Doctors underpaid

[BigBoyOrtho]

there are capitalist countries with free healthcare. In fact US is probably the last developed country without accessible healthcare. In fact the country I talk about nowdays 10 times more capitalist than US nowdays.

well...do you like the idea of being paid very little for being a doctor? somone that invests time/money/EVERYTHING into potentially saving peoples' lives?

I like how much doctors are being paid right now in the US. I think it is fair for the amount of work, time, and money they invest.

its all about supply and demand. it always will be about supply and demand.

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[Avrelian]

well...do you like the idea of being paid very little for being a doctor? somone that invests time/money/EVERYTHING into potentially saving peoples' lives?

No I dont like the idea at all. It ends up with poverty for good doctors and patient's problems with bad ones. Extortions are not that rare overthere, especially in ER. Doctors and nurses getting tipped and bribed with champaign and chocolate candies. Can you imagine getting a candy from a patient as your fee?
Well at least medical education is free overthere. You even get paid some crumbs and you get a very cheap place to sleep at. Basically free. Usually, with a roommate or two. Doctors also get a free condo from the state eventually. Right away if they go to a small city/village.

I like how much doctors are being paid right now in the US. I think it is fair for the amount of work, time, and money they invest.

its all about supply and demand. it always will be about supply and demand.

I agree, but there are people, actually millions and millions of them, who rot at home becouse they cannot afford to come to a doctor .
Demand for healthcare is high, and there are not that many doctors; therefore high salaries. If USA will open 10-20-30 more medschools and will pay for tution/room&board ( same as they do for doctors/dentists for the military ) , also open a chain of state-run clinics/hospitals, US doctors will work for 50-60-70K, and noone will question their allegiance to the medecine.

 

[DoctorPardi]

well...do you like the idea of being paid very little for being a doctor? somone that invests time/money/EVERYTHING into potentially saving peoples' lives?

I like how much doctors are being paid right now in the US. I think it is fair for the amount of work, time, and money they invest.

its all about supply and demand. it always will be about supply and demand.

I think Australia's model for universal healthcare has shown to be favored by the doctors and the patients of that nation. You should check it out. No significant decrease in pay, more autonomy, all patients get to be seen, everyone wins.

 

[Towelie]

Notice that the exams you take for all your courses tend to be NOT standardized. There may be a shelf exam thrown in for good measure, but that's it. The only guy I know with a Step 1 over a 250 had a 28 on his MCAT.

I'm talking about USMLE. Not course exams.

I know 3 people over 250, all of them with over 38 on their MCAT. All of these personal stories are anecdotal, however. The fact is, MCAT has been shown to be "strongly correlated" with USMLE Step 1 scores.

 

[sirus_virus]

I'm talking about USMLE. Not course exams.

I know 3 people over 250, all of them with over 38 on their MCAT. All of these personal stories are anecdotal, however. The fact is, MCAT has been shown to be "strongly correlated" with USMLE Step 1 scores.

Not strongly. You will see a lot of high MCAT/low USMLE or Low MCAT/high USMLE people. Even the research that points to the correlation doesn't dare to call it a "strong" corelation.

 

[Towelie]

Not strongly. You will see a lot of high MCAT/low USMLE or Low MCAT/high USMLE people. Even the research that points to the correlation doesn't dare to call it a "strong" corelation.

The words "strongly correlated," as you will see in an above post, are taken directly from an Academic Medicine article reviewing the relationship between MCAT scores and USMLE scores:

Basco, W.T., Jr., Way, D.P., Gilbert, G.E., & Hudson, A. (2002). Undergraduate Institutional MCAT Scores as Predictors of USMLE Step 1 Performance. Academic Medicine, 77, S13-S16.

 

[sirus_virus]

The words "strongly correlated," as you will see in an above post, are taken directly from an Academic Medicine article reviewing the relationship between MCAT scores and USMLE scores:

Basco, W.T., Jr., Way, D.P., Gilbert, G.E., & Hudson, A. (2002). Undergraduate Institutional MCAT Scores as Predictors of USMLE Step 1 Performance. Academic Medicine, 77, S13-S16.

I had a high MCAT score and I am not for one second going to take refuge in that, because I have personally met someone with just as high an MCAT score that strugled in medschool, and his step 1 score was not that stellar either. So don't put too much stock in MCAT scores. That type of research provides general information for people trying to look at the issue in a general context(e.g medschool ADCOM), but I will be carefull to apply that information on an individual basis.

