avoiding that field all together due to extremely high malpractice insurance costs.
you might check your figures on Malpractice insurance AC I know one Othropedic 500,000 a year.
This is quite off topic, but I'll reply because you're wrong.
Tuition at NC state university is $5500 each year + $1000 for books. Sorry sir, but you're totally wrong on this point. Here is the website:
http://www.ncsu.edu/future-students/can-i-afford-it/index.php
And regarding engineers being sued: as long as they are employed and not working as sub-contractors, the legal doctrine of respondeat superior will hold the company liable. The engineer may get fired, which you agreed with, and as I clearly mentioned earlier, but the engineer is not personally sued. If you have have an example of an engineer making a mistake, getting personally sued, and then losing personal assets I would love to see it. Until then I have to assume that you are simply blowing smoke.
Justin,
First they left out one whole semester in ALL of their figures. Fall, spring, and SUMMER.
Second the 3rd, 4th and 5th year Engr courses are not based on 12 SH try 16+, when you factor in your minor, even more hours.....
The books every semester cost usually as much as the tuition. A Chem class + lab book w/cd can cost $1,000.00. And because they are update every year or so, you can not go to the Used Book store......
Just the parking pass on campus cost over $300.00 a year and because classes are spread out, you're almost required to have a car/motorcycle...
Throw-in the required computers and printer and network connections, class trip expenses both international and domestic. Just a few little things that are REQUIRED.
And this does not count the food, boarding, health-insurance, vehicle cost, etc, etc, etc..... But they all add up and have to be paid, because the student does not have the ability or time to work part-time jobs..........
Most Engineers and ED/specialist Doctors work as sub-contractors...... Welcome to the new world of labor cost reductions.......
In Thailand, the Doctors are trained in the West and the Thai Government pays for this training. The Doctors have to work in public medicine for a set number of years, prior to going into private medical practices....... They speak English and their offices are equipped with the same equipment they used in the western hospitals. If they make a error in their diagnosis, you have to sue the Thai Government. The Doctors are paid just like the military and other Government workers......
The Doctors and RN's are selected during high school and these students are required to receive special classes.... To prepare them for the Medical Schools and travel to the west.....
Dentist charge $30.00 a hour and that includes; x-rays, shots, any needed medicine and dental work....
My wife was charged $150.00 for a complete physical, x-rays, ultra-sound, vaccine up-dates, pelvic exam, and blood-work. We were met at the door of the hospital, (that catered to the westerners), ushered into a empty waiting room, and served water and snacks. Fifteen minutes later the Doctor arrived and started the examination. I was introduced to the insurance administrator and he informed me of the different services the Hospital had available. Two hours later we were finished and were told we had to return in 3 days. At that time we were breifed about the test results and given copies of the records for the US Visa application....... It cost about $40.00 a hour total......
The Doctors and Hospitals that serve the Thais, rely on their RN's. They are trained in Thailand and they preform the same duties as a GP in the USA. The average office visit cost $30.00 (two days average wages) which includes needed medicine and any special test. Serious health issues are refered to the hospitals where the Government Doctors are. This cost is usually covered by the Government for everyone that has a Thai Government ID card......
ALL foreigners must pay-first or pay a deposit and have proof of insurance..... The Thai Hospitals are clean and equipped for most health-care operations. Specialized care is refered to the larger hospitals in the cities or to the military hospitals........ And they have EMT services and local RN's offices in most of the small villages....
Maybe the US Government needs to look at Thailand. Then decide how to adopt polices that work of everyone and control cost..... The US Doctors would have to learn how to park the EGO's at the door.......
"The US Doctors would have to learn how to park the EGO's at the door."
I'm not sure where this comment is coming from, but I have two words for you: Cleve Killingsworth. He is the CEO of Blue Cross health insurance and made 3.5 million dollars last year, a 26% increase despite the fact that the company's earnings went down. That is money coming out of the pockets of patients. That is money that could be going back to you to pay your rent/mortgage, buy food, and pay bills. Do you think he needs 3.5 million dollars to live? How about 2.5 million? If you want to talk about egos, let's talk about how much money is getting sucked out of health care by insurance companies while they act as middle men for the money that patients pay for health care services.
