Have we been deceived?

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These excerpts are all from the Journal of Medical Economics for a class I'm taking on the state of the healthcare profession. Can things really be this bad?


"I'm frustrated and disillusioned,I do not know one single M.D. who is happy right now, and many are actively looking for a way out. The system is all very broken. But the health plans, the insurance companies, are all more solvent than ever."
-Dr. Patrick Lyden, UCSD Department of Neurology

"I love being a physician, but practicing medicine is extremely frustrating when I never know how much my charges will translate into actual dollars. Medicine used to be about helping people. Our system of fragmented care is broken. It's time for the big overhaul."
-Patricia M. Martin, MD

"I'm a practicing board-certified internist, and over the past 25 years I've seen catastrophic changes to the practice of medicine in the state of Pennsylvania. Even the busiest physicians have found it impossible to keep up with their monthly costs. Overhead continues to rise at exponential rates and our reimbursement continues to fall. This explains why so many physicians have fled the state. Nevertheless, at 50 years of age with an established practice, and a family devoted to remaining in this area, I struggle to enhance the finances of my practice, while finding it more and more difficult to succeed."
-Ronald M. Block, MD

Medical Economics, Sept 2, 2005 v82 i17 p8(1)

Is this any way to run a business? (MEMO FROM THE EDITOR)(Editorial) Marianne Dekker Mattera.

Next issue we'll reveal, the results of our latest survey on physician income, and the picture isn't pretty. Primary care physicians total compensation is flat for the third year in a row and now specialists are struggling to keep up with the cost of living; some are losing the fight.

The big question is not why it's happening now, but why it didn't happen sooner. No other business in the country is forced to operate under the economic constraints that physicians in private practice have had to endure for nearly two decades. No other business in the country has its ability to price services and deal with customers curtailed by both big business and big government. No other business in the country is expected to operate successfully without knowing how much it will be paid for its services.

Yet that's just what doctors must endure. Health plans won't reveal what they pay or how they calculate payment. It's possible to be paid different amounts for the same service under the same contract by the same payer. Medicare's reimbursement formula is consistent, but it's based on mind-numbing calculations that factor in a variety of parameters including changes in the GDP over a decade.

Of late, those calculations have determined you deserve less money than you got the year before. The cut is 4.3 percent for 2006. Year after year, physicians live on edge, until Congress steps in at the last minute to offer a reprieve. What business can run that way?

And now the pay-for-performance concept is sweeping both private insurers and Medicare. On the Medicare front, the Feds face an interesting conflict in logic: theoretically, pay-for-performance will increase utilization as doctors are more diligent about getting patients in for follow-up and ordering tests and treatments according to guidelines. Yet the reimbursement formula penalizes physicians for increases in healthcare expenditures. Still, the Senate wants to pass P4P legislation without fixing the formula. The mind boggles. What's the physician-businessman to do?

Organized medicine is making itself heard on both the private health plan front and on Medicare, but the various groups don't always speak with one voice. You can join your individual voices by writing your legislative representatives.

The chair of the House Ways and Means health subcommittee has introduced a bill that throws out the current Medicare reimbursement system and includes voluntary participation in pay-for-performance, but the overall price tag for reform of the system may be too much for legislators approaching a 2006 re-election campaign to swallow. Again, you can write your representatives.

But, in the end, there may be nothing the doctor-businessman can do but leave the business. Maybe then big business and big government will take notice and give physicians the same leeway to run their business enjoyed by every mom-and-pop flower shop and deft in America.

Marianne Dekker Mattera

mmattera@advanstar.com

Originally Posted by joedoctor

These excerpts are all from the Journal of Medical Economics for a class I'm taking on the state of the healthcare profession. Can things really be this bad?

Who do you think has been deceived? That salaries have been pretty flat for a couple of years is public knowledge. That the insurance company/HMO driven system is not patient friendly or netting income comparable to the "golden age" of medicine that the prior generation practiced under is hardly a hidden fact. And that there are dissatisfied folk out there from which publications can get sound bites is hardly a revelation either. Sounds like someone needs to do some more research.

It's been said a million times here. Learn medicine to practice medicine - not to get rich.

Also - this healthcare crisis will partially be ours to solve as future physicians, and to me, that is exciting.

