Interesting to see what gets said. For primary care some things should really help, like immunization coverage and well care.

MD's are greedy, entitled people. The work they do isn't that challenging and the services they provide aren't worth anywhere close to what they charge for them. Cries of pain over student loans are false, it's a problem they could easily mitigate by being more frugal and less extravagant in their personal lives. Furthermore, they won't let you through the health system unless there is a real possibility it will generate government funds for their corporations. Those are the facts - maybe an agenda item at their little pow-wow should be about reducing their salaries and overhead and disengaging big-pharma so that they take in what they earn and prescribe what is actually needed.

14 years of training and incredible life altering responsibility....the only ones who feel doctors are over paid are those who are simple minded, uneducated, jealous or socialist. If you don't think that my time is worth it....stay out of my operating room and take care of your own problem. Just that simple.

If they are smart they will use some common sense ! GET RID OF THE INSURANCE COMPANIES ! As long as you have a middle man who has NO KNOWLEDGE of the professional provider / patient relationship making the decisions and directing the purse strings you are going to have a mess. The providers spend half their working lives specialising in a field and running up a huge debt - then fork over half their earnings for malpractice INSURANCE and then INSURANCE companies tell them what they should make for a particular procedure and who is eligible for what ?

Why would any M.D, want to complete a residency in "Family Medicine?" A nurse practitioner of PA can do all of that kind of thing as well as a medical doc?

My sister is a medical specialist and she is not a member of the AMA and few of her colleagues are. She is a member of the medical profession's professional association for the particular discipline of medicine that she practices. Most docs shun the AMA in favor of membership in their respective state professional associations.

Dear Mr. Harper,

Recently on my way out of the hospital after a 15 hour day, I responded to a request for help from the ICU. As an anesthesiologist I am expected to be an expert in the airway and critical life saving medicine. I responded and spent the next 90 minutes helping a 26 year old, +450lb man who was unable to breathe, ultimately rushing him to the operating room for an emergency tracheotomy. He left the hospital 4 days later alert, completely intact, and quite grateful. His insurance company paid me $248.00.

So, while you are full of @!$%# that what we do isn't challenging you are correct that the service we provide is not anywhere close to what we are paid.

Hope Meg is right.

These doctors should understand that because of these reforms I will no longer be buying insurance and will remain uninsured during my older years, which means that I will not have a doctor when I am most likely to need one. I am ready to die for my principles if need be.

I have worked in healthcare for over 30 years, and own a healthcare related business.

In my opinion, as long as doctors keep insisting on being business men and women the system will be broken. Each practice, whether it's an individual (rare) or a group practice (most common) must employee a host of support persons such a clerks, front office persons, nurses, physician assistants (PA), nurse practitioners (NP), billing personnel, and collection personnel. In addition malpractice insurance cost must be factored. All of these costs are duplicated in every practice.

These physicians can order a host of test performed by other physicians or in hospitals and they have no burden for the cost that is caused. If a patient is not insured most physicians won't see them and so the cost is shifted to hospitals. Hospitals, despite appearances and their high bills are not usually making more that 3 – 5% profit over their costs. Smaller hospitals often run in the red.

The only model that really seems works to both control cost and provide good patient care (that I have seen) is the one that Kaiser Permanente uses. All doctors are employed by the system (which happens to also be the insurer). The great majority of testing, inpatient care, outpatient care is all provided within the Kaiser system. All patient first encounters are with a PA or NP. These first-line care givers evaluate the patients, order testing and determine whether or not the needs of the patient are within their scope of practice. If the patient needs exceed their scope of practice the PA or NP makes the necessary referral to the right specialists (which include general practitioners and family practitioners). Because all cost is within the system unnecessary testing is significantly decreased.

Every one that I know that has Kaiser as their insurer loves the system. There is not usually a significant wait to be seen (I almost always have to wait 2 -3 weeks to get an appointment with my Dr.), not significant waits for complex testing or surgery.

I do not, and have not worked for Kaiser, and they are not one of my clients.

As you read the Kaiser model I have listed above you may have come to realize that for persons insured by Kaiser they are basically in a single payer system that makes doctors employees.

I know some of you are going to tell me about someone you know that had a bad experience or negative outcome at Kaiser. But that happens in healthcare regardless of the system.

True healthcare reform will mean that physicians stop being businesses and work with healthcare systems, that incentives for excessive testing is eliminated, and that quality is an ongoing concern.

I don't see this happening within the current insurance and care provider model. Change cannot be incremental, it will have to be significant and business model changing. Simply changing rates will not do the trick.

Physicians do not collectively have the guts to actually stand up for their rights against the asses in congress. They continue to threaten and put off a reduction in Medicare reimbursements and miss the entire point. Physicians are not teachers (actually they are as well), they are not construction workers or car repair people. They are the ones that have the only really important job for every human being, unless of course the human being is dead. Why is every other occupation valued, but physicians are continually being put down? Simple, the AMA is a say much but do nothing organization. It has no real clout, for if it did, this would have ended years ago.