Think of this, BHO wants to cap the health insurance profit at 10%. That would double what most insurance companies are now making...... In comparison, McDonald's makes 20.1% profit margin and XOM makes 6.7% profit margin.....
The CEO's pay of any company is determined by their contract, which the companies board and stock holders vote for....
If you want obscene look at what the Freddie and Fannie CEO's make, and they gave us the sub-prime mess...... Or the CEO of AIG.........
When a Doctor makes a mistake and injures a loved one. Then refuses to admit or accept responsibility, because it would make them liable. Or charges 3x the allowed rate for a procedure, and justifies it because they went to extra classes....
Thailand may have a highly organized medical model which 'caters' to westerners.
Thailand also has the largest, most organized child sex-worker infrastructure in the entire world which caters to westerners.
During my son's medical school he was taught to document as though a trial attorney was sitting behind him and would eventually be reading every patient's chart he wrote in. Obstetrics is high stress because everyone wants, expects and demands a perfect baby. Sadly, this does not always happen so their specialty has impossibly high malpractice rates. Many OBs gave up obstetrics and now only to GYN.
Years ago the doctor was in charge of his practice. He had one boss (himself) and his customer was his patient. He owned his own practice (and didn't have 14 partners which all worked in a megapractice which was owned by the hospital). Today the doctor wants to work independently, but is really owned by a larger clinical entity which pays his malpractice, hires the nurses, pays everyone's salary, health care insurance and provides CME, parking, lab coat costs, etc., but now he's the pawn of his employers and has 'encounter numbers' which is a quota system. He is expected to see 30 patients a day. If he doesn't (because he spends more time with his patients than he should, he is then censured by the practice for not carrying 'his share'. He never sees his wife or kids and wonder's why he didn't go into dermatology or ENT. While certain speciality practices are still highly valued - they often require an 'inside' track to the field (like a parent, grandparent who practices in that field and has a reputation for excellence or an endowment to a famous school. (Say Ron Perleman's NYU Dept of Dermatology)- where as a newly minted dermatologist you're starting salary will be ~300K. But these are fields where patients pay a lot of their $$$$ up front so less interaction with Ins. co's are necessary. Primary care is a ball buster and no one wants to do it anymore. Just staying current with all the new developments/meds in Diabetes and Hypertension ALONE is a full time job. IM/FP patients are SICK and hard to follow given the 30 patient a day work load. I have no answer - just glad to be retiring. Golden age of medicine is long gone never to return. A new model IS necessary - but too much quarrelling and infighting within the ranks won't allow any progress at all. Soon - patients will really have trouble finding basic care providers not because they can't afford it or don't have insurance, but because there will be fewer and fewer places to offer it. We'll be a nation of specialists and subspecialists and basic care will go by the wayside. This country will find itself lined up at the Walmart Minute Clinic for everything which does not require specialist care and even THAT will eventually be available at the Little Clinic. Maybe we need to try that model for a while and see what the M&M numbers turn up?
Don't get sick. If you do, try to stay out of the Hospital for > 24 hours.
If you DO wind up as an inpatient - pay a family member to stay by your side 24/7 - which might keep you alive or from getting wrong meds because the nurse assigned to care for you has 18 other really sick patients too.
OR - you can emigrate to Thailand, Sweden, Netherlands etc.,or any of the other coveted nations where Medical care is so revered by our citizens.
Sadigie,
If you own several hundred shares you maybe correct. But when you own 20% of the stock, you have the power to change the rules. Ask Warren Buffet if he thinks his vote is not worth squat.
Even I receive instructions on how to vote for board members and policies of the companies I hold stock in..... Every vote counts....
buche de noel,
You would not like it in Thailand, they put child molesters in jail for LIFE.......
So how did you like Uncle Sam paying for you medical schooling?????? Were you one of those that refused to go to Iraq, because it would interfere with your practice???
AC - Are you kidding me? I served proudly for eight years on active duty and during that time deployed to operation desert shield in 1990. What gave you the idea that I'm not a patriot? I wore and WEAR my Navy uniform with pride and STILL drill with the reserves! I also favor the idea of pedophiles and the like being jailed or put to death for crimes against innocent minors, so you're wrong on BOTH counts. I'm not sure where you're disdain is coming from. Have YOU ever served? Sounds like you are yet another doctor hater for reasons unknown to me.
