U.S. Physicians are paid far more relatively than in any other country.

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Sure you can blame the cost of medical education but doing that is not going to change the mess of unaffordable healthcare in the country. The obvious solution is to simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession.

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

I think younger physicians and medical students know that we're probably in for a long ride down in income in the coming years. It will barely dent this country's massive health care costs, and won't contribute meaningfully to deficit reduction, but it'll probably still happen.

Originally Posted by SteinUmStein

I think younger physicians and medical students know that we're probably in for a long ride down in income in the coming years. It will barely dent this country's massive health care costs, and won't contribute meaningfully to deficit reduction, but it'll probably still happen.

Well what do you think is needed to put a dent in the country's massive costs? The research says the physician's usual go-to of tort reform will have a negligible impact (but I agree it should be done).

http://theincidentaleconomist.com/wo...f-tort-reform/

http://theincidentaleconomist.com/wo...-red-herrings/

I normally don't reply to ignorant posts, but u sir have successfully boiled my blood...


If you are insinuating that lowering physicians salaries is a major fix to the current healthcare system, you are misled... do your research before you post in cynical forums like this please. Physician salaries only make up 20% of healthcare cost in this country. Sure some specialists make more than others and a great deal more than primary care in some instances. Are they not entitled to their salary? Do they not go through years of training and work insane hours that no other american would even touch, except for military? If you really want to target the big money makers of the system- chekc out your own health insurance company holding money back from caregivers who take all the risk and make extremely tough decisions with little time to think. Check out the pharma industry you buy your drugs from (dont even get me started).

For you to say, and I quote
"simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession." is a completely incorrect statement, the fault is not on behalf of students seeking strong education, and you won't see them disgruntled for bearing the cost of their education- there are so many factors that go into physician quality of life other than loans and how much they have to pay back!

I've said my two cents. And just to let you know- as a med student at one of the most expensive schools around, I am extremely happy here, would not go to any other school in the world because of the training I get and the caliber of students, teachers, and physicians I work with every day.

Right, because physician salaries are what drive healthcare costs in this country.

US doctors are also more qualified, by virtue of more schooling (4 undergrad, 4 medical + 3-10 residency vs 6 medical + 0-10 residency in most other countries) and a more rigorous residency, than other nation's doctors. European residencies aren't nearly as intense nor rigorous as US residencies. Furthermore, the patient population in the US is one of the most complex in the world. Moreover, the US does not have subsidized education, which leads to 200k+ in debt, while most European countries have essentially free education. US doctors are work far more than European doctors, who essentially work a 30-40 hour work week vs the 40-60+ hours here in the US. Finally, doctor salaries are only a small pie of the overall healthcare budget.

Originally Posted by SchroedingrsCat

Sure you can blame the cost of medical education but doing that is not going to change the mess of unaffordable healthcare in the country. The obvious solution is to simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession.

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

Originally Posted by SchroedingrsCat

Well what do you think is needed to put a dent in the country's massive costs? The research says the physician's usual go-to of tort reform will have a negligible impact (but I agree it should be done).

http://theincidentaleconomist.com/wo...f-tort-reform/

http://theincidentaleconomist.com/wo...-red-herrings/

Tort reform isn't going to change anything in the short run, but if we can move away from practicing defensive medicine constantly I do think it could have a significant long-term impact.

As far as actually fixing this mess we're in, any real solution I can think of would either get shot down as "socialism" by the average American, or would end in millions more Americans losing coverage and potentially bankrupting themselves any time they are admitted to a hospital. The current political climate suggests that we are headed to the latter option in the coming years.

Originally Posted by notbobtrustme

US doctors are also more qualified, by virtue of more schooling (4 undergrad, 4 medical + 3-10 residency vs 6 medical + 0-10 residency in most other countries) and a more rigorous residency, than other nation's doctors. European residencies aren't nearly as intense nor rigorous as US residencies. Furthermore, the patient population in the US is one of the most complex in the world. Moreover, the US does not have subsidized education, which leads to 200k+ in debt, while most European countries have essentially free education. US doctors are work far more than European doctors, who essentially work a 30-40 hour work week vs the 40-60+ hours here in the US. Finally, doctor salaries are only a small pie of the overall healthcare budget.

Ok great. We can all agree that this extra education, income, and money spent on healthcare would be awesome if it led to better outcomes compared to other countries. Except it DOESN'T. At all.






Also, nowhere did I argue that Physician salaries are a large part of the healthcare mess. I just pointed out that US physicians are paid more relatively than their counterparts in other developed countries (whose healthcare results and expenditures the US is desperately trying to emulate).

