We should not be whining about these pay rates when the new hire they send out to fix your printer (ie, replace your toner cartridge) costs 120 bucks an hour on average. The villains of health care are the hospitals, drug industry, insurance industry and of course lawyers. Until we go to an entirely different approach to health care it will become less and less affordable. The exclusion of public option and interstate competition in the national health care racketeering and shakedown act should have been a wake up call to all Americans. Vote out your representative on tuesday. They clearly do not represent you, unless you have bribed them to do so.

By the way paying alot of money to the hotshots in banking sure did help us all to be happy healthy and wise.

Someone please tell me why a company president that is running a business losing millions of dollars a day, markets share, laying off and receiveng government benefits needs huge 100 million dollar salaries even while in the same area other companies are succeful at the same industry.

Until we go to an entirely different approach to health care it will become less and less affordable.

This is probably a result of the health insurance industry in conjunction with our private healthcare system. When people are totally insulated from the costs of medical care, doctors and hospitals can basically charge whatever they want and the patient doesn't care because he's not paying for it... everyone else in the insurance pool is.

Insurance companies don't directly care about controlling how much money the doctor makes... all they care about is the difference between the premiums they take in and their payouts. The doctors are charging more? Just raise premiums.

So patients don't care, insurance companies don't care... who's left to be concerned about the value of healthcare?

But who would want to go to a discount neurosurgeon?

No! The lay public is grossly misinformed by political propaganda.

http://benbrownmd.wordpress.com/

The point of the article is that we are not incentivising young doctors to go into primary care medicine. Even a "capitalist" has to look at how to ensure that there are enough primary care doctors out there - especially since apparently it costs 1/2 as much for them to fix the problem What is the alternative - make doctors be primary care doctors?

I imagine the folk entering the medical practitioner gig are going to try to get the best return on their investment.

It seems that the trend for GP's is to have one MD/DO and a small host of PA/NP do the leg-work.

It seems to work too.

In most situations, the PA/NP doesn't do the work. These guys go to school for 2-3 years, and come out making $100,000+ - more than the GP. Oh yeah, they don't work after 5pm. You can say MDs make too much $, but at the end of the day, its the insurance companies that are collecting big time. The MDs can CHARGE whatever they want, they are only going to get PAID what the insurance company has determined.

Medical doctors should start billing like veterinarians if they want to make a lot of money. Asking for cash (or credit card) up front to cover the bill will leave the consuming public to deal with insurance companies. When they get the measly insurance check in the mail, they will realize who's making out under the current system.

This post implies that your agree with the solution in the article regardless of if you think it will be taken seriously or not. This does not fall in line with your other posts. In other posts, you say you understand and agree that specialists should and do make more money than GPs, but you also say that you agree with the article which quotes this guy Leigh who says we should pay specialists less and shift that money to GPs to pay them more.

Which is it?

Depending on the specialist, I don't mind paying more. It is the 5 bucks for an aspirin tablet in the hospital that chaps my hide.

well when you have to borrow $200,000 to pay for medical school on average and commit to 4yrs undergrad, 4 yrs medical school and 3-5 yrs of residency before getting to make $60/hr - it really is that much. Most primary care providers dont do it for the money - if we did we would have become a specialist lol. Problem is alot of doctors do want to do it for the money so your running out of primary care doctors