The problems with the child sex trade in Thailand is that it's tacitly approved of and is a very healthy tourist sideline. So the hypocrisy of tolerating the pimps and then jailing the johns is a bit odd. But kiddie porn/child prostitution is an huge industry in that lovely land where your medical bill was negligible. Good for you. How do YOU earn a living, by the way? Given that you're so quick to revile the physicians and somehow need to insult their best intentions - makes me wonder what the source of your earnings are?? It's obvious to anyone reading your remarks that you are NOT a military or civilian health care provider or a lawyer.
Ag nothing against RN, but their degree of training is quite diffrent then a physician.
buche de noel,
I served 26+years in the Marines, EMT certified in 1982, 8+years of college, Mom was a RN, and the X was a lab tech for 15+years. I have been around hospitals all of my life. And I turned down a commission in 1972..... My present income is from investments and the stock market....
Most doctors are egotistical, treat their medical staff with contempt, and will do anything to remove the last dollar from a patient...... They NEVER admit to making a error and cover their A$$ with mutable needless test. They hide behind HIPAA and the 'Good Old Boy' system........ But some do care, if they had the time.....
I have lived in Thailand the majority of the last 4 years, with my wife and children... My son has lived though-out Asia for the last 10+years with his wife. Who works for XOM as a chemical engineer. I'm 60+ and take no medications, have no medical problems, and avoid doctors.......
If you want to brand a country by what happens in a few tourist areas... Great..... The USA is judged by; the morals of the CA movie industry, NV casinos, and NYC/SF homosexual/drug users...... And the USA does nothing except promoting the freedoms these people enjoy......
Thailand puts their drug dealers & traffickers to death, Illegal drug users can go to jail for life, pedophiles go to jail for life, and Illegal immigrates are jailed and deported. Unlike the USA.......
You seem to know a lot about the child sex trade. I'm assuming that you enjoyed yourself, trolling the tourist areas......... My friends in the Royal Thai Police, will enjoy locking you in jail.... You can visit with the other US Naval Officer there, that will be in jail for the remainder of his life..... Do not try this away from the tourist areas, the locals take care of Ferangs..........
Jake J,
RN's in Thailand receive more training than the US RN's. They are fully qualified EMT's, can prescribe medicine, and can preform many out-patient services. They regularly preform procedures, normally reserved for the Doctors in the USA....
What a despicable and vile troll you are. I will be sending your post one to the moderators.
Buche de noel,
I'm not the one calling names.
I'm just stating the true facts about a country that you seem to know so much about..... And probably never traveled outside of BKK, Pattaya, or Phuket city limits.... If you even did that.... Ha! Ha!
And I know what the priorities of most doctors are....... I have family members that have DIED because of their GREAT and CARING services.....
Like I stated earlier, "You would not like it in Thailand...."
...
Implying another Viner's a pedophile is just as bad, really, AC Robertson. You're capable of much better. You're suspended for a week for violating #1 of the Code of Honor.
...
Second part of that rule, buche de noel.
AC Robertson. Too bad you cannot see the forest for the trees. I have no doubt that your medical tourism trip was pleasant and saved you money. But you are comparing apples to oranges. Of course your bill for these services ws incredibly low...........so are the wages for the people who so willingly served you. I wonder if you, as an American, would accept the same wage in the US? Just wondering.
You did make one very good observation, and that is, that in countries who have some form of socialized medicine, they generally not only pay totally for the medical school education, but they also often PAY their medical students a stipend or salary for the years they attend school. Thus, the medical students are not in huge debt when they finish medical school and internship and residency. Many years ago I visited Germany where the doctors there have combination practices including both private pay and socialized practise. Their medical students were paid stipends during medical school....I was astonished. They were appalled when I told them that we were certainly not paid during school, were charged a huge tuition for 4 years, and room, and board, and then went on to make about $1.50/ hour for our 120 hour work weeks for the next 4 to 6 years as interns and residents. They could not understand it.