It is reasonable to believe that salaries will decrease as part of the solution. Sure outcomes may get worse but all our extra money and education is not giving us any better outcomes than other countries in the first place.

The US is the world's most diverse country. You can see some crazy abject poverty and then not 30 miles away, you can see some of the world's most opulent mansions. Every other country in the world is fairly homogenous in comparison. Only in America will you treat a Jew, a Mexican, an Argentinian, Irish, German, Frank, Sudanese, Italian, Chinese, Japanese and a bunch of the nationalities in the same day. And the next day, you might treat an entirely new set of ethnicities than the previous day. No other country has this diversity and that is one, of many, reasons why the US has such disparate health outcomes compared to the rest of the world.

One of the reasons our health care costs are so high is because of that high infant mortality rate. Our health care expenditures from age 1-80 are pretty much in the middle of the pack for the rest of the industrialized countries, but we have huge spikes around birth and death relative to other countries.

Why? We deliver more premature babies (hence our low life expectancy) and treat them more aggressively than any other country, and we pump a few million dollars of health care into every 85 year old with multisystem organ failure.

These points have been made a thousand times. The solution to those problems is not to pay physicians less.

Originally Posted by notbobtrustme

The US is the world's most diverse country. You can see some crazy abject poverty and then not 30 miles away, you can see some of the world's most opulent mansions. Every other country in the world is fairly homogenous in comparison. Only in America will you treat a Jew, a Mexican, an Argentinian, Irish, German, Frank, Sudanese, Italian, Chinese, Japanese and a bunch of the nationalities in the same day. And the next day, you might treat an entirely new set of ethnicities than the previous day. No other country has this diversity and that is one, of many, reasons why the US has such disparate health outcomes compared to the rest of the world.

NICE TRY. Normally I wouldnt get sucked into this but what a TYPICAL stubborn American comment!!

I know Americans like to pretend they are multicultural and know things about other countries/cultures, but Americans dont know **** about other cultures. Even if caucasian Americans are surrounded by other cultures within America, they are too stubborn to even get to know other cultures.

There is several countries that hold a similar if not more diverse population than the US AND people in those countries actually understand other cultures instead of stereotype.

How do I know this? Well im not American, but I go to med school in the US. The biggest shock about moving here was how little Americans know about other countries (to make things worse, many of these people are med students who represent the top 10% of your countries intelligence)

Love the US, it has tons of great things about it. I get the US a lot of credit for things. Being accepting towards other cultures and "Being the worlds most diverse country" is not only false but it means nothing if you are arrogant to learning about other people

Originally Posted by VisionaryTics

One of the reasons our health care costs are so high is because of that high infant mortality rate. Our health care expenditures from age 1-80 are pretty much in the middle of the pack for the rest of the industrialized countries, but we have huge spikes around birth and death relative to other countries.

Why? We deliver more premature babies (hence our low life expectancy) and treat them more aggressively than any other country, and we pump a few million dollars of health care into every 85 year old with multisystem organ failure.

These points have been made a thousand times. The solution to those problems is not to pay physicians less.

I just about had a heart attack when I found out how much it costs to keep a preemie alive in a NICU per day. And the hospital (and thus everyone) ends up eating the cost when uninsured pregnant teenagers show up in labor a few months early.

Originally Posted by SchroedingrsCat

Sure you can blame the cost of medical education but doing that is not going to change the mess of unaffordable healthcare in the country. The obvious solution is to simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession.

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

are you sure you are reading this charts correctly? I feel like Luxembourg is kicking our asses. We have a higher number of physicians working at a lower % GDP.

being below the trend line means your country has fewer physicians sucking up the same per capita GDP. We have a shiz-ton of physicians according to your chart who are raking in a similar per-capita GDP as data points with 1/2 the number of physicians.

Originally Posted by VisionaryTics

One of the reasons our health care costs are so high is because of that high infant mortality rate. Our health care expenditures from age 1-80 are pretty much in the middle of the pack for the rest of the industrialized countries, but we have huge spikes around birth and death relative to other countries.

Why? We deliver more premature babies (hence our low life expectancy) and treat them more aggressively than any other country, and we pump a few million dollars of health care into every 85 year old with multisystem organ failure.

These points have been made a thousand times. The solution to those problems is not to pay physicians less.

Can you cite a source for the 1-80 health expenditures being in the middle of the pack? Also, sure the "solution" to the entire problem isn't simply to pay physicians less but how can you justify them getting paid far more than their counterparts in other countries. Just because there is a education system with unchecked tuition hikes doesn't cut it.