Shenlee: A lot of jobs pay $60.00/hr if you are willing to go through years of training. ELECTRICIANS get paid more than this. You are about to "get a break" when there are not enough general surgeons around to handle trauma. I am not a general surgeon, but I know what they do. At least half of all the trauma they get called out to do from midnight to 6AM has no insurance. Other specialties are doing the highly reimbursed proceedures they once did. They make well over $60 and hour for elective surgery, which they can do at a scheduled time and at their convenience and the patient's convenience. It is the car wreck that involves your darling daughter at 2am that was caused by and uninsured drunk motorist that results in needing a guy who is willing to get out of his warm bed, drive 5 to 20 miles and sew her intestines back together that you are paying for....or maybe not...but they do it at a far lower rate than a pro football player gets paid. Get real! The reimbursement to these doctors is too low and there are going to be fewer and fewer of them willing to put up with the long hours and the ingratitude that you express. Complain about what they are being paid when you are lying in an ER in agony with a hot gallbladder and see how much sympathy you get. I can assure you that most family practitioners and internists handle their call over the telephone. It is still hard to do this every 2 to 6 days but not as hard as what the surgeons do. Try this: Set your clock every hour for one night out of every 4 and wake up, call someone or some weather report on the phone and remember it the next day. Then you will know what a family practitioner does at least. Or, get up at 2AM, go out and walk for three hours every 4th night, then go to work the next day, function normally, and you will know what a surgeon does. EXCEPT that no ones life will have been in danger and you won't be sued if the patient dies.

You seem angry Jack. You seem to have some issues. I hope you feel better soon.

I'm a Urologist, and my call is no where near as brutal as a general surgeon. But jack has just posted a very accurate account in the life. I've always thought that the vast majority of people would NEVER want a surgeon's job if they were truly aware of what it entails. But in turn, I feel truly blessed that my patients put their lives in my hands as a surgeon, I couldn't do any other job, period. 1/4 of patients have no ability to pay, and this is where I do it for free, because I love it. Dont hassle me about what I make when I DO get paid. BTW, my partners and I provide jobs and benefits to 20 other employees!

The best doc experience i ever received was from a urologist.....a solid decent guy, really caring.

I have a PhD, 4 master's degrees and two technical certifications. I left school with as much debt as a doctor specialist (most PhD's do). As professors, we are not paid nearly what doctors are, even as we too struggle to pay back student loans.

You must be a doctor. Only a sociopath would kill someone because he is only making $100 per hour.

One other thing, its the TEACHERS in this country that deserve a raise. Obviously, based on merit. Oops, that's gonna bring up the same issues!

If your car makes a noise and you take it in and it turns out to be a five minute fix, you still get charged the full hour rate plus parts. There are just some professions out there that command high rates of pay.

Madness, any charge for the psychoanalysis? From previous encounters with you I sense that you have anger issues. I was stating facts. I really see evidence from my friends and acquaintances who are general surgeons that they would not go into that field again if they could have a do-over. Most have to quit well before age 65, not because they have a bundle of money but because they are worn out.

As far as Shenlee's comment about $60/hour, there is a list of 15 jobs on MSN this morning that pay more than $50/hour including construction foremen, adult day care center directors, co-pilots, pharmacists and human resource managers. These are all good jobs. I have worked as a field office manager on a construction site and I know the job is hard, but I never had to get up at 2AM to go operate to save a life and I'm glad I never will have to do so. The people doing these other jobs certainly deserve to be paid appropriately. I would not want to fly with a co-pilot making minimum wage or leave a parent with an under-paid adult day care director.

I would agree the article is incomplete about catagorizing every specialty and the reasons for the entitlement to greater income. Your arguement doesnt address the need for more primary care providers who need to borrow just as much to finish medical school. I cant tell if you think that primary care providers arent smart enough to play a role and we should just have specialist.

I agree here that the article is glaringly incomplete. They haven't taken into account the cost of the education nor the cost of the malpractice insurance that specialists have to buy. I'm not that close to the industry but it seems to me that the specialists are sued more often than are the family practioners, driving up the cost of malpractice.

By the way, a good family doctor can keep in proper touch and recognize when they are out of their element and recommend a specialist. I've known too many that don't do this. I go to both general and specialists depending upon my own needs. I am very careful about the care for me and my family and want to make sure we get what is needed.

I agree with both of you in the above posts. Costs for malpractice because of lawsuits is much higher for specialists. The fact that a parent can sue their OB 18 years after their birth of their child because the child did not get into ivy league school is ridiculous (and I am not kidding about that or making it up).