 

[Towelie]

I had a high MCAT score and I am not for one second going to take refuge in that, because I have personally met someone with just as high an MCAT score that strugled in medschool, and his step 1 score was not that stellar either. So don't put too much stock in MCAT scores. That type of research provides general information for people trying to look at the issue in a general context(e.g medschool ADCOM), but I will be carefull to apply that information on an individual basis.

Clearly. Correlations are correlations. Nothing more.

However, I would think that, in general, good standardized test takers are likely to remain good standardized test takers.

 

[sirus_virus]

Technically speaking, that is true.
However, in the real world, you need a lot more than smart and motivation to land in dermatology. It's not like it's one of the most cut throat residency program to get into. Oh wait, it is.

And this is why http://www.physicianrecruiting.com/jobs/75455/top

 

[Towelie]

And this is why http://www.physicianrecruiting.com/jobs/75455/top

Hilarious. I love how it doesn't even say where the town is.

 

[MinnyGophers]

And this is why http://www.physicianrecruiting.com/jobs/75455/top

rofl....
I wonder how many people actually applied for that.

 

[45408]

The words "strongly correlated," as you will see in an above post, are taken directly from an Academic Medicine article reviewing the relationship between MCAT scores and USMLE scores:

Basco, W.T., Jr., Way, D.P., Gilbert, G.E., & Hudson, A. (2002). Undergraduate Institutional MCAT Scores as Predictors of USMLE Step 1 Performance. Academic Medicine, 77, S13-S16.

The highest correlation anyone's ever posted was still under a 0.5, which is not nearly as strong as you seem to think, unless you know about something we don't.

 

[wrong_answer]

I think Australia's model for universal healthcare has shown to be favored by the doctors and the patients of that nation. You should check it out. No significant decrease in pay, more autonomy, all patients get to be seen, everyone wins.

I would like to point out that there is no such thing as "everyone wins." Someone must lose, and in this case, it is healthy people who pay more taxes for services they don't use. Tax in universal healthcare countries is higher than in private healthcare economies.

 

[MinnyGophers]

I would like to point out that there is no such thing as "everyone wins." Someone must lose, and in this case, it is healthy people who pay more taxes for services they don't use. Tax in universal healthcare countries is higher than in private healthcare economies.

I agree.
From personal experience, I used to live in France where they have universal healthcare. They pay taxes through the roof there. Economically, there isn't a huge a gap between the rich and the middle class, even the middle class to the lower class,compared to the U.S.
Also, a lot of people seem to think that directly implementing universal healthcare is the solution to everything, however, there are A LOT of socioeconomic effects associated with that, that a lot of people don't see or understand, and I personally do not see the majority of the middle class/upper middle class ( basically the majority of the population) ever accepting those changes in the U.S.

 

[PhantomfanMD]

your asking where all the money comes from.. A better question would be where does all the millions of dollars earned by kids who landed a lucky role go to? what do actors need 100s of millions for? if theres that much money flowing around then it could be used for better causes..

THAT'S PRIVATE MONEY! Film companies are not government supported so they can do whatever they want with their money!

 

[Towelie]

I would like to point out that there is no such thing as "everyone wins." Someone must lose, and in this case, it is healthy people who pay more taxes for services they don't use. Tax in universal healthcare countries is higher than in private healthcare economies.

This is so misleading. The fact is, the United States spends more money PER CAPITA on healthcare than any other nation in the world. And yet, there are millions of uninsured and underinsured individuals who do not have adequate access to health care. The solution is not to raise taxes, but to reform health care spending to allow more individuals to be appropriately insured.

 

[Arc]

This is so misleading. The fact is, the United States spends more money PER CAPITA on healthcare than any other nation in the world. And yet, there are millions of uninsured and underinsured individuals who do not have adequate access to health care. The solution is not to raise taxes, but to reform health care spending to allow more individuals to be appropriately insured.

With the way most politicians are going, its going to be a while before we see some significant changes. Most of them are all talk.

 

[dutchman]

This is so misleading. The fact is, the United States spends more money PER CAPITA on healthcare than any other nation in the world. And yet, there are millions of uninsured and underinsured individuals who do not have adequate access to health care. The solution is not to raise taxes, but to reform health care spending to allow more individuals to be appropriately insured.

Or as some congressmen have suggested cut doctor reimbursements.

 

[BNSN]

Here's an easy way to deal with a lack of health insurance:

End the government-enforced monopoly MD's have on drug prescription. Encourage less highly trained people to take over frontline health delivery (for common colds, aches, pains, etc), and save the MD's for where they're really needed -- surgery, specialized care to specific ailments (heart disease, cancer, psychiatric disorders), etc.

There is no reason someone needs 7 years of training to be able to prescribe Amoxil or cough syrup.