The kids coming out of med school today carry about $200,000 in student loans when they graduate.......basically they have taken on a mortgage for a house they will never live in, and, unlike a homeowner, get no tax deductions for it. They are faced with crippling overhead that rise every year, and decreased compensation. So, if you as a taxpayer really think docs have egos to check at the door, I suggest you be ready to pony up many many many millions of dollars to support the future young doctors of America so that they can afford to take care of all the socialized medicine patients you want to be included in cost controlled medicine. For one year of graduating medical students in my medical school alone, that would amount to $40,000,000 in today's money.
The US is not Thailand.............grow up.
Anne - glad to read your response to this poster's immature and propagandist vitriol. Not a person you or I need as a patient - chronic whining fault finder type with no redeeming qualities.
It appears the insurance execs are probably better compensated by the doctors who are actually do the work....why is that not surprising???
http://www.physicianssearch.com/physician/salary2.html
Primary Care
Family Practice
Internal Medicine
Pediatrics
147,516
160,318
149,754
111,894
117,984
111,113
197,025
205,096
201,086
second website with more salaries.......................................
http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
It is Bush's fault.
No. It's Russia's fault. Everyone knows that.
We had all better take some basic medical training as that is what it will come to. The mammograms are being phased out until after the fact, having a baby requires 24 hours or less in a hospital, you cannot get help in an emergency room unless you are at death's door (or speak Spanish) and it is not uncommon to have to wait a month to see a physician.
And this is just the beginning, folks.
opto is not that far off. many in our field, when asked, will say that on some level they chose medicine in order to be able to help family members when one of them is gravely ill and cannot navigate the lunacy which is health care in our nation when the need arose. Of course - we become physicians, etc., for other reasons too. When we are young we have a romantic ideal of what we can do in our careers and some of us DO achieve goals like this. Working pro bono for a small amount of time each year is incredibly rewarding. Knowing that you improved quality of life for someone who could otherwise NEVER afford your services is a great way to pay back. So is serving your country as a commissioned officer in the Navy/Army/Air Force where your medical education is 'free' and you wear the uniform, and your patients are all armed servicemen/women, their families and retirees. MANY doctors, dentists, etc started their careers working for Uncle Sam and I am one of those. But the problem remains the same. Can your patient get an appointment with you in a reasonable time frame and can you do for them what your independent practice should allow you to do? No longer can I give you a 'professional courtesy' if I think you're behind the 8-ball......or allow you to pay my fee by painting my porch in lieu of cash. That's a colossal no-no because the 'group' demands insurance first, and forget about not collecting the co-pay. God forbid if we tell you we'll forgo the co-pay! We'll likely be guillotined for this. So the little niceties we used to be able to give you are OVER. We (physician groups) lose, you (the patient group) loses, but the 3rd party payer wins big time, every time.
Insurance reform is where our efforts must go. We can no longer afford for them to tell us how to practice medicine or what drug we can or cannot give you. Managed care is the devil and it can no longer be permitted to govern your the management of your health. It will be nearly impossible to crack the juggernaut, though, because senators, congressmen, local legislators and mayors are OWNED by the insurance industry along with Big Pharma. Those are the real enemies.
Fortunately, I have no medical bills and take no medication.................but my sympathy goes to those who do. The extent (so far) of my medical needs is a yearly physical. I am fortunate.
opto-glad you are well. Are you also quite young? (to me this means ~30 yrs of age) I saw the need for health care interventions much more simply when I was 20 years younger and could not understand why older Americans had so much chronic DZ. I always blamed their lifestyles, too. I no longer see things so black and white.
I will add one caveat to your post and say that 24 hour maternity/neonatal discharge has risks to mom and baby. Neonatal hyperbilirubinemia often appears AFTER 48 hrs of life and the bili level increases daily after that so close home monitoring is important to head off the brain damage of kernicterus (rare) level of >20 heelstick bilirubin requiring phototherapy.
Neonatal cardiac emergencies don't always manifest until 24-48 hours of life, such as hypoplastic left heart, transposition of the GVs and Patent Ductus. There are other issues with newborn health which are better found in the nursery when medical intervention is immediately available then at home where a busy mother might not pick up until damage is already done.