I do think there is a need for GP doctors, they just can't expect to make more than specialists due to all the other legitimate circumstances and factors. In fact, I do agree with the article in that we do need more GP doctors as they are the "first line of defense" of the medical community, but if the medical issue is of greater complexity, then they are referred to the more (generally) educated specialists. We need more front line doctors in the system.

And let me say, I do think we need to find a way to allow GP doctors to make a better living as they are needed and need to be more appreciated, I just don't know what that is (but don't compare to specialists as it is apples and oranges).

I do think specialist should be entitled to additional income based on additional training. I was perfectly content to finish residency after 3 years to raise a family. This is the same commitment that a general ophthalmologist makes and they 2-3 x what I make. They rarely have any emergencies and have great hours. Dermatology only requires a 4 yr residency and no real emergency call and great hours - they make 1.5 - 4 x what a primary care provider makes. If I was a neurosurgeon I would be pissed about how much dermatologists make lol I think relooking at the salary structure in medicine and what people are really paying for would make a lot of sense and not just for family docs.

A sincere question....Who sets the salary structure that you refer to?

Considering the ridiculous malpractice insurance premiums doctors have to pay, I'd say they don't make ENOUGH.

I once had a pulmonary specialist come to me after he had seen my Xrays. It would seem that I had a rare type of pneumonia. Talk about shocked. I went in for a pulled tendon. He grabbed the wrong Xrays. But to be fair, the other patient and I had similiar last names.

I agree we need more GPs. But saying that specialists make too much isn't the answer. I was treated for increasingly bad asthma for years by 2 GPs, and it wasn't until a bout with pneumonia that the tumor blocking my lung was discovered. And due to a brilliant thoracic surgeon, I still have half a lung instead of losing the whole thing. So, do I think she is over paid? Heck no. I'm not saying that GPs aren't competent -- they deal with a huge variety of ailments as opposed to a specific field. And do surgeons really end up getting that much if they're in practice for themselves? Do insurance companies actually pay that? I know there was a huge difference between what was billed and what was paid on mine.

Amy, You got it right. And starting "occupation" warfare is the modus of politicos who play on peoples' greed and/or envy. Why not pick on attorneys, dentists, financial people etc.? This is stupid. The guy (Leigh) is a hack. Probably a doc in public policy or a medical bureaucrat. Not a practicing physician busting his hump to care for his patients with ALL that that entails. I love these types-WORTHLESS! Just another BS study funded by some advocacy group or the govt. Bottom line: We do need more primary care physicians and physician extenders (for basic uncomplicated care) such as nurse practitioners (NPs) and physician assistants (PAs). And it is also true that remuneration should be increased for primary care MDs. But not by taking it from specialists. How about taking it from professional athletes, Hollywood "stars", members of Congress, AND the huge number of govt. workers who get paid (with their benefits) twice what salaries are in the private sector for the SAME work. How's that for reverse class/occupation warfare?

I'm tired of hearing about how specialists are sued more often. Many are incompetent. A friend of mine had a specialist use her as a guinea pig to get practice for the medical boards. In short, she was given a total hysterectomy with oophorectomy when she only signed off on a total one without oophorectomy. When she asked after surgery if she still had her ovaries, she was told "yes." Within three months of the surgery, she was diagnosed with bipolar disorder at age 36. She had been okay until then. She thought her mother dying six months before had just suddenly caused her to lose my mind, because she had become extremely moody. She was placed on psych meds that caused a lot of weight gain and metabolic syndrome, and she was placed on federal disability. It wasn't until ten years later when she complained about a deep pain on her side that she was sent to ultrasound by her new doctor and was told that she had no ovaries, that what she was feeling was scar tissue when she moved a certain way. She does not have bipolar disorder, but instead she is, and has been, post menopausal for the last thirteen years and that could have been treated had she known that she didn't have ovaries. She sent for the complete medical record, including the surgery report. Ovary removal is not in there. However, it does state that she asked to keep her ovaries and that her ovaries were not to be taken without waking her up and getting permission first. She had another doctor tell her to sue, because that was definitely malpractice. So sometimes these fools deserve to pay high malpractice insurance rates.