Sounds to me like a pretty biased class probably taught my some bleeding heart liberal... next thing you know, you'll be protesting the war for homework

If it were so bad there wouldn't be 85 people on this forum right now

Originally Posted by nimotsu

Sounds to me like a pretty biased class probably taught my some bleeding heart liberal... next thing you know, you'll be protesting the war for homework

Yeah, I forgot that the hallmark of the "bleeding heart liberals" has always been to defend business owners from market intervention by the federal government, allowing them to function in a fair market, while conservatives fight for the right of the fed government to dictate and interfere with market forces. Oh, wait, it's generally the exact opposite.

Cripes, you O'Reilly Factor loving Coulter clones sure have a skewed view of American politics. You see something you don't like and label it a "liberal conspiracy". Forgive me if I don't don a tin foil cap just yet.

Originally Posted by Jaykms

If it were so bad there wouldn't be 85 people on this forum right now

My guess is that a good percentage of applicants are naive about the extent of the situation. We're all so hell-bent and preoccupied with getting in that we don't spend enough time keeping up with the field. For one thing, it's amusing that on average there are 150 people looking at the Pre-Allo forum and 4 people looking at the HealthCare Issues forum.

I don't think I'm completely naive in wanting to enter the field, myself. I've formally studied our healthcare system in a Masters program (healthcare MBA) and I try to keep with the current situation by doing a lot of reading, but still... there's only so much you can do as a pre-med to get a real sense of the situation. I think we're all in for a pleasant surprise once we start practicing years down the line. And, I still consider myself an optimist.

Anyway, we'll see...

Originally Posted by Jaider

My guess is that a good percentage of applicants are naive about the extent of the situation. We're all so hell-bent and preoccupied with getting in that we don't spend enough time keeping up with the field. For one thing, it's amusing that on average there are 150 people looking at the Pre-Allo forum and 4 people looking at the HealthCare Issues forum.

I'm probably naive. I have an image of setting up a practice with decent hours, getting some level of respect, and having a job where i'm continually learning/challenging myself.

I'm sure everyone's been warned multiple times that Bureaucracy and politics are taking over, but nobody ever said it was an easy lifestyle. I pity the 30 year-old in med-student who realizes that theres more to medicine then saying "stick out your tounge and say ahhhh".

Money is nice and all... but if it's anyone's main motivation to get into medicine, it's probably not the best field to be in. Go into computers instead. The economy is gross, and that's public knowledge. But medicine is what you make of it, so if you're coming into this with dreams of fancy cars and a jet-setter lifestyle, you probably need to reevaluate your career goals.

Originally Posted by LabMonster

It's been said a million times here. Learn medicine to practice medicine - not to get rich.

Also - this healthcare crisis will partially be ours to solve as future physicians, and to me, that is exciting.

Listen, when you choose your job, you do it because it interests you (for whatever reason). We don't need to berate people, though, for expecting the government not to stick their fat nose in the business of physicians who demand the market value of the care that they provide.

Demanding a fair price for your services doesn't mean that you have "chosen the wrong profession".

I'm sure Lebron James loves to play basketball. But I'm damn sure if I was Lebron James I'd be certain that I'm making the money that I'm worth.

Originally Posted by chef_NU

Listen, when you choose your job, you do it because it interests you (for whatever reason). We don't need to berate people, though, for expecting the government not to stick their fat nose in the business of physicians who demand the market value of the care that they provide.

Demanding a fair price for your services doesn't mean that you have "chosen the wrong profession".

I'm sure Lebron James loves to play basketball. But I'm damn sure if I was Lebron James I'd be certain that I'm making the money that I'm worth.