Yes? No?

 

[Law2Doc]

Here's an easy way to deal with a lack of health insurance:

End the government-enforced monopoly MD's have on drug prescription. Encourage less highly trained people to take over frontline health delivery (for common colds, aches, pains, etc), and save the MD's for where they're really needed -- surgery, specialized care to specific ailments (heart disease, cancer, psychiatric disorders), etc.

There is no reason someone needs 7 years of training to be able to prescribe Amoxil or cough syrup.

Yes? No?

Uninsured people cannot afford many prescription drugs no matter who is prescribing them, and it's rare that you can dismiss a patient as non-serious until the patient is actually examined by a trained physician. You would be chasing your tail if you sent such people to a non-physician and hope they can recognize when they are out of their league in a timely fashion. Not to mention the fact that most drugs have pretty significant medical contraindications and side effects, so its not feasible for non highly trained people to be in the prescribing role. If you give an antibiotic to someone with an unknown allergy, this becomes a medical emergency pretty quickly. More training is not a negative for this role. It's dangerous enough that people self medicate with OTC meds and herbs.

Plus I'm not sure any folks in allo are going to be excited about your suggestion of eliminating the monopoly of medicine to instead just do a relatively small percentage of functions. Once you start giving away this kind of function, the next question is going to be what else you don't really need doctors to do. You give an inch, you lose a mile. The smart approach for medicine is to lobby hard to entrench themselves against such onslaught. MD and DO should allign and use combined forces to push others back. In law, nonlawyer attempts to provide will advice, simple divorces and corporate document advice and the like have been met with lawsuits and lobbying -- the lawyers are smart enough to know when their livelihood is being threatened. Medicine should rally the same way.

 

[sirus_virus]

Here are a few implications of your genius idea

End the government-enforced monopoly MD's have on drug prescription.

i.e cut doctor's pay by at least 80%

Encourage less highly trained people to take over frontline health delivery

i.e increase lawyers pay by at least 200%

save the MD's for where they're really needed -- surgery, specialized care to specific ailments (heart disease, cancer, psychiatric disorders), etc.

i.e create more competition for already competitive specialties while drastically cutting their pay

 

[Towelie]

Here are a few implications of your genius idea


i.e cut doctor's pay by at least 80%


i.e increase lawyers pay by at least 200%


i.e create more competition for already competitive specialties while drastically cutting their pay

So, what you're saying is, you care more about your salary than reforming a completely messed-up health care system. I guess we know where your priorities are.

 

[sirus_virus]

So, what you're saying is, you care more about your salary than reforming a completely messed-up health care system. I guess we know where your priorities are.

Are you saying you don't mind practicing medicine for 80% less money while carrying your 150k debt?

 

[BNSN]

Here are a few implications of your genius idea


i.e cut doctor's pay by at least 80%


i.e increase lawyers pay by at least 200%


i.e create more competition for already competitive specialties while drastically cutting their pay

All your complaints deal with MD compensation. I'm talking about improving health care, not making sure you have a lot of money.

I'm interested in mental health and work on a suicide health line, and if it means I have to take a 20% pay cut as a psychiatrist in the future so more people can have better mental health, well, I'll just have to tell my wife she won't get as many diamond rings in a year.

But, anyways, you won't see a significant reduction in compensation. I'm talking about the first line of health care delivery -- not specialized procedures. When you're talking about specialized procedures, those will always be done by MD's, because they're the only ones trained for it.

Uninsured people cannot afford many prescription drugs no matter who is prescribing them, and it's rare that you can dismiss a patient as non-serious until the patient is actually examined by a trained physician. You would be chasing your tail if you sent such people to a non-physician and hope they can recognize when they are out of their league in a timely fashion. Not to mention the fact that most drugs have pretty significant medical contraindications and side effects, so its not feasible for non highly trained people to be in the prescribing role. If you give an antibiotic to someone with an unknown allergy, this becomes a medical emergency pretty quickly. More training is not a negative for this role. It's dangerous enough that people self medicate with OTC meds and herbs.

Plus I'm not sure any folks in allo are going to be excited about your suggestion of eliminating the monopoly of medicine to instead just do a relatively small percentage of functions. Once you start giving away this kind of function, the next question is going to be what else you don't really need doctors to do. You give an inch, you lose a mile. The smart approach for medicine is to lobby hard to entrench themselves against such onslaught. MD and DO should allign and use combined forces to push others back. In law, nonlawyer attempts to provide will advice, simple divorces and corporate document advice and the like have been met with lawsuits and lobbying -- the lawyers are smart enough to know when their livelihood is being threatened. Medicine should rally the same way.