Saying "even though we are paid above other averages, cutting pay won't solve the entire health system problem" is not a very strong argument... And no, you're not "entitled" to anything for your years of education. This entitlement sentiment is pretty darn high among med schoolers many of whom have never held a real job.

Originally Posted by SpecterGT260

are you sure you are reading this charts correctly? I feel like Luxembourg is kicking our asses. We have a higher number of physicians working at a lower % GDP.

being below the trend line means your country has fewer physicians sucking up the same per capita GDP. We have a shiz-ton of physicians according to your chart who are raking in a similar per-capita GDP as data points with 1/2 the number of physicians.

No check out the graph again. The average income in Luxenbourg is 80k/year (it is a very wealthy country) and the average physician specialist income is around 200k/year. 200k is 2.2 times higher than the average of that country and it makes sense that a medical specialist should be making more than double of the rest of the population average.

In the USA, the average income is about 42k (yet all these docs complain they can't survive off 100k+) and the average specialist income is about 280k. 6.5 times higher than a citizen's average income. Does it make sense that a medical specialist should be making 6.5 times more than the average citizen? Every other country (with a sustainable healthcare system) thinks not...

Originally Posted by SchroedingrsCat

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

Thankfully for us, and unfortunately for America, that's not how the free market work. Costs don't get driven down because they're 'unreasonably' high, or because they're out of line with other locations, they get forced down when the supply starts going up and/or the demand starts going down. Recently our government has moved to insure virtually every lower income American via Medicaid, and forced every state to pay Medicare rates for Medicaid patients. We also have a population that is getting fatter, sicker,and older by the day, and ever expanding range of life saving and life improving treatments that have increased the demand from the patients we already had. That is balanced against an almost static number of licensed physicians. Demand is increasing at a fantastic rate, and supply barely budging.

Unless the government finally gets aggressive enough to force us all into a national healthcare system and make working in a cash/private insurance model illegal (which I think is unlikely) I predict higher salaries in the years to come.

I've said it before and I'll say it again. I'd be more than happy to accept European style pay as long as I get European style working conditions. I'd better be working 50 hours a week max in residency, I'd better not go over 40 hours a week as an attending, I'd better be getting several weeks of paid vacation a year, and I'd better never have to work past 4 or 5 PM. Oh, I also expect all of my debt to be expunged.

As long as we can agree to these terms, go right ahead and cut my pay. Nothing I'd love more than to work M-F 8-5 during residency.

Originally Posted by Perrotfish

Thankfully for us, and unfortunately for America, that's not how the free market work. Costs don't get driven down because they're 'unreasonably' high, or because they're out of line with other locations, they get forced down when the supply starts going up and/or the demand starts going down. Recently our government has moved to insure virtually every lower income American via Medicaid, and forced every state to pay Medicare rates for Medicaid patients. We also have a population that is getting fatter, sicker,and older by the day, and ever expanding range of life saving and life improving treatments that have increased the demand from the patients we already had. That is balanced against an almost static number of licensed physicians. Demand is increasing at a fantastic rate, and supply barely budging.

Unless the government finally gets aggressive enough to force us all into a national healthcare system and make working in a cash/private insurance model illegal (which I think is unlikely) I predict higher salaries in the years to come.

Or, you know, since that is unaffordable for most of the population, DNP and PA schools popping up all over the country (along with increased care ability) to more affordably take care of most of the population.

Originally Posted by SchroedingrsCat

Or, you know, since that is unaffordable for most of the population, DNP and PA schools popping up all over the country (along with increased care ability) to more affordably take care of most of the population.

While that could certainly drive down primary care pay (which is low enough as it is) that wouldn't in any way address the glut of overpaid specialists. Even DNPs aren't yet gunning to be cardiothorasic surgeons. If anything it would increase the disparity between specialized and general care.

BTW, are you in medical school?

Originally Posted by SchroedingrsCat

Can you cite a source for the 1-80 health expenditures being in the middle of the pack?

Health care costs by country by age

Also, sure the "solution" to the entire problem isn't simply to pay physicians less but how can you justify them getting paid far more than their counterparts in other countries. Just because there is a education system with unchecked tuition hikes doesn't cut it.

Saying "even though we are paid above other averages, cutting pay won't solve the entire health system problem" is not a very strong argument... And no, you're not "entitled" to anything for your years of education. This entitlement sentiment is pretty darn high among med schoolers many of whom have never held a real job.