I'm not sure I get your analogy. Lebron went into a profession where market forces apply. He didn't make them change the system to accomodate him, and if basketball player salaries declined over the past 25 years, he would have played for whatever the system provided, i.e. a lot less. If you don't like the system, and it's relevant to your decision, then you need to choose something else.

i don't think people are complaining about not making millions but are complaining about the difficulty of maintaining a lifestyle. "lifestyle" means an income, work hours, and autonomy that is associated with what most people perceive as a good professional job. i understand that the income pendulum may have swung too far in the physician's favor 15 years ago, but now it is going in the opposite direction. here's an example my family doctor makes less money, real annual income amount, not including inflation and what not, then he did 7 years ago. PLUS he works 15-20 more hours a week. now i am not saying that is salary is not good or 60 hours a week is too much, bc it's not. i am saying that as physicians we should stick up for ourselves and not allow the insurance companies to keep "agreeing" to pay lower and lower percentages of the bills, bc they will keep trying to do that until someone puts up a fight. yes i am going to be a physician bc i love medicine all things associated with it. But i will not stand around and watch insurance companies make money by sacrificing healthcare, that's why insurance companies should not be on the stock market but thats another story.
Bottom line i am only a student that will start med school next year and haven't any experience running a practice. But i do believe the physician to a certain extend should be involved in deciding whether a pt needs a procdure, not the insurance company.
i am interested for feedback
-mike

The more time I spend in a healthcare setting, the more convinced I become that insurance companies are The Devil. They deny patients the fundamental right to choose their own physicians. They deny doctors the right to recommend important procedures. On the uncommon occasion that they permit a procedure, the doctor can be assured that he will receive MAYBE 50% of the amount he bills, if he's lucky. If a patient suffers malpractice and sues, during the trial the insurance company places a lien on the potential winnings the recoup all of their legal expenses, thus leaving the suffering patient with nothing (I learned about that practice recently from an MD/JD).

Insurance companies are boiling cesspools of raw, naked greed. They screw the doctor, they screw the patient, and they get rich doing it. Something has to break, and I fear that it's going to happen soon. Either we'll see a total de-regulation of the industry, or we'll see national healthcare. I think the latter is more likely, given that Washington loves to legislate.

CQ

Originally Posted by thorg12

i don't think people are complaining about not making millions but are complaining about the difficulty of maintaining a lifestyle. "lifestyle" means an income, work hours, and autonomy that is associated with what most people perceive as a good professional job. i understand that the income pendulum may have swung too far in the physician's favor 15 years ago, but now it is going in the opposite direction. here's an example my family doctor makes less money, real annual income amount, not including inflation and what not, then he did 7 years ago. PLUS he works 15-20 more hours a week. now i am not saying that is salary is not good or 60 hours a week is too much, bc it's not. i am saying that as physicians we should stick up for ourselves and not allow the insurance companies to keep "agreeing" to pay lower and lower percentages of the bills, bc they will keep trying to do that until someone puts up a fight. yes i am going to be a physician bc i love medicine all things associated with it. But i will not stand around and watch insurance companies make money by sacrificing healthcare, that's why insurance companies should not be on the stock market but thats another story.
Bottom line i am only a student that will start med school next year and haven't any experience running a practice. But i do believe the physician to a certain extend should be involved in deciding whether a pt needs a procdure, not the insurance company.
i am interested for feedback
-mike

While I don't think anyone will disagree with you, I think some folks on here are naive and think that when they become a doc they will "change the system" to suit themselves, or somehow manage to run a practice the way someone they know from an older generation managed to do it. As if things haven't changed at all. The AMA will certainly continue to be a big lobbying force, but the truth of the matter is that as health care costs continue to rise for the aging voter population, and "universal health care" continues to be a nice sound bite voter issue, the pendulum is more likely to swing toward more insurance involvement, not less. With most paying customers now paying for health care through HMO type systems or governmental funds, the insurance companies get to be the gatekeepers of the medical profession. Salaries have been flat or declined for quite a few years. If reimbursements become less or more difficult to secure, then salaries will have to decline or hours increase. That is the environment into which we are entering the profession. That's totally out there and on the table, no deception at all.

i know. the concept of insurance companies was born out of the motivation of helping people be prepared for the unknown, and now they have totally evolved into the modern symbol of greed and dishonesty! they just take people's money and do everything in their power to get out of paying claims when it happens. they are parasites that get fat on people's fears of the future!!

Originally Posted by bubbleyum

i know. the concept of insurance companies was born out of the motivation of helping people be prepared for the unknown, and now they have totally evolved into the modern symbol of greed and dishonesty! they just take people's money and do everything in their power to get out of paying claims when it happens. they are parasites that get fat on people's fears of the future!!

You may not think that the first time you get sued for malpractice and don't have to lose your house.