Of course they won't be thrilled. But MD's will always have a place -- I just don't think there place is in ALL health care delivery. MD's are expensive to see because they are so highly trained.

Anyways, I disgaree with your saying that I want MD's to take over a small number of functions. They will still be the majority -- just not for common colds or rashes or anything like that. And the wealthy can still see an MD for a cold -- but the poor can see a nurse practitioner or someone else for that. Those who have the money will still go to the best, i.e. the MD.

And I have never gone to a doctor with something trivial and found out it was serious. It happens, but I doubt a lot. As for drug coverage, that's a very fair comment. I don't have any suggestion about that to be honest.

Anyways, I don't want to step on anyone's feet. I'm just an undergrad, and I could be 100% wrong. I just wanted to throw out that idea about ending MD monopoly to get a discussion.

 

[Towelie]

Are you saying you don't mind practicing medicine for 80% less money while carrying your 150k debt?

80% less? You're on crack. A better healthcare system could be put in place without lowering doctors' salaries by anything substantial. It certainly wouldn't be 80%. We spend more per capita on healthcare than any other nation in the world (more than twice the OECD average). We can afford to restructure our system to broaden insurance coverage, without impacting physicians' salaries (which are not a result of the governmental contribution to healthcare spending).

And I won't be 150K in debt.

Obviously, I want a high salary as much as the next person. Part of implementing a national healthcare system would have to be lowering (if not eliminating) the cost of medical education, as other nations do. Don't you think it a bit strange that we are the only industrialized nation without universal healthcare (with the exception of Mexico and Korea)?

 

[notdeadyet]

Good lord, folks. If you think doctors get paid too little money, go into another field. The element of whining is a bit tired.

Do a spreadsheet and take a look at the projected salary even with $150K debt and compare it to almost any other job. You will make more money over the course of your career than just about anybody, even with big money loans. Do a spreadsheet and work it out.

Are the hours long? Yes. Is the respect for the profession declining? Yes. Is the red-tape and hassles associated with beinga physician growing? Yes. But this is true of many of the highest paying professions.

But lord, these threads. If you think doctors make bank, good for you. If you don't, carefully evaluate your decision, but please don't whine about it. The other 99% of americans you'll be outearning do not want to hear about it.

 

[Trismegistus4]

Obviously, I want a high salary as much as the next person. Part of implementing a national healthcare system would have to be lowering (if not eliminating) the cost of medical education, as other nations do. Don't you think it a bit strange that we are the only industrialized nation without universal healthcare (with the exception of Mexico and Korea)?

You know, I have to butt in here and say that there are respectable arguments for universal healthcare, even if I ultimately disagree with them, but I've never understood the appeal of this "all the other countries are doing it" argument. It comes up a lot on the subject of the death penalty, too ("The USA is the only Western industrialized nation that..."). Didn't we learn anything from our mothers' saying "If all the other kids jumped off a bridge, would you jump too?"

 

[Law2Doc]

And I have never gone to a doctor with something trivial and found out it was serious. It happens, but I doubt a lot.

That is a bizarre statement. The fact that you never hit a snag does not negate the fact that some percentage of people who go to the doctor actually need a doctor. Plenty of people who go to the doctor are really sick, and it won't always be obvious without a thorough medical workup. Drug allergies are not that rare. There are people who genetically are unable to metabolize certain meds correctly as well. And people who get into trouble with meds due to undiagnosed liver and kidney function issues. And under your plan having nonphysicians dispensing meds without adequate examination would likely be lethal. Sure the majority can take meds without problem but what if someone you care about is in that minority. And, it's not only allergies but also complications from contraindications, cross reactions of prescription things and non-prescription things and the like. When someone starts to crash after being medicated, you better have a doctor close by or that person is most likely dead. Sure it doesn't happen that often. But that is like saying you have no problem playing russian roulette because most of the time you come out of it fine. I don't think much of this plan. Let people go to doctors first, and if they are healthy, then they can be referred to nonphysicians for non-medical care (as is done for things like physical therapy).

 

[sirus_virus]

Here's an easy way to deal with a lack of health insurance:

End the government-enforced monopoly MD's have on drug prescription. Encourage less highly trained people to take over frontline health delivery (for common colds, aches, pains, etc), and save the MD's for where they're really needed -- surgery, specialized care to specific ailments (heart disease, cancer, psychiatric disorders), etc.

There is no reason someone needs 7 years of training to be able to prescribe Amoxil or cough syrup.

Yes? No?