Just a side note to some contentious medical debate over LDRP/NSY inpatient payments to hospitals.
I'm 62 and have been to the doctor twice in my life. The first time was in 1954 when I fell off a horse and broke my wrist. The second time was last year when I fell off a ladder and broke my foot. Treating the wrist cost less than $200 even though it was a severe break that required surgical treatment in the hospital. The broken foot cost $2400 even though it was a simple green twig break that was treated in the doctor's office. (I swear his X-ray machine was hand built by Nikola Tesla.)
But on the bright side, I've saved many thousands of dollars over the years by self-insuring, self-diagnosing, and self-medicating from the veterinary supply store. I probably should have saved the $2400 by wrapping the foot myself. But it was hurting like the mischief and the doc's office was handy to the job site. Just getting lazy in my old age I guess.
So what does the good Dr. Ann O'Malley at the Center for Studying Health System Change make a year? Does the good Doctor have to carry malpractice insurance?
And the grant that the National Institute on Aging, did they take the grant money out of the 20% they are not going to pay doctors who see Medicare patients? I'm sure it was more important to the government to know how many doctors were working less hours, so they will have someone to blame if Obama gets his health care bill through and it fails...
I think if any group could fairly reform health care it would be physicians and other health care workers.They are the ones doing the work why not let them decide how to charge? Maybe they would get back to the way it once was and just get paid then they perform their service
They see first hand the injustice to the people they serve. They also see how much they get ripped off by insurance companies and the government health plans already in place. Their voice is drowned out by the insurance and pharmaceutical industries lobbyist in Washington. Who wants to be under so many thumbs in their work? Certainly not someone who has to work so hard and pay so much to be of service to their fellow human beings.
I think doctors ought to do an all cash business and stop accepting all insurance payments and work out payment plans with their patients like "buy here pay here car lots" would do. They could lower their rates and probably heal a lot more of the sick. Their patients could end up saving a lot of money and the doctors would make a decent living what is wrong with that?
I have always paid cash for my medical treatments some doctors even offer me a discount for cash payment. I do take good care of myself and I don't go running to the doctor for every sniffle or cut. So I don't spend as much catastrophic illness or injury has not ever happened to me. What would be wrong with having an accident policy or a hospitalization plan that got refunded to the payer if there are no hospitalizations or accidents?
I don't blame doctors one bit for wanting out of this trap that will only get worse if government takes over health care.
Lisa - that is how things used to be in my late father's surgical practice and in the bulk of my days when I took over dad's practice. My son - however, cannot run his practice that way and your comment has much to be said for the wisdom of how medical professionals USED to work in this country.
Those days are gone forever. But many of my son's colleagues are leaving capitated practices and insurance in the dust along with malpractice and opening 'concierge' practices. I don't know that I like that idea but I understand the frustrations of his generation of younger physicians. They are pawns in the war of 'heath care reform' yet directly on the firing line and blamed for every failure in their professional world. Thankless and miserable way of life for many fine young minds who did NOT see the deterioration of medicine as it exists today.
So your father, who was a Doctor would not pay for your medical training. YOU choose to give the bill to the US Taxpayer....... And then brags about serving during 'Desert Shield'............ Some of use were there on the ground when the bullets were flying and made multiple trips to the sand-box.......
And you will not work in some medical fields because they 'DO NOT PAY ENOUGH'.....
Just another carring doctor worring about his pocket-book, FIRST....... TYPICAL doctor.....
FYI - my father's medical training was part of his Army service in the 40s in the midst of WW2 so there is a long and honorable tradition in my family of military service. It's not really any of your concern or business but of course he assisted me during my medical training. By virtue of his being a surgeon was help of an invaluable nature. By accepting my commission to serve Navy medicine I continued the proud tradtition and military service is a source of pride for me and our entire family. You are not special because you served and neither am I. We did our duty, pure and simple. Why do you place your life details out there so that everyone can think that you are somehow different or better than any other man or woman wearing the uniform? You and I both served - difference here is that while YOU accuse me of 'billing the taxpayer', I am a taxpayer, too? A strange and nasty world view in my opinion
What you seem hell-bent on doing is sadly, calling each and every doctor on this board money-motivated as though that is the sum total of our beings and you are unkind in the process. To you, for whatever reason, doctors (regardless of their training and specialty) are just looking for cash! If that were true there are easier ways to make a buck than to undergo the rigors of medical/surgical training.