Originally Posted by Law2Doc

You may not think that the first time you get sued for malpractice and don't have to lose your house.

actually i think the whole culture of "sue and get sued" these days is pretty screwed up in general. and opportunist lawyers and "victims" are all at fault, just as much as greedy insurance companies for the state of modern healthcare. the hospital, insurance companies, and teh law should all exist to PROTECT people, not to net greedy people money that they don't deserve!

Originally Posted by Law2Doc

I'm not sure I get your analogy. Lebron went into a profession where market forces apply. He didn't make them change the system to accomodate him, and if basketball player salaries declined over the past 25 years, he would have played for whatever the system provided, i.e. a lot less. If you don't like the system, and it's relevant to your decision, then you need to choose something else.

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Pardon the repeats - SDN needs an upgrade or something.

Originally Posted by chef_NU

From what you have said, it seems that the conclusion that you are trying to convey is:

"if you really want to be a doctor, you must sacrifice your economic justice in order to realize your dream"

I can't agree with this. I want to be a doctor. I also want economic justice. Am I going to bitch once I start practicing? You betcha. You think I hate the way that government has intruded on medical care in America? You betcha. Does that mean I'm going to be a bad (or poorly-intentioned) doctor? I doubt it.

I'm not saying that at all. And who the heck said you were going to be a bad doctor? (It's possible, but I certainly wouldn't assume it from a post on SDN). What I'm saying is that there is currently a very known and visible system in place, with pretty likely changes coming down the pike. No deception, no secrets. If you are going into a profession that's already set up that way, you (and the OP) need to go in with your eyes open. Just as you don't choose a specific med school and immediately upon enrollment go to the administration complaining that the longstanding curriculum needs to be changed and realistically expect a remedy, you don't go into a profession expecting it (or the government or insurance involvement in it) to be changed. If you are okay with the way medicine is going (give or take a little bitching), then great -- you'll do fine, and the net benefits will likely outweigh the negatives. If you are expecting some utopian practice where market forces dictate your income, where insurance companies make your life easy, and where the only problem you have is where to park your Bentley, then I think you ought to do some more research before applying. It's not about economic justice -- you are free to choose any profession you want, and some things are better tied to the laws of supply and demand than medicine. You can pick your own poison, so it's totally just.

Originally Posted by Law2Doc

I'm not sure I get your analogy. Lebron went into a profession where market forces apply. He didn't make them change the system to accomodate him, and if basketball player salaries declined over the past 25 years,

please, just because pay declines doesn't mean market forces aren't at work. the ama has a guild mentality and if there were enough mds to meet demand there wouldn't be do schools popping up everywhere. if you ask me doctors certainly get paid a lot for a profession that so many want to be involved in. it seems to me that more physicians practicing would certainly drive prices down. i read a economics classic from the 50's that mentioned this. please end rent seeking on capitol hill.

oops just had any acceptance hope rescinded by the ama.

Originally Posted by bubbleyum

i know. the concept of insurance companies was born out of the motivation of helping people be prepared for the unknown, and now they have totally evolved into the modern symbol of greed and dishonesty! they just take people's money and do everything in their power to get out of paying claims when it happens. they are parasites that get fat on people's fears of the future!!

this might come as a shock to you, but so does every business. whole foods isn't in it for the joy of being a grocer but rather to make $$$. insurance companies are in tight spot, because not only do they have to deal with doctors that are inclined to charge too much, they must keep premiums low to attract customers and adhere to reams of federal laws. one thing we can all agree on those, is that the current byzantine system makes no sense, either let people buy insurance on the market (not through employer!), with a variety of choices or nationalize it already. A heavily regulated private insurance industry serves no one.(except mebbe lobbyists)

Originally Posted by mdterps83

please, just because pay declines doesn't mean market forces aren't at work. the ama has a guild mentality and if there were enough mds to meet demand there wouldn't be do schools popping up everywhere. if you ask me doctors certainly get paid a lot for a profession that so many want to be involved in. it seems to me that more physicians practicing would certainly drive prices down. i read a economics classic from the 50's that mentioned this. please end rent seeking on capitol hill.

oops just had any acceptance hope rescinded by the ama.