Well I must say that it is only on the pre-allo forum that you can find this type of delirium. You will be hard pressed to find someone say this type of stuff on the residency or specialty forums(the actual guys in the trenches). Keep working on those interview statements guys, and when you go to your interview make sure you remind the MD interviewing you that you would like to cut down on his monopoly on prescriptions. Also remind the interviewer that you are willing to work for free. I am sure he/she will marvel at your wisdom and humility.

 

[45408]

And I have never gone to a doctor with something trivial and found out it was serious. It happens, but I doubt a lot.

You'd be wrong. I brought a guy to the hospital once with a severe headache, nothing else. He died in the OR later that die from his brain aneurysm. Or collapsing in the elevator and later dying from a pulmonary embolism.

 

[Towelie]

You know, I have to butt in here and say that there are respectable arguments for universal healthcare, even if I ultimately disagree with them, but I've never understood the appeal of this "all the other countries are doing it" argument. It comes up a lot on the subject of the death penalty, too ("The USA is the only Western industrialized nation that..."). Didn't we learn anything from our mothers' saying "If all the other kids jumped off a bridge, would you jump too?"

So universal health care or eliminating the death penalty is tantamount to "jumping off a bridge"? Riiiight. Compare the infant mortality rates in the US to those in nations with national healthcare. Compare the rates of death of absurd causes, like malnutrition. Or just look at the WHO rankings, which puts the US healthcare system at 37th (!) in the world. Look at surveys of satisfaction with healthcare in other countries, and compare that to the United States. All of these things point to the necessity of universal healthcare in this country.

The "other countries are doing it" argument certainly has merit. Countries aren't immature children, as your analogy describes. If EVERY industrialized nation is doing something that we are not, it might be worth looking into. That applies to universal healthcare, as it applies to the death penalty.

 

[deleted87716]

End the government-enforced monopoly MD's have on drug prescription.

Brilliant. While you're at it, let's end the "monopoly" that the police have on law enforcement. Why pay all those taxes when you can just buy an Uzi and take care of yourself? How' bout that "monopoly" those darn teachers have on public education? You can save a bundle by homeschooling! Don't forget about that "monopoly" the public utilities have. I'll bet your electricity would be a lot cheaper if those power companies had some competition from Joe's Crab House and Nuclear Power Plant.

 

[8744]

So universal health care or eliminating the death penalty is tantamount to "jumping off a bridge"? Riiiight. Compare the infant mortality rates in the US to those in nations with national healthcare. Compare the rates of death of absurd causes, like malnutrition. Or just look at the WHO rankings, which puts the US healthcare system at 37th (!) in the world. Look at surveys of satisfaction with healthcare in other countries, and compare that to the United States. All of these things point to the necessity of universal healthcare in this country.

The "other countries are doing it" argument certainly has merit. Countries aren't immature children, as your analogy describes. If EVERY industrialized nation is doing something that we are not, it might be worth looking into. That applies to universal healthcare, as it applies to the death penalty.

Whoa. Our infant mortality rates are a combination of two factors. The first is that we try to save preemies who our European cousins, whether rightly or wrongly, wouldn't touch but instead hand to the mother and say, "There's nothing to do."

Second, most of the infant mortality comes from the poor, people who's children are fully covered under medicaid in every single state. If they don't have their pre-natal visits or avail themselves of free health care for their babies it's because of their ignorance, drug abuse, laziness, apathy, or just plain, old-fashioned stupidity. Their children have access to health care. It's a myth that they don't.

As for malnutrition, as anybody with eyes can tell you, the problem afflicting our poor is obesity, not malnutrition. You can tell somebody's socioeconomic class by their throw-weight. The poorer they are, the fatter they will be. It's almost axiomatic. The typical welfare family waddles in following their single mother like so many hippos following momma to the wallow.

Now, if you want to talk about that I'd be perfectly happy to listen to your explanation of what's wrong with our people (particularly the poor) that they stuff enough food into their gullets on a daily basis to choke a small village in Bangladesh.

But malnutrition? Dude. the only malnourished people I have ever seen are the chronic alchoholics and the junkies.

 

[8744]

So universal health care or eliminating the death penalty is tantamount to "jumping off a bridge"? Riiiight. Compare the infant mortality rates in the US to those in nations with national healthcare. Compare the rates of death of absurd causes, like malnutrition. Or just look at the WHO rankings, which puts the US healthcare system at 37th (!) in the world. Look at surveys of satisfaction with healthcare in other countries, and compare that to the United States. All of these things point to the necessity of universal healthcare in this country.

The "other countries are doing it" argument certainly has merit. Countries aren't immature children, as your analogy describes. If EVERY industrialized nation is doing something that we are not, it might be worth looking into. That applies to universal healthcare, as it applies to the death penalty.