Health care education in other countries is subsidized. It isn't in the US. Malpractice premiums in foreign countries are kept artificially low. They are comically high in the US.

Average malpractice award in Sweden: $22,000
Average malpractice in US: $400,000

Average internal medicine malpractice insurance in Canada: $2400
Average internal medicine malpractice in Cook County, Illinois (Chicago): $41,000
Average OB/GYN malpractice in Chicago: $180,000


There are financial components of being an American physician that simply do not exist ANYWHERE else in the world. These include malpractice and education costs.

By the way, I get the feeling you aren't involved in medicine at all, SchroedingrsCat. No one in their right mind could possible believe US physicians should make $100k while working 80 hours per week, with up to 40% of that income to malpractice, on top of a few hundred thousand dollars of student loans.

Originally Posted by VisionaryTics

Health care costs by country by age



Health care education in other countries is subsidized. It isn't in the US. Malpractice premiums in foreign countries are kept artificially low. They are comically high in the US.

Average malpractice award in Sweden: $22,000
Average malpractice in US: $400,000

Average internal medicine malpractice insurance in Canada: $2400
Average internal medicine malpractice in Cook County, Illinois (Chicago): $41,000
Average OB/GYN malpractice in Chicago: $180,000


There are financial components of being an American physician that simply do not exist ANYWHERE else in the world. These include malpractice and education costs.

Residency is also very well paid in other countries. And the education is much shorter. If you took our average lifetime earnings vs. theirs you'd see less of a differential.

Originally Posted by SchroedingrsCat

Can you cite a source for the 1-80 health expenditures being in the middle of the pack? Also, sure the "solution" to the entire problem isn't simply to pay physicians less but how can you justify them getting paid far more than their counterparts in other countries. Just because there is a education system with unchecked tuition hikes doesn't cut it.

Saying "even though we are paid above other averages, cutting pay won't solve the entire health system problem" is not a very strong argument... And no, you're not "entitled" to anything for your years of education. This entitlement sentiment is pretty darn high among med schoolers many of whom have never held a real job.



No check out the graph again. The average income in Luxenbourg is 80k/year (it is a very wealthy country) and the average physician specialist income is around 200k/year. 200k is 2.2 times higher than the average of that country and it makes sense that a medical specialist should be making more than double of the rest of the population average.

In the USA, the average income is about 42k (yet all these docs complain they can't survive off 100k+) and the average specialist income is about 280k. 6.5 times higher than a citizen's average income. Does it make sense that a medical specialist should be making 6.5 times more than the average citizen? Every other country (with a sustainable healthcare system) thinks not...

pcGDP is not the same as average income (median) http://en.wikipedia.org/wiki/Median_household_income it is total wealth produced by the country per head. So basically this makes luxembourg look like there is a larger disparity between classes. But I dont think GDP and household income are exactly linked .

Is the Y axis in dollars? because it appears to be # of physicians. Either way I dont think that this data supports an argument that healthcare expenses are due to doctor salary.

U.S. medical school cost lots lots more to attend than any other countries. And the Residency salaries are much much less than any other countries in the world.

Originally Posted by SchroedingrsCat

Can you cite a source for the 1-80 health expenditures being in the middle of the pack? Also, sure the "solution" to the entire problem isn't simply to pay physicians less but how can you justify them getting paid far more than their counterparts in other countries. Just because there is a education system with unchecked tuition hikes doesn't cut it.

Saying "even though we are paid above other averages, cutting pay won't solve the entire health system problem" is not a very strong argument... And no, you're not "entitled" to anything for your years of education. This entitlement sentiment is pretty darn high among med schoolers many of whom have never held a real job.



No check out the graph again. The average income in Luxenbourg is 80k/year (it is a very wealthy country) and the average physician specialist income is around 200k/year. 200k is 2.2 times higher than the average of that country and it makes sense that a medical specialist should be making more than double of the rest of the population average.

In the USA, the average income is about 42k (yet all these docs complain they can't survive off 100k+) and the average specialist income is about 280k. 6.5 times higher than a citizen's average income. Does it make sense that a medical specialist should be making 6.5 times more than the average citizen? Every other country (with a sustainable healthcare system) thinks not...

Yes it does make sense that they should make 6.5x the average citizen since they have 6.5x the schooling and well more than 6.5x the responsibility.

How many hours are though euro docs working? Also you're comparing socialism to the north american system of full out capitalism. Everything over there is scaled down, it's not JUST physicians. What about having 200k debt vs. 0 debt? What about having more years of your life sacrificed vs. less years? What about higher risk of being sued? What about having to deal with more diverse problems? What about residency salaries?