Brenda, one friend's bad experience with one specialist does not make many specialists incompetent.

Brenda, it looks like you really don't understand. The first mistake is generalizing that "many are incompetent" when you probably only have this one example. The other mistake was made by your friend. I would never go to anyone who hasn't passed their boards yet. Especially for something as intrusive as a hysterectomy. Have you ever heard of a "second opinion".

This is what I mean when I say that I take great care of my own medical needs. You have to be educated about what's going on. Doctors are human too and can make mistakes just like the rest of us but you need to go in with your eyes wide open.

To say that there aren't incompetent doctors out there would be like saying that there aren't any incompetent people either. We all know this just isn't true. Like any profession you have good ones and bad ones but you need to be aware of what constitutes one or the other. For example, I was going to a particular General that made a glaringly bad diagnosis on my son. My son had a soft tissue break in his nose and the doctor didn't catch it because he was out of his element. That break developed an infection that ate away the cartilage in his nose. He's had 2 reconstructive surgeries in order to fix the problem. I did NOT sue the doctor for this mistake although many told me I was completely in my right to do so. I had a long talk with him about his mistake and that he better take more care about such things and be ready to refer to someone else because the next time he makes that type of mistake might be the last in his practice. My son is fine, but I no longer go to that doctor.

Take responsibility for your health care! Be aware of who you're going to! If you have questions, ask! We need the generals. But we also need to be responsible, because what I'm tired of is hearing about unjustified lawsuits.

Actually, it is very possible to approach health care in this fashion. You have the right to go to a doctor or hospital and obtain an estimate of medical costs. The problem is that the average American is not knowledgeable enough to do this.

Capt. Obvious I would like your idea about being able to price compare if there was any price transperancy in it. THere are different rates for insurance companies, if medicare pays and if you pay in cash another> What realy bothers me is that if you pay they stick you with the charges that the insurance companies will not pay, that medicare will not pay. Only person that pays full price is the one that pays by themselves.

Good comment DRRJD, after all when the house is on fire you do not call your insurance company, you call the fire department.

DRRJD, Bravo!

Either a troll or have some serious jealousy issues. Either way, get some help.

Didn't get into med school, huh?

Johnny B, you are an embarrassment, and an obvious angry, bitter, and envious person. Sad.

I agree I felt some good feelings reading the article. However the replies here have shown the real challenge we have is that the general populations has limited appreciation for what we bring to the table. I admit that I would probably have gone into a specialty if I knew that this is how bad things were going to get for primary care providers - but I do still enjoy what I do. The major benefit society gets from paying primary care doctors so little is that we wont be able to retire - thats more likely to keep primary care numbers up then new doctors going into it lol

That's why doctors need stark reform and the power to unionize. Otherwise the general public, the insurance companies, and the government will never respect us. We are in fact the most skilled, most educated and most needed group of people in the nation.

I work from 8am-8pm almost every day, I have to be on call, and I have to travel to multiple facitilites. 2-3 hrs of that is spent talking to patients or family on the phone without compensation. I dont know who your primary care doc is but that person is seriously underappreciated.

I see a PA.

Who bills the same amount with years of less training lol

To Steven B- I am a patient who has seen both PA's and doctors. I will take a doctor any time! The care and level of knowledge is much better. I have also worked for doctors offices that had PA's working there. The doctors are much better. Sorry, it's just the truth!

True enough.

I wonder if that helps the GPs bottom line?

It does. I work in a 3 FP practice trying to survive with insurance companies paying 50-60% of medicare rates for visits. A practice less focused on quality of care would hire NP or PAs for a lower salary so that they can see some profit. When there is enough of a shortage of FP or IM we will just see more NP and PAs to see those folks. Of course that will lead to more testing, more referrals for specialists and more hospitalizations where the real costs of medicine lies.