The UN. Riiiiight.

 

[dutchman]

Here's an easy way to deal with a lack of health insurance:

End the government-enforced monopoly MD's have on drug prescription. Encourage less highly trained people to take over frontline health delivery (for common colds, aches, pains, etc), and save the MD's for where they're really needed -- surgery, specialized care to specific ailments (heart disease, cancer, psychiatric disorders), etc.

There is no reason someone needs 7 years of training to be able to prescribe Amoxil or cough syrup.

Yes? No?

 

[NonTradMed]

Good lord, folks. If you think doctors get paid too little money, go into another field. The element of whining is a bit tired.

Do a spreadsheet and take a look at the projected salary even with $150K debt and compare it to almost any other job. You will make more money over the course of your career than just about anybody, even with big money loans. Do a spreadsheet and work it out.

Are the hours long? Yes. Is the respect for the profession declining? Yes. Is the red-tape and hassles associated with beinga physician growing? Yes. But this is true of many of the highest paying professions.

But lord, these threads. If you think doctors make bank, good for you. If you don't, carefully evaluate your decision, but please don't whine about it. The other 99% of americans you'll be outearning do not want to hear about it.

I think SDN tends to the two polar extremes: the altruistic "I'll work for free and beg for food so I can practice medicine" to the "I'm just here to make bank" notion. Medicine is neither and both. There's money to be made, and there's people you will help. People need to understand that, like any job, there are positives and negatives to be had with all professions and there is a 'grass is greener' mindset by many. My old job had plenty of programmers that were making $60-70k who thought entering medicine was just so cool and that I was 'smart' for having gotten out of the IT field and entering the 'lucrative' world of medicine. My parents are researchers at BigPharm and they also hate their field and think I'm 'smart' for not doing research and entering medicine, a field they view as far more lucrative and financially secure than their own. Everyone has this idea that they are getting the shortend of the stick. I just figure, if I'm going to get the shortend, might as well get one that allows me to do some good, make some money and do stuff to people that would otherwise be illegal.

The UN. Riiiiight.

What's wrong with the WHO? They help to erradicate smallpox and are on their way to erradicating polio. The UN has many problems but the fundamental idea of countries gathering together is still a good one and world health care has benefited from such a joing effort. I'm actually interested in doing some work for them.

Btw, good blog. I think it's pretty humorous but I don't consider it 'balanced' in terms of good and bad stuff in medicine because you do tend to tilt toward the 'jaded/cynical' approach but I guess I can see where you are coming from with that attitude.

If I ever did a blog about the IT indusry (an occupation I had previously worked at for two years), I'm sure I would also be pretty jaded and surly about what I did simply to counteract the unrealistic expectations that some of my college friends have for the field:

"isn't it great, you get to work 40 hours and then you have thousands of dollars to spend on fun stuff!"

"Working is much less stressful than school because there's no exams!"

"I'll be making six figures within a few years" (I hear that on SDN as well....I wanna know these mysterious six figure programming jobs for 22 year olds are outside of SanFran....)

"you just work and they'll promote you to management and you'll make $200k easily!" etc.

Premeds are no different in this regard. I guess I should be glad I worked for a few years, gave me perspective on what it takes to keep down a job fulltime.

 

[Towelie]

But malnutrition? Dude. the only malnourished people I have ever seen are the chronic alchoholics and the junkies.

Over 3400 Americans die each year from malnutrition. Influenza kills over 80,000 per year: (http://www.cdc.gov/mmwr/preview/mmwrhtml/00039389.htm).

These are things that just shouldn't happen in a developed country, let alone one as rich as ours.

 

[Miami_med]

What's wrong with the WHO? They help to erradicate smallpox and are on their way to erradicating polio. The UN has many problems but the fundamental idea of countries gathering together is still a good one and world health care has benefited from such a joing effort. I'm actually interested in doing some work for them.

I think P. Bear was actually trying to get at the fact that this information is heavily biased. I tend to agree. The vast majority of countries that contribute to the UN and WHO have universal healthcare and they thus base quality indicators on things that go up in a universal system. If speed or technology had ANYTHING to do with these things, the US would win hands down. I'm actually not trying to claim a superiority, just how the criteria can change the winner.

Infant mortality indicator comparisons are inherintly biased, as no two countries calculate them alike. Life expectancy is also a poor indicator with a reasonable margin of error, as outside factors influence this that have nothing to do with medicine. In the US, non-minority populations probably fare just as well as our European counterparts in life expectancy. This means that we have a social problem, not a healthcare problem.