I'm not sure I took the position you ascribed to me. I'm actually the one who is saying the world is what it is, so suck it up and only go into the field if you are cool with the current landscape. (I certainly am not advocating lobbying for change -- that was chef NU I think. So don't blame me for the capitol hill rent seeking)
However I do think the laws of supply and demand do not actually apply to a field that cannot set their own prices. And medicine cannot, because they get patients funnelled to them through HMO participant PCPs and generate their revenues from reimbursements from insurance companies, who set the prices.

Originally Posted by LabMonster

It's been said a million times here. Learn medicine to practice medicine - not to get rich.

Also - this healthcare crisis will partially be ours to solve as future physicians, and to me, that is exciting.

Very true!!! But solving this crisis has been the "future physicians" job for a long time now.
Doc, in general, are too stubborn to find a medium where they are all willing to work towards a greater goal.
Plus you will always have new docs, who are will be willing, to figuratively get tossed around like a rag doll.

Originally Posted by mdterps83

this might come as a shock to you, but so does every business. whole foods isn't in it for the joy of being a grocer but rather to make $$$. insurance companies are in tight spot, because not only do they have to deal with doctors that are inclined to charge too much, they must keep premiums low to attract customers and adhere to reams of federal laws. one thing we can all agree on those, is that the current byzantine system makes no sense, either let people buy insurance on the market (not through employer!), with a variety of choices or nationalize it already. A heavily regulated private insurance industry serves no one.(except mebbe lobbyists)

this might come as a shock to YOU, but i don't see whole foods making people pay up front for a sandwich in case they get hungry for lunch tomorrow, and then when the customer shows up for the sandwich next day at lunch time, try to give them all sorts of excuses why they shouldn't be asking for the sandwich.

i know every business is in it for the business. was not born yesterday. but there is still a way to do business in a legitimate, moral way and not sucking the bloodlife out of people while basically providing them no or poor service.

and excuse me if i don't feel sorry for the poor insurance companies who are in a tight spot and try to pay the doctors heaps of money while charging low premiums. wow they must not be making any money at all, gimme a break.

What if a union was started. The main problem is the lack of a strong unified voice representing heath care. You figure if doctors were even made mention of the word strike; lawyers would be crapping their pants from this side of the country to the next. Its not like you can hire scabs to replace doctors, they are a hand picked group with years of education and have enough money to hold out on a strike for a long time. If anything, it’s a far more scary notion to think of a skilled heath care strike than the bureaucracy we have to face.

As bad as things are, its obvious things could be worse. As of now I don't see a clear and present threat to patients or doctors welfare.

Originally Posted by Golddanboy

Its not like you can hire scabs to replace doctors, they are a hand picked group with years of education and have enough money to hold out on a strike for a long time.

You can open the floodgates to foreign trained doctors and let them practice here. The cushy licensing monopoly is the big stick the government has over physicians.

Originally Posted by bubbleyum

actually i think the whole culture of "sue and get sued" these days is pretty screwed up in general. and opportunist lawyers and "victims" are all at fault, just as much as greedy insurance companies for the state of modern healthcare. the hospital, insurance companies, and teh law should all exist to PROTECT people, not to net greedy people money that they don't deserve!

Yeah, I agree. This is just my opinion, but I think that there are too many lawyers in this society. If you get to the point where lawyers have to advertise on television, then you know there's too many lawyers out there. How many doctors do you see advertising on TV? I don't think I've EVER seen one. I'm not saying there aren't good lawyers - I have friends who are in law school. However, when there are so many lawyers that they have to create a demand for their services - which in most cases involves frivolous lawsuits - we have too many.

Originally Posted by bubbleyum

this might come as a shock to YOU, but i don't see whole foods making people pay up front for a sandwich in case they get hungry for lunch tomorrow, and then when the customer shows up for the sandwich next day at lunch time, try to give them all sorts of excuses why they shouldn't be asking for the sandwich.

that's a pretty big disanalogy. nobody forces you to sign up for a prepaid healthcare plan...now maybe your employer prodded you into it. plus, under HIPAA it is patenly illegal to not care for people that don't have insurance. btw, its all in the print of your hmo's contract. don't like it well than don't pay for it.