IF you understand basic economics you will realize that when you remove rewards from any society's infrastructure and when EVERYONE makes $1000 a week from the dung slinger to the cardiac surgeon you are certain to enjoy mediocrity across the board. I don't care to live in that sort of society hence I live in and revere the US, despite all our flaws.
Case in point - Our society pays a neurosurgeon more money than a gardener. Both have value - however when YOUR head splits open in the MVA you were just injured in, you will pray for the top of the line neurosurgeon who will repair your near lethal head injury and you (or at least your loved ones) will thank God that he is skilled enough to put your frontal lobe back inside your skull, drain the large cerebral hematoma which would otherwise kill you by suspending your respiratory impulse and give you the proper dose of mannitol to prevent your grey matter from herniating down the brainstem.. Let's not forget the anesthesiologist who kept you ALIVE during this salvage operation and the internist/hospitalist who kept an eye on you in the SICU 24/7, and the many nurses who coded you when your precarious state could have ended your life at any time. Oh, let's remember the Physical therapists who got you back on your feet and worked your atrophied musculoskeletal system as you began to slowly come back from near death and of course, your pharmacy which provided the various medications to keep you alive and the respiratory therapists who made it possible for you to breathe when your lungs were full of blood and collapsed.
Your admitting surgeon/IM/hospitalist doctors gave you your life back. But that's OK because even though you are 'grateful' to be alive - you're not going to pay them because they're only in it for the money. Right?
Such a mind set reveals only grotesque naivete, lack of any real knowledge of health care, along with what is far, far worse -
Colossal, misplaced hubris.
News flash, Mr. Obama: Econ 101 teaches that when you price fix/price cap something (medical pay/healthcare insurance) you get less of it and when you subsidize something (unemployment compensation) you get more of it. And with Econ, like math, facts are facts regardless of how eloquently you speak to the contrary.
smiley - I agree and don't think prix fixe medical care has EVER been the way to go NOR has it been the desire of doctors to provide services in this manner. It is a fairly new phenomenon and when I was a child and teen medical doctors did worked independently, NOT for insurance company premiums NOR did they work for hospital owned and operated practices like they do today. Medicine and the manner in which it is administered via fiscal intermediaries has slowly co-opted only the most elite of specialties where the specialists themselves set their fee schedule, do NOT accept Medicare assignment though will file for you - require the patient to be fully responsible for payment. These guys are able to to this in large part because of 'cash up front' policies for high end procedures which, though not 'medically necessary' are nonetheless highly desired by their patient base. Those specialties are highly coveted, as I have said in earlier comments, and there are few bonafide 'emergencies' therein. However, many of those guys and gals do significant pro-bono work each year. It is there and then that we see their altruism. The problem is that we (as a larger group of non-medical citizens) don't brag about it and unless you are seeking that info, you will never know that the local dermatologist spent three weeks in say, Thailand or India, fixing cleft palates and correcting cosmetic deformities at no charge or trying to cure a highly disfiguring cutaneous eruption in a young man who would NEVER have left his rural villiage to come to America for an impossibly expensive operation. I find this VERY motivating because this plastic surgeon, dermatologist, oral surgeon and infectious disease specialist could just have easily stayed home or gone to Oahu for three weeks instead. Those are also facts which cannot be quantified by Econ 101 formula's.
I'm not making enough money (sniff, sniff) so I'm going to take off a 1/2 day per week.
Priceless!!!!!!!
More BS. The study, probably paid for by the insurance companies comes out just on time.
One of the scare tactics the republicans had in the summer was that a government run health care option would create a shortage of doctors.
Tarahhhh! Here we are. A new study supports it.
Any idiot can see if you pay someone less then they can make as a waiter (11 dollars per patient average per medi-cal patient) their going to do something else.
I think it is healthy they have done this. 51 hours a week in a profession where one must be hyper alert and up to date on all the latest is still a very long work week. This has got to be one of the most difficult professions.