As an example, If I decide that a major indicator for my "healthcare rank" is the number of uninsured, and I then give universal healthcare, I will improve my rank, even if my healthcare is universally poor.

Of course, some of us do not care much for the UN regardless of the fact that so many people are so enamored with it.

 

[Miami_med]

Over 3400 Americans die each year from malnutrition. Influenza kills over 80,000 per year: (http://www.cdc.gov/mmwr/preview/mmwrhtml/00039389.htm).

These are things that just shouldn't happen in a developed country, let alone one as rich as ours.

How many of them were junkies or alcoholics?

As to your last statement, I would ask why? Why shouldn't they happen? How do you intent to stop people from making poor life choices? Anyone (and I mean ANYONE) in the US can find a minimum wage job and buy food unless they are horrendously disabled or incredibly unwilling. The other day, I saw a bag boy at the grocery store with Down's Syndrome. Anyone who thinks that most of the people that we are supposed to feel sorry for couldn't do that job is truly insulting those people.

Also, there are SO many programs in the US to give poor people food, that anyone who doesn't have food hasn't been looking very hard. We have foodstamps, welfare, WIC for the poor with infants, and every charity in the country seems to feed the homeless. It is just so politically incorrect to point this out, that people continue to believe that there are actually people starving in the US who are looking for food instead of drugs.

 

[dutchman]

Over 3400 Americans die each year from malnutrition. Influenza kills over 80,000 per year: (http://www.cdc.gov/mmwr/preview/mmwrhtml/00039389.htm).

These are things that just shouldn't happen in a developed country, let alone one as rich as ours.

Wow dude! you are actually serious about this stuff. So why don't you share a couple of your plans on combating malnutrition and influenza with us

 

[DulcimerDude]

As for malnutrition, as anybody with eyes can tell you, the problem afflicting our poor is obesity, not malnutrition. You can tell somebody's socioeconomic class by their throw-weight. The poorer they are, the fatter they will be. It's almost axiomatic. The typical welfare family waddles in following their single mother like so many hippos following momma to the wallow.

Pretty much agree with this unfortunately. A little personal story - when I decided to go back to school I quit my full time job (which I couldn't work whilst in school) and began looking for a new one. It turned out to be a little harder finding what we needed than I thought and so after our savings was gone, things got exciting for a couple of months on my very part time salary (until I found a great overnight job!) During that time my wife decided to go out and apply for food stamps seeing as that we had payed our taxes for years and now we actually had some need! I did not qualify for food stamps due to my work status, but she and our kid (just 1 at that time) did qualify. So one adult and one little kid. The food money she got those couple of months was beyond belief. It was FAR MORE MONEY per month than we had been spending on the three of us. We ate like freaking kings until we went off the program just a couple of months later, we must have all gained 10 pounds - and not because of all of the cheap junk foods that poor people supposedly eat all the time, but because we were pretty much able to afford to eat steak every night. We got back to work full time after just 2 months of that and got off the program right away, and had to go back to eating far less and far lower quality food.

Let me say, it was just mystifying. After that we felt pretty guilty (because we had thought we'd get a little help when we needed it, not be eating like kings off of the government) and were also really mad at the people who live like this all the time off of our taxes without even trying to get employment. But then, can you blame them? So if we want more money to treat the poor and underinsured in our country, I say cut some food stamps and put it into healthcare. I mean, good God, you would not believe the money a family of 2 gets for food in a month. As for a family of 8, I can't even begin to imagine. A little off subject but still perhaps relevent in some way.

 

[8744]

Btw, good blog. I think it's pretty humorous but I don't consider it 'balanced' in terms of good and bad stuff in medicine because you do tend to tilt toward the 'jaded/cynical' approach but I guess I can see where you are coming from with that attitude.

I am not jaded. I am endlessly fasicinated by the medical profession and most of my patients. In fact, one of the selling points of Emergency Medicine is that it can be something of a freak show. If I was jaded I would be too bored to write my blog.

Everybody likes a freak show.

I am cynical but only because there's a lot to be cynical about.

And I never claim to be balanced. I try to be fair but on the other hand I tell it like I see it. The only comments I delete are the ones with ad hominem attacks (and spam) and if the attacks were creative (instead of "U R a moran") I'd leave them posted too. Everyone who disagrees with me is welcome to post their comments so long as they have a certain level of good manners or can at least curse creatively.

 

[8744]

Over 3400 Americans die each year from malnutrition. Influenza kills over 80,000 per year: (http://www.cdc.gov/mmwr/preview/mmwrhtml/00039389.htm).