Originally Posted by bubbleyum

i know every business is in it for the business. was not born yesterday. but there is still a way to do business in a legitimate, moral way and not sucking the bloodlife out of people while basically providing them no or poor service.

and excuse me if i don't feel sorry for the poor insurance companies who are in a tight spot and try to pay the doctors heaps of money while charging low premiums. wow they must not be making any money at all, gimme a break.

business has one motive and one motive only profit. now some corporations, try to appear moral, but is only for more business and therefore more profit. sometimes, profits and morals overlap and it's all gravy. the insuree entered into a contract, just like the hmo did, and if neither side hold up their end then you are correct.

now if you feel that doctors should be paid more and get the shaft, then i suggest you join and insurance co. that will pay a reasonable salary to drs (in your mind) or start an hmo. see if you can make that work.

Originally Posted by Golddanboy

What if a union was started. The main problem is the lack of a strong unified voice representing heath care. You figure if doctors were even made mention of the word strike; lawyers would be crapping their pants from this side of the country to the next. Its not like you can hire scabs to replace doctors, they are a hand picked group with years of education and have enough money to hold out on a strike for a long time. If anything, it’s a far more scary notion to think of a skilled heath care strike than the bureaucracy we have to face.

As bad as things are, its obvious things could be worse. As of now I don't see a clear and present threat to patients or doctors welfare.

It's my understanding that docs in private practice can't do this due to anti-trust laws, and that that fact is driving an increase in HMO clinics physicians, hospitalists, and other "employee doctors" so that they can negotiate rates, etc as a group without breaking the law. Right now if one doctor discusses what kind of price break another doc is giving to insurance company A, they're engaging in anti-competitive practices, whereas if insurance company A talks about the same with insurance company B, they're just two customers being market wise. The legal solutions to this clusterfu%k seem pretty convoluted. I understand that some docs just subtly hint to their practice's office manager/secretary, who then go talk to other docs' manager/secretary to get the dirt. Sh*tty.

Originally Posted by zook

Yeah, I agree. This is just my opinion, but I think that there are too many lawyers in this society. If you get to the point where lawyers have to advertise on television, then you know there's too many lawyers out there. How many doctors do you see advertising on TV? I don't think I've EVER seen one. I'm not saying there aren't good lawyers - I have friends who are in law school. However, when there are so many lawyers that they have to create a demand for their services - which in most cases involves frivolous lawsuits - we have too many.

Not to defend lawyer advertising, because I'm not a fan of that either, but I don't think there's the scarcity of doctor ads you think. Around here certain cosmetic surgeons do run TV ads. Open any regional magazine and you will see numerous plastic surgery and laser eye surgery ads. Some medical weight loss consultants as well. You can also see medical group and hospital system ads in several major league ballparks. Not to mention that shows like Dr. 90210 are one giant ad for the several physicians followed. So, its a whole people in glass houses thing...

Originally Posted by mdterps83

that's a pretty big disanalogy. nobody forces you to sign up for a prepaid healthcare plan...now maybe your employer prodded you into it. plus, under HIPAA it is patenly illegal to not care for people that don't have insurance. btw, its all in the print of your hmo's contract. don't like it well than don't pay for it.

business has one motive and one motive only profit. now some corporations, try to appear moral, but is only for more business and therefore more profit. sometimes, profits and morals overlap and it's all gravy. the insuree entered into a contract, just like the hmo did, and if neither side hold up their end then you are correct.

now if you feel that doctors should be paid more and get the shaft, then i suggest you join and insurance co. that will pay a reasonable salary to drs (in your mind) or start an hmo. see if you can make that work.

mdtwerp83, now as we all know and have been discussing in this thread, one person can not make such a huge difference. that does not mean that we can not have an opinion and voice it. and if the voice of those opinions can become loud enough and consistent enough, then maybe there will be some people who will hear and be able to help make a difference. i am just stating my opinion as is the purpose of posting in a forum, sorry that my opinion does not agree with yours. that does not mean that i should quit trying to get into med school and should go start my own hmo instead.

i never said that i don't think doctors don't get paid enough. i was just refuting your notion that the poor insurance companies are stuck in a bind because they are trying to give the doctors all the money and making them to look like the saints that they aren't. then at the same time you are saying here that "hey every business is in it for the money, don't be naive."

you are the naive one if you think "hey nobody is forcing people to buy insurance. if they don't like it then don't get it and complain afterwards." the way the system is set up now, it's almost like you are getting screwed if you have insurance, and you are screwed if you don't have insurance. but since you are so hell-bent on defending them, i can only guess that either you or your daddy must work for an insurance company??