The #1 cause of our dis-ease and downfall....MONSANTO.

That GMO stuff is killing us, not only that seeds you keep will not grow.
You have to buy a new crop of seeds each year form Monsanto.
Really look them up and pay careful attention.

Side note I am ask everyone's boss to give you a raise.
Apparently you are too poor to Pay Attention.

The biggest fail is from the insurance, that has been a scam since its inception.

Next are the pharmas and patents.
You can not make a chemical and expect it perform like nature, it pisses off Mother Nature and she retaliates.

How about some good old fashion health care.
My doctor got me off my vegan kick.
It was nearly killing me.
Now at least 3 times a week [only eat lunch] big juicy med-rare chunk of cow.
Amazing how natural fatty acids can heal you.

A different rant is the food industry itself.
Nitrates, renaming MSG [bad stuff] just to keep using it - and the FDA approved that.

Guy, 

I want to know where the people you're making those assumptions about got their training because I know for sure that none of us got paid for high school, undergrad, or med school, which amount to at least 12 years of training...If you're lucky, you get some scholarships, but even still, most people run between 100k-200k+ in debt after JUST medical school and those are figures from an in-state, public institution!  Add any possible undergrad debt to that and the figures get even more fun.  

Yes, we do get paid starting in residency, but it's far from the six digits people assume we get.  While we're starting to work on the mountain of debt we've accumulated, we're being paid between 40-50k a year, depending on your location.  Assuming we work the ACGME "80 hour week," it amounts to about $11 an hour.  Considering the fact that a lot of residents end up working 100+ hours because it only has to average out to 80 over 4 weeks, the hourly wage drops to $9.

It's only AFTER your 3-8 year residency that doctors start pulling in even a fraction of the money people assume, often incorrectly, that we receive.  Add into that what can be up to 200k a year in malpractice insurance for some specialties.  You can also consider the fact that a majority of us never got to sign up for "Ronnie's" Extravagant Lifestyle fine print as we're still struggling to pay back loans for as long as a decade or more.

Regardless of whether or not you think doctors should be paid more or less...the fact is that medical education is way out of control and will only contribute to fewer primary care physicians because who wants to pay back 200k in loans plus interest on pay that barely covers the cost of keeping your clinic open?

The MD says "make it better"--better for who and in what way? $ to MD or patient?

I've been a nurse since 1978. That's when Drs were rich, and rightly so. In the late '80s and early '90s, (MIS)managed care (HMOs, PPOs, etc) ruined healthcare. They have annihalated the Dr-Patient relationship. Employers change insurance companies, sometimes on a yearly basis. This results in employees having to change Drs because their present Dr is not on THAT insurance's panel.

Drs can no longer make swift decisions when an ill patient seeks help. Non-physicians (RNs, administrators) decide if a particular patient is allowed to have a specific diagnostic test the Dr ordered...or not! It's all for the insurance companies' bottom line. Many times a patient's care is delayed because of (MIS)managed care. I worked for the same physician from 1990 to 2002. Each year she made less money than the last, while seeing even more patients, because of the insurance companies' bottom line. So people who are not in the healthcare business haven't a clue what physician's salaries are. Unless the Dr is a surgeon, the money sucks. A CEO of our group (a non-physician) made more money than ANY of the Internists did, and got a Jaguar as a sign-on bonus! So those of you that are not in the business...well...mind your own business and keep your trap shut about something you don't know anything about.

There's a statistic that says, "about 80% of the money we spend on healthcare is used by about 20% of the population."

Bottomline: We need to shift our paradigm on how we view health. Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease. Let's be honest, you go to an MD, you're going to get a prescription for meds. That's great in that it's a good short term solution, but we need long term solutions to this enormously growing epidemic of very unhealthy americans that rely too much on meds. Modern medicine is great for emergency cases, but terrible for chronic conditions because of our faulty view of what health is and how to achieve health.

Someone on this board posted that we're living longer. We're definitely living longer, but our quality of life is worse. Medicine has made us live longer, but I'm not sure it's made our lives better.

I encourage the use of other options such as naturopaths, homeopaths, chiropractors, acupuncturists, etc. They're a lot cheaper and use natural things to help with dis-ease.

Overpay of physicians, pharmacists, and registered nurses is a major contributor of rising health care costs, but it is a sacred cow that the establishment does not want to tackle. Has it ever occurred to you that the discrepancy between medical costs and a workers salary grows every year? I would want to be in the operating room of an ignorant fool like you anyhow. Would rather die.

Not until they learn to remove appendix instead of kidney they should always be under the radar and tort law.