These are things that just shouldn't happen in a developed country, let alone one as rich as ours.

Whoa. 3400 out of a population of 300,000,000 or almost one third of a billion? I have have seen, just in my personal corner of the United States, at least five deaths due to starvation and every one of them was a junkie, and alcoholic, or psychotic. What can we do? We can't round up every terminal crack addict and force-feed them.

I also once saw a five-year-old who had been starved and abused by his psychotic parents. In what utopia do you think this kind of thing could be prevented?

As to influenza deaths, you know that most of the 80,000 are the elderly. Let's say my 85-year-old mother-in-law gets the flu, requires hospitalization, and later dies of a superimposed pneumonia. (It happens) Is that the same as saying that the Four Horsemen are abroad and we must wear sackcloth and ashes?

I realize that there is a lot to criticise in the way health care is bought and sold in our country but let's not get silly about it. A few random people starving themselves to death (for whatever reason) in a country of 300 million is nothing but an abberation and not the symptom of any problem feeding people.

Hey, didn't 15,000 French nursing home patients die like dogs one summer because the doctors and nurses in the most advanced friggin' country on earth with one of the most socialistic health systems in the Western world decided to go to the Cote D'Azur for the summer?

 

[deleted87716]

Influenza kills over 80,000 per year

Incorrect. The number of influenza deaths annually in the U.S. is less than half that.

http://www.cdc.gov/flu/keyfacts.htm

 

[Faebinder]

1) Infant Mortality high in the US?

Here is wikipedia's figure for the infant mortality rate... I see the US is low.. WTF is this claim of high infant mortality... the definition is here and it does not include premies.. so if you read some stupid rating that includes premies then you are messing up.

 

[sdn1977]

All your complaints deal with MD compensation. I'm talking about improving health care, not making sure you have a lot of money.

I'm interested in mental health and work on a suicide health line, and if it means I have to take a 20% pay cut as a psychiatrist in the future so more people can have better mental health, well, I'll just have to tell my wife she won't get as many diamond rings in a year.

But, anyways, you won't see a significant reduction in compensation. I'm talking about the first line of health care delivery -- not specialized procedures. When you're talking about specialized procedures, those will always be done by MD's, because they're the only ones trained for it.



Of course they won't be thrilled. But MD's will always have a place -- I just don't think there place is in ALL health care delivery. MD's are expensive to see because they are so highly trained.

Anyways, I disgaree with your saying that I want MD's to take over a small number of functions. They will still be the majority -- just not for common colds or rashes or anything like that. And the wealthy can still see an MD for a cold -- but the poor can see a nurse practitioner or someone else for that. Those who have the money will still go to the best, i.e. the MD.

And I have never gone to a doctor with something trivial and found out it was serious. It happens, but I doubt a lot. As for drug coverage, that's a very fair comment. I don't have any suggestion about that to be honest.

Anyways, I don't want to step on anyone's feet. I'm just an undergrad, and I could be 100% wrong. I just wanted to throw out that idea about ending MD monopoly to get a discussion.

Its a good thing you mentioned you're still an undergrad....and you did indeed get your discussion.

I'm a pharmacist & you probably think the 8 years it took me to get my degree was pretty worthless because all I do is pour your cough syrup or add water to your kid's amoxicilin. As a matter of fact...yesterday I was filling a premed from a dentist for erythromycin. But...the dentist didn't know the pt was on chronic Sporanox..didn't even know what it was. But...the combination could have landed the pt in a world of hurt.

So...until you walk in our shoes....don't assume another's job is easy. I deal with medications every day. I could not nor would not want to take on the job of the prescriber. Its hard enough for me to get the pt to take the medication the way its supposed to be taken & safely!

As for your example of a cold or a rash...well....I get those folks every day. I try to keep them out of prescribers offices - most colds go away in 5-7 days without treatment & rashes can be dealt with otc medications. If the issue doesn't resolve within that time....or there are extenuating circumstances......I send them on to the physician.

One day....you may indeed walk into your physician's office & get a diagnosis which was not trivial. You may be grateful you actually saw a physician & not someone who knew only the first choices your symptoms reflected!

 

[tncekm]

Its a good thing you mentioned you're still an undergrad....and you did indeed get your discussion.

I'm a pharmacist & you probably think the 8 years it took me to get my degree was pretty worthless because all I do is pour your cough syrup or add water to your kid's amoxicilin. As a matter of fact...yesterday I was filling a premed from a dentist for erythromycin. But...the dentist didn't know the pt was on chronic Sporanox..didn't even know what it was. But...the combination could have landed the pt in a world of hurt.

So