You should keep these things in mind....

Originally Posted by SchroedingrsCat

Or, you know, since that is unaffordable for most of the population, DNP and PA schools popping up all over the country (along with increased care ability) to more affordably take care of most of the population.

Until those DNPs start killing patients due to incompetent care.

Originally Posted by VisionaryTics

By the way, I get the feeling you aren't involved in medicine at all, SchroedingrsCat. No one in their right mind could possible believe US physicians should make $100k while working 80 hours per week, with up to 40% of that income to malpractice, on top of a few hundred thousand dollars of student loans.

Based on his/her posting history, he/she is most certainly a med school reject who thinks they should bring down physician pay so that he/she can feel like they got revenge on the system.

Originally Posted by SteinUmStein

I just about had a heart attack when I found out how much it costs to keep a preemie alive in a NICU per day. And the hospital (and thus everyone) ends up eating the cost when uninsured pregnant teenagers show up in labor a few months early.

... and that's before we put them on ECMO.

Originally Posted by SchroedingrsCat

Sure you can blame the cost of medical education but doing that is not going to change the mess of unaffordable healthcare in the country. The obvious solution is to simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession.

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

Interesting. If Luxembourg were excluded, it looks like it would be a pretty nice straight line with the high US salaries commensurate with the high GDP. I wonder what the difference between predicted and actual would be without that one outlier.

Originally Posted by VisionaryTics

One of the reasons our health care costs are so high is because of that high infant mortality rate. Our health care expenditures from age 1-80 are pretty much in the middle of the pack for the rest of the industrialized countries, but we have huge spikes around birth and death relative to other countries.

Why? We deliver more premature babies (hence our low life expectancy) and treat them more aggressively than any other country, and we pump a few million dollars of health care into every 85 year old with multisystem organ failure.

These points have been made a thousand times. The solution to those problems is not to pay physicians less.

Agree c above.

Many countries just don't count those premature babies as live births and don't offer them care ($/QALY is ridiculous), so they have better numbers.

Originally Posted by dienekes88

Agree c above.

Many countries just don't count those premature babies as live births and don't offer them care ($/QALY is ridiculous), so they have better numbers.

ive heard this as well. I dont know where other countries premie line lies, though. Ive heard situations here where they know the baby just wont make it and don't do anything. However that is not to say that we wouldnt hop-to well before another country would.

Originally Posted by SpecterGT260

ive heard this as well. I dont know where other countries premie line lies, though. Ive heard situations here where they know the baby just wont make it and don't do anything. However that is not to say that we wouldnt hop-to well before another country would.

While I don't doubt there are cases where doctors talk to the parents about the chances of survival and the parents agree not to push extraordinary measures, I would be very surprised if it is common practice anywhere in the US to refuse parent demands to "do everything for my baby" no matter how bleak the outlook for the child... Just imagine the press and the lawsuits...

Originally Posted by SchroedingrsCat

Sure you can blame the cost of medical education but doing that is not going to change the mess of unaffordable healthcare in the country. The obvious solution is to simply not attend high cost schools but obviously the drive for prestige & success won't let that happen (see law school) and these students will just end up being disgruntled and a detriment to the profession.

This is one aspect of the astronomical US healthcare costs that will surely be addressed to get back in line with OECD averages, so expect salaries to go down significantly. Please just don't incessantly whine about this when you're a doc, you should know what you're going into.

Umm...can you at least normalize it per hour. Its a well know fact physicians in the US work a crap ton of hours.

Look at the UK http://news.bbc.co.uk/2/hi/health/8177878.stm their hour caps for residency is a joke compared to ours.

Pretty sure there isnt a huge difference in pay for a handful of those countries when you reduce it to per hour pay.

Originally Posted by SpecterGT260

ive heard this as well. I dont know where other countries premie line lies, though. Ive heard situations here where they know the baby just wont make it and don't do anything. However that is not to say that we wouldnt hop-to well before another country would.

Notably our experience is affected by the limited breadth of cases we see. We are all at academic medical centers, and that's where all the super sick babies go to get ECMO.

Gotta love ECMO.

Some other threads the OP has created:
Any luck with sleep aides?
What specialties can be least easily done by computers?
What specialties can least be done by mid-levels?
Moving toward two "classes" of healthcare?
Parents paying for school - animosity?

How about a screening for you for paranoid schizophrenia?