Originally Posted by mdterps83

that's a pretty big disanalogy. nobody forces you to sign up for a prepaid healthcare plan...now maybe your employer prodded you into it. plus, under HIPAA it is patenly illegal to not care for people that don't have insurance. btw, its all in the print of your hmo's contract. don't like it well than don't pay for it.



business has one motive and one motive only profit. now some corporations, try to appear moral, but is only for more business and therefore more profit. sometimes, profits and morals overlap and it's all gravy. the insuree entered into a contract, just like the hmo did, and if neither side hold up their end then you are correct.

ffwaaaaa.. it's like a jumbled mixture of an intro to microecon textbook.
a) HIPAA has nothing to do with whether or not you are obliged to take care of people without insurance. That would be EMTALA, and it only refers to emergency care providers having to make sure people are OK before they d/c them.
b) You can start a business for any reason and are in no way obligated to have profit as your sole (or even primary) obligation. I would refer you to dirty hippies like Ben and Jerry (before they sold out to the man).

Medicine is in a terrible, terrible place and many phsyicians are fleeing it. Just like the article said. Pensylvannia and I believe Florida? especially.

I don't want to practice medicine here in the states, except maybe pathology. This is a profoundly messed up system. We need a government system of health care like the rest of the world.

Originally Posted by Law2Doc

Not to defend lawyer advertising, because I'm not a fan of that either, but I don't think there's the scarcity of doctor ads you think. Around here certain cosmetic surgeons do run TV ads. Open any regional magazine and you will see numerous plastic surgery and laser eye surgery ads. Some medical weight loss consultants as well. You can also see medical group and hospital system ads in several major league ballparks. Not to mention that shows like Dr. 90210 are one giant ad for the several physicians followed. So, its a whole people in glass houses thing...

I see your point. I'd be afraid to live in an area where cosmetic surgeons advertise on TV Where do you live, Hollywood? I think there is a difference, however, between lawyers who advertise on TV and physicians. Lawyers who advertise on TV can offer their legal services for free in return for a percentage of each successful settlement. Cosmetic surgeons usually cater to an upper-class clientele who pay out of pocket since most procedures are not covered by insurance policies. A common bond remains, though, since I think both of those are examples of unnecessary services in most cases.

Going back to the original discussion, I think the point I was trying to make was that part of the problem with healthcare nowadays is the malpractice suits. Sure, some are legitimate, and some are not. But if the overall number of malpractice suits are increasing - which I believe I read somewhere (correct me if I'm wrong) - physicians become increasingly burdened by legal affairs when they should be practicing medicine.

Originally Posted by nimotsu

Sounds to me like a pretty biased class probably taught my some bleeding heart liberal... next thing you know, you'll be protesting the war for homework

Great post.
By the way, how many broke doctors do you know? Me?? NONE. Come on people, lets keep it real. Work hard and you will do just fine.

Physician salaries are still better than other occupations, although it seems that many lawyers have passed MDs financially. The medical field is not as lucratic as it once was and that will probably never return. But if you enjoy working with patients, then it's still a good choice.

Originally Posted by jbone

Great post.
By the way, how many broke doctors do you know? Me?? NONE. Come on people, lets keep it real. Work hard and you will do just fine.

Actually, I know a lot- my father is an opthalmologist in a nice town in Nor Cal. He's been practicing since 1969. Attended UCSF, he's AOA, does Lasik and all that stuff. His salary just got cut in HALF.
This I find out after he tells me a few weeks ago that he makes the same in dollars as he did in 1975. Let me repeat that: In Dollars.
And he's honestly the busiest physician in town, and the most well-respected eye surgeon- I have people on the street at home stop me and thank me for his work (weird). He's also the kind who has taken an apple pie from someone in exchange for an exam. And he's no bleeding-heart liberal, trust me, we argue about stuff all the time. Most of the money he's made has been from investing in stocks, and he had a small business for a while that he sold to Smith sunglasses. But that doesn't
Friends of our family who are newer doctors bought modest homes in our town, maybe $400K (that's a modest home in our town, which is a problem in and of itself) and are declaring bankruptcy.