If you mean that the fee paid for the PA services is going to the GP's practice with the PA drawing less of a salary than the GP, probably so, but it's also true that the PA's frequently have to consult with the doctors when they need advice on what meds to prescribe, or are unsure of the diagnosis, so the bottom line, medically speaking, is that the doctor's years of training and experience still make them more valuable than the PA. The PA is practicing under the supervision of the doctor. I have nothing personal against PA's, and they have their place, but they are not doctors.

They do give Dr's time to say something more than yea we have had some of that going around. I have had several PA's that were better than the dr's I thought.

Cant compete with the love everyone has for their specialists here. I would agree with you that decreasing pay for specialist would potentially decrease their numbers somewhat but then again we are training too many of them. I also know plumbers that get paid better then I do.

Where does the money come from? How does compensation structure in Europe compare to compensation here? Is the level of care similar, worse, or better?

Go to Canada or England with an aortic aneurysm and try to get treate, then report back to us here.

My neighbors are from Montreal, they have nothing but good things to say regarding their healthcare system. Only complaint was having to wait for some elective procedures. But you didnt tell me where the money comes from to maintain the status quo?

JamesR : that's when the 250.00 hr Lawyer gets called to sue the 50.00 hr doctor

Megabrains--The Spaniards will need plenty of coaching regarding storming the Bastille since it has nothing to with the history of Spain It is an important part of the history of France, not They (the French) celebrate it every year on July 14th, genius.

Wow! I need to write that comment down! Reminds me of a flight attendant who told me to be prepared to swim to Argentina from Chile.

Good Evening Jack. Where did the advice re swimming from Argentina to Chile come from?

I believe Jack said a flight attendant.

Just another funny miss-statement I overheard. I'm not laughing at the person (Megabrains), just the comment.

Where does the money come from? We are already spending in some cases 20% of take home income on health care. A very different delivery system is going to be required.

The question to ask is not where the money will come from, but where is it going. I wonder what percentage of this 20% is contributed to physicians. I bet you the number is going to be small. So where is it going?

TrinPA-Wonder who is paid higher, Brain surgeons or the insurance company executives?

According to fillings from the SEC for the year of 2007 Aetna's Ronald Williams made 23,045,000 a year and Cingna's Edward Hanay made 25,839,000 a year.

Well that certainly sounds like a fair salarly after all we all know the costs of keeping up a mansion in Aspen, yacht in the South of France and a Penthouse in NYC.

Best I can guess a really good brain surgen makes maybe million a year if he isnt bothered by the idea of double billing and maybe has own tv show

From a patients point of view, the Int Med and FPs have already been replaced. When I visit my IP or my children see a ped, they and I usually see a PA. The primary care folks are adding PAs to leaverage their practice. The next logical step will be PAs and NPs practicing on their own. In reality in many cases they already practice with very little supervision especially in those chain doc in the box offices.

The consumption of income (gdp) cant continue. Train wreck and single payer system is on the way.

Heart : Unfortunately I have to agree. The American public has no idea about the disaster called reimbursement. I work for a large hospital as an analyst and I'm in the middle of trying to cut costs just to keep the doors open. Medicaid / medicare reimbursement is about 30%. For the nonmedical folks out there, we get paid 30 cents on the dollar. The insurance companies have contracts with the hospital that pays anywhere from 50% to 75%. Now it's being reported that some companies are looking at the possibility of dropping their insurance and have their employees go onto the government plans. Don't expect your medical facilities to have the answers, that don't have the answer. The single most expensive item in a hospital is people. That means people will be laid off and there will be less staff to keep up the increased number of patients. The insurance companies, the supply and pharmaceutical manufacturers, and lawyers have watered the bill down so much, that I believe with Heart, we are going to have medical collapse in this country in the next 3 to 5 years. This has nothing to with Democrats or Replubicans, they both get flooded with so much money that they don't care about you, the American public.

I agree. We are headed toward collapse. Business cannot afford to keep paying a large percentage of their employees healthcare costs and remain competitive. Individuals cannot afford to pay for premium and out of pocket costs that far exceed the rate of inflation year after year after year.