As a pediatric anesthesiologist at a large Children's Hospital, I can assure you that no expense is spared keeping essentially non viable children alive indefinitely. Children with no hope at all of recovery. We also have great success pulling them out of the ashes only to have them live for decades with completely devastating neurological impairment. By that I mean completely unable to care for themselves in any way, nonverbal, etc. Because of their condition they often require multiple surgeries, again with no expense spared (spinal fusions, peg tubes, trach, airway reconstructions, etc) hundreds of doctor visits, round the clock care, etc. Billions of your dollars completely wasted, as many do not have any private insurance. I can't tell you how much futile care occurs every day.

Cheers!

Originally Posted by IlDestriero

As a pediatric anesthesiologist at a large Children's Hospital, I can assure you that no expense is spared keeping essentially non viable children alive indefinitely. Children with no hope at all of recovery. We also have great success pulling them out of the ashes only to have them live for decades with completely devastating neurological impairment. By that I mean completely unable to care for themselves in any way, nonverbal, etc. Because of their condition they often require multiple surgeries, again with no expense spared (spinal fusions, peg tubes, trach, airway reconstructions, etc) hundreds of doctor visits, round the clock care, etc. Billions of your dollars completely wasted, as many do not have any private insurance. I can't tell you how much futile care occurs every day.

Cheers!

Ugh. Am I wrong in believing that most European countries would simply tell the parents that there's nothing they can do, that the child is going to die? (even if there's a 1% chance of them living with massive neurologic deficits after maximal expenditures)

In relation to premature births and infant mortality.
Aren't several other industrialized countries even way more aggressive than we are when it comes to resuscitating premature births? I seemed to remember a neonatologist giving a world health lecture say that in Japan they will resuscitate premies a couple weeks younger than most academic hospitals in America will.

Originally Posted by SteinUmStein

Ugh. Am I wrong in believing that most European countries would simply tell the parents that there's nothing they can do, that the child is going to die? (even if there's a 1% chance of them living with massive neurologic deficits after maximal expenditures)

As I mentioned in another post, I'm pretty sure Japan is even more aggressive than we are when it comes to kids. I don't know about Europe, but I would be shocked if they were much different than here when it comes to kids.

Originally Posted by SteinUmStein

Ugh. Am I wrong in believing that most European countries would simply tell the parents that there's nothing they can do, that the child is going to die? (even if there's a 1% chance of them living with massive neurologic deficits after maximal expenditures)

The problem is the child isn't going to die, the child has a very significant chance of living with massive neurological deficits. The question is how much value do you place on the life of a child with massive neurological deficits. Is what matters that the child can work? That he can communicate? That he can feel happy? Does it even matter if the child is conscious of his surroundings?

FWIW the standard I have always gone by is that any child capable of loving and being loved in return is viable. This is a broader standard than many other pediatricians, who consider the survival of a medically dependent, non-verbal child a tragedy. You'd be surprised how clear and intense an emotional reaction a non-verbal child can have to their parents. I don't consider that non-viable.

Originally Posted by theseeker4

While I don't doubt there are cases where doctors talk to the parents about the chances of survival and the parents agree not to push extraordinary measures, I would be very surprised if it is common practice anywhere in the US to refuse parent demands to "do everything for my baby" no matter how bleak the outlook for the child... Just imagine the press and the lawsuits...

I cannot recall the specific example I heard from another med student. I think there is a combination of forces happening here - my language implying a more dire situation than I intend and your reading making it as much more dire
I believe it was something about whether or not to induce someone at about 20 weeks due to a complication... I dont remember what happened but basically they didnt bother administering steroids because there was "no hope".

Originally Posted by SpecterGT260

I cannot recall the specific example I heard from another med student. I think there is a combination of forces happening here - my language implying a more dire situation than I intend and your reading making it as much more dire
I believe it was something about whether or not to induce someone at about 20 weeks due to a complication... I dont remember what happened but basically they didnt bother administering steroids because there was "no hope".

This is very operator dependent. The record I've seen was someone who had PROM at 14 weeks, delivered at 21 weeks. Almost complete pulomany hypoplasia, no heart beat for the first 8 minutes of life. They revived the child and put him on a vent anyway. Never did find out how it turned out.

right. there is wiggle room at the discretion of the physician. but i think the take-home message is that we are already operating within the acceptable guidelines. if the rules say "save at 25 weeks" nobody can get too upset if a physician makes the judgement call to pass on a 20 weeker just because the guy down the hall attempts all the way down to 10 (could you imagine )

Originally Posted by SpecterGT260

right. there is wiggle room at the discretion of the physician. but i think the take-home message is that we are already operating within the acceptable guidelines. if the rules say "save at 25 weeks" nobody can get too upset if a physician makes the judgement call to pass on a 20 weeker just because the guy down the hall attempts all the way down to 10 (could you imagine )

Why 10 weeks? Let's save every endangered zygote! Actually, why stop there... "Every sperm is sacred. Every sperm is great. If a sperm gets wasted, God gets quite irate."