I have no illusions about money in the healthcare industry. The insurance companies and pharmaceuticals are making lots, and doctors are not getting what people think they are. Yes there are a few cardiologists/plastic surgeons here and there who make a ton, but many don't.
Every doctor I've spoken to has definitely said, "Don't go in it for the money."
I hope my physician is not there because he or she sees dollar signs. Definitely the wrong reason to go into medicine.

As to malpractice insurance, look at Nevada- Las Vegas area- how many OB/GYNs have they lost over the last few years?

Originally Posted by jbone

Great post.
By the way, how many broke doctors do you know? Me?? NONE. Come on people, lets keep it real. Work hard and you will do just fine.

In my prior profession I dealt with quite a number of bankrupt medical practices and physicians. It happens. There are no guarantees in life, no matter how much young hopefulls on SDN would like to think there are.

Originally Posted by joedoctor

These excerpts are all from the Journal of Medical Economics for a class I'm taking on the state of the healthcare profession. Can things really be this bad?


"I'm frustrated and disillusioned,I do not know one single M.D. who is happy right now, and many are actively looking for a way out. The system is all very broken. But the health plans, the insurance companies, are all more solvent than ever."
-Dr. Patrick Lyden, UCSD Department of Neurology

HOLY CRAP!!! I'VE talked to Dr. Lyden! My dad is friends with him! I need to talk to him again obviously :\

I think the succinct message is that when somebody is trying to maximize profits when it comes to an issue as important as the health of the nation, there is a fundamental conflict of interest.

I support national healthcare because, although it has it has inherent problems evidenced by other countries that use it (long procedure times, etc.), and

you may not think insurance is the devil when you get sued and don't have to lose your house

(not exact quote i'm lazy)

the fact is that insurance companies are sometimes reimbursing as little as 50% of what they receive as payment, and they sure as hell don't have operating costs that high. HMO stocks have always been pretty-well off, even when the rest of the market has been crap.

Another thing to consider: Since the government loses such a ridiculous amount of revenue in the form of tax breaks for businesses that provide healthcare for their employees, the net effect is that the government in reality is already "spending" much more than the ~13% GDP that we appear to be, but it is going to a system that is obviously broken.

Originally Posted by SeventhSon

I support national healthcare because, although it has it has inherent problems evidenced by other countries that use it (long procedure times, etc.),

Depends on how it is implemented and how much is spent.

This report analyzes waiting times between two groups of countries. The first group has well reported problems with excessive waiting times (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom), and the second has relatively small waiting times (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States).

No huge suprise in the conclusions. Countries that have activity-based budgets for their hospitals, reimburse physicians on a fee-for-service schedule, and have higher numbers of practicing generalists and specialists, as well as higher numbers of acute care beds tend to have smaller wait times.

In contrast, if you pay doctors fixed salaries, have fixed operating budgets for hospitals, and lower capacity (both in beds and in manpower), wait times increase.

Shocking, isn't it?

Originally Posted by kimmcauliffe

Money is nice and all... but if it's anyone's main motivation to get into medicine, it's probably not the best field to be in. Go into computers instead. The economy is gross, and that's public knowledge. But medicine is what you make of it, so if you're coming into this with dreams of fancy cars and a jet-setter lifestyle, you probably need to reevaluate your career goals.

Medicine is a BUSINESS! Arghhh.

There is nothing I cant stand more than naive typically primary care types that insist medicine is the pseudoreligious moral high ground and we all should take a vow of poverty.

I went into medicine to MAKE $$$, it may not be the main motivator but it sure was a factor. Do think that devoid of the $ factor, American medicine would even remotely be as advanced as it is??? Money drives innovation AND quality, be it cardiac surgery or Burberry handbags!!!! How hard is this to understand people?!

And thank you for being the reason why this profession is going into the crapper.

No, life in medicine is not some sweeping romantic drama where we wake up everyday "for the love the game" and subsist soley off the "love" of our patients! sheesh, grow up

Originally Posted by LADoc00

I went into medicine to MAKE $$$,

Should've gone rads, my man. The bonus for full partners in my bro's practice was 860K last year.