Hospitals have had the affluent patients siphoned off by physician group surgury/diagnostic centers, leaving the non insured to be picked up by the hospitals. I think we are headed toward a lower level of service for the patient. Ultimately, for better or worse, I think we are headed towards socialized medicine.

The way we have refused to address seriously the problems means that you are correct. No one wants to address hard solutions.

Invalid comparison. We do not have a pubic reimbursment system for legal "care". Nor do we have the same kind of societal imperative as we do re healthcare.

So, just so we all have this clear: you were foolish enough not to see your primary care doc first and instead insisted on seeing a specialist because your co-workers said you should? Are your co-workers doctors? And then you apparently don't feel totally stupid getting on here posting about your bad decision making while complaining about your medical bill - the bill that you asked for in the first place by insisting on seeing an unneeded specialist? Go complain to your co-workers - maybe they'll pay it for you.

I have to see my PCD in order to get a reference and authorization for a specialist. Most HCP's have the same policy. Only if it is an emergency can mine bypass the system and send me there directily.

I'm sorry you chose a worthless career, but your frustration is misplaced. If your insurance didn't cover the testing the trouble lies with your insurance company, not the doctors charging a totally appropriate amount for a test. That type of testing is very complex. A 5 minute exam to you translates to a much longer period of review by the physician reading the test afterward followed by carefully crafting the report accurately. The machines are very expensive and the staff required to run this type of test (generally a tech and a nurse) need to be paid. Sometime contrast is necessary, and that material is expensive. Add in to that the overhead of all of the office staff, heating, electricity, phones, dictating systems, machine maintenance, malpractice insurance, etc. etc. etc. The actual profit from your test was very very small. Now, consider this: what if that same test had turned up something life-threatening, that you were then able to be treated for and your life was prevented from being cut short. Still too expensive?

ok, some of your points are duly noted zephyrous, but after thinking about it, I guess my beef is how the medical world is still so out of reach for the common man. I can go in for a preventive care visit paid for by insurance, but i have to stop the doctor in their tracts if they want to pursue any further tests because in all likelihood these will cost me what I make in a couple days to a couple weeks of hard labor. I am a hard working person making important business decisions daily but because my work is not life and death it is apparently 1/10th the value of a doctor's labor. Therefore I cannot afford to use that expertise if I ever really need it. So, my real life option is to eat healthy, exercise, and hope I never get sick. That's wrong. There is frustration over working hard 50 hour weeks, then if I do get sick I can't afford to fix it while the doctor drives around in a new model car wondering where all his patients went. I take responsibility for choosing my major but the damn universities need to stop offering worthless degrees or at least make students more aware of the actual options available with each degree. There is WAY to much opportunity contrast between one 4 year degree and the next.

You're still blaming doctors and universities for your own naivete. There is NO future income guarantee with any four-year degree. You aren't even guaranteed an education, just provided with the opportunity to obtain one. The rest is up to you. But you can usually safely bet that someone with 7 to 10 years more education than you have will make more money than you do.

BTW, do you really think the doctor who ordered or interpreted your echo got all of the money charged for it? They see a very small percentage of the money paid for that test, and their cut comes after all the other bills are paid. Factor in staff, expensive equipment that needs to be repaired or replaced often, insurance, and other costs of running a business, and there are occasions on which your doctor pays to take care of you.

I understand your point, Slim. But there is a significant disparity between the bill or the charges you see and what the physician gets paid. Case in point, if I get called in at 2am to put back together a fractured tibia, I may get paid (if at all) ~$500.00. This not only covers your actual surgery, but all the post op visits as they fall under a global period (can be as many as 90 days). Essentially, I may see you for 6 visits, plus the surgery for a few hundred dollars. I do hear complaints about what I get paid. What frustrates me is when someone needs four new tires on their car every two years, thats justifiable; but the leg you need to drive your car or to stand on for the rest of your life isn't?

Umm... off topic?

Way off.