Originally Posted by SteinUmStein

Why 10 weeks? Let's save every endangered zygote! Actually, why stop there... "Every sperm is sacred. Every sperm is great. If a sperm gets wasted, God gets quite irate."

this reminds me of a story a highschool classmate wrote entitled "shower drain babies". use your imagination.

Watch this first: http://www.pbs.org/wgbh/pages/frontl...theworld/view/

Before you guys start arguing, it would be wise to look at how other healthcare systems across the world work. If you think after watching that video, that the current US healthcare system is not flawed, then you are sadly closed-minded. Some countries whether you want to admit or not, have a healthcare system (unlike US) where the patients never get bankrupt because of medical costs. That is a big deal. Those other countries also have docs that go through the same training, hard work, bla bla, etc. and they get a smaller salary. They still make enough to live a pretty comfortable life, so I really don't understand all the greediness. It would be pretty stubborn not to learn from other countries' ideas and adopt a few.

A system has to be made for the whole of the country not to favor one population or group (i.e. doctors). I honestly, do not care if my salary goes down if the system as a whole will improve. Docs make too much anyways. If salaries is the only reason to not support Obamacare, I think that reason is not sufficient and it is a bit selfish.

cliffnotes? That got very boring very fast... I didnt make it past the intro

The U.S. healthcare system is undoubtedly broken, but it's not due to physician salaries.

Not only are payments to physicians only 20% of healthcare costs, that is just revenue. For a specialty like EM that only has malpractice and billing to pay for it's not a big deal, but for stuff like outpatient IM/FP/Peds they've gotta cover fixed costs too (~50-60%).

Basically you could decimate physician salaries and healthcare costs in this country would only budge downward 5ish percent (This is assuming you do stuff like cut primary care salaries by 50%, don't be terrible at math remember there are fixed costs outside of salary). Considering healthcare costs are growing at 5-8% PER YEAR that does basically nothing except make sure that you drive intelligent, driven people away from medicine. Maybe you add 2 years to the time until the U.S. healthcare system goes completely bankrupt.

If you want to fix healthcare it's not going to happen by chipping away at physician salaries.

Unfortunately, that's about the only politically possible thing at this point. The whole healthcare bill debate made brain hurt. "DEATH PANELS WAAAAAH."

I'm really not optimistic about the future of the system.

Other countries definitely have systems that work much better than ours that we could adopt. Reforming healthcare would involve radically changing the whole healthcare system, not just slashing reimbursements by x%, and right now that just isn't happening politically.

Also, as others have mentioned, physician salaries aren't comparable to other countries because:

1) medical school elsewhere is generally a (free) undergraduate degree
2) little to no malpractice expense in many other countries
3) U.S. physicians work 1.5-2x the hours of physicians in other countries.

Originally Posted by shadowfox87

Watch this first: http://www.pbs.org/wgbh/pages/frontl...theworld/view/

Before you guys start arguing, it would be wise to look at how other healthcare systems across the world work. If you think after watching that video, that the current US healthcare system is not flawed, then you are sadly closed-minded. Some countries whether you want to admit or not, have a healthcare system (unlike US) where the patients never get bankrupt because of medical costs. That is a big deal. Those other countries also have docs that go through the same training, hard work, bla bla, etc. and they get a smaller salary. They still make enough to live a pretty comfortable life, so I really don't understand all the greediness. It would be pretty stubborn not to learn from other countries' ideas and adopt a few.

A system has to be made for the whole of the country not to favor one population or group (i.e. doctors). I honestly, do not care if my salary goes down if the system as a whole will improve. Docs make too much anyways. If salaries is the only reason to not support Obamacare, I think that reason is not sufficient and it is a bit selfish.

When Liberals talk about an ideal healthcae system they generally talk about social justice. Does everyone get the same treatment? Do people go bankrupt over illnesses? What is the infant mortality rate? Important points? Yes, and by that measure Europe is trouncing us, and the problem is that we don't have completely socialized health care.

However when conservatives talk about an ideal healthcare system they talk about sustainability. Are we paying more an more each year for healthcare? Is there any end in sight? How do we control costs? By that standard Europe is just about as bad as we are, eating up an averageof 17% of their GDP (vs. our 21%) and on the same rising trajectory. We cannot spend every dollar we earn treating each others' hypertension. In this system the problem with our healthcare system is the uncapped benifit systems of Medicare and Medicaid, and the countries we want to emulate are the ones like Singapore that still operate on a cash market for healthcare and have held their healthcare costs to a rock steady 5% of GDP.

And, funny story, Singapore's health care outcomes are on par with Europe's. And better than ours.

Which leads to my conclusion: the misery of American healthcare is not because people are uninsured, but because they are uninsured in a market where others are insured by the government. The uncapped benifits of government healthcare programs has driven up costs to the point where they are either unavailable for average people, or when absolutely necessary are so expensive that medical care ends in bankruptcy. If we let the free market do its work we could have a better system for a fraction of the cost. However because we let our seniors buy any amount of healthcare they want with the government's money they artifically raise the cost of healthcare and price everyone else out of the market.

Originally Posted by Perrotfish

When Liberals talk about an ideal healthcae system they generally talk about social justice. Does everyone get the same treatment? Do people go bankrupt over illnesses? What is the infant mortality rate? Important points? Yes, and by that measure Europe is trouncing us, and the problem is that we don't have completely socialized health care.

However when conservatives talk about an ideal healthcare system they talk about sustainability. Are we paying more an more each year for healthcare? Is there any end in sight? How do we control costs? By that standard Europe is just about as bad as we are, eating up an averageof 17% of their GDP (vs. our 21%) and on the same rising trajectory. We cannot spend every dollar we earn treating each others' hypertension. In this system the problem with our healthcare system is the uncapped benifit systems of Medicare and Medicaid, and the countries we want to emulate are the ones like Singapore that still operate on a cash market for healthcare and have held their healthcare costs to a rock steady 5% of GDP.

And, funny story, Singapore's health care outcomes are on par with Europe's. And better than ours.

Which leads to my conclusion: the misery of American healthcare is not because people are uninsured, but because they are uninsured in a market where others are insured by the government. The uncapped benifits of government healthcare programs has driven up costs to the point where they are either unavailable for average people, or when absolutely necessary are so expensive that medical care ends in bankruptcy. If we let the free market do its work we could have a better system for a fraction of the cost. However because we let our seniors buy any amount of healthcare they want with the government's money they artifically raise the cost of healthcare and price everyone else out of the market.

to sum up where I think Johnny was going before i stopped reading....

The USA could make our stats look VERY much like the "best" countries out there and it would be very easy. However more people would experience a burden as a result of this than would benefit. The death rates and stats are deceiving.

Originally Posted by SpecterGT260

cliffnotes? That got very boring very fast... I didnt make it past the intro

One of the big points was around medical bankruptcy, here are a couple quotes from politicians they interviewed.

Q: One of the problems we have in America is that many people -- it's a huge number of people -- go bankrupt because of medical bills; some studies say 700,000 people a year. How many people in Switzerland go bankrupt because of medical bills?

A : Nobody. Doesn't happen. It would be a huge scandal if it happens.


Or from the Germans

Q:How many Germans go bankrupt in a year because of medical bills?

A: In Germany it's impossible to go bankrupt for medical bills, because even if you are bankrupt, ... the social solidarity system pays for your medical bills. The idea is, if you do have financial problems and a lot of worries for other reasons, you do not need to have another burden in not being able to pay medical bills.


Q: ... If you lose your job, what happens to your health insurance?

A: Health insurance continues with no change if you lose a job. We do know very well that people who become unemployed are at an increased risk of becoming ill, and therefore becoming unemployed is about the worst time to lose health insurance. So therefore, everyone who loses a job remains in exactly the [same] insurance system he is in.


Q:... In America, when you lose your job, we take it away
.
A: Right. ... And this is absurd. This is exactly the time when you need the support of the health care system, not additional problems by the health care system. ...


Q: Does that make sense economically?

A: I do think it makes sense. First of all, our health care system is not the most expensive; it is, [in] comparison to the U.S., about a third cheaper. And secondly, you should never underestimate the cost of having someone with a disease who is not treated, because people that are chronically ill and have no treatment, they cost in other social systems. Or they ultimately end up in the emergency room and then have inferior-quality treatment which is even more expensive. ...

Originally Posted by SpecterGT260

to sum up where I think Johnny was going before i stopped reading....

The USA could make our stats look VERY much like the "best" countries out there and it would be very easy. However more people would experience a burden as a result of this than would benefit. The death rates and stats are deceiving.

Who are you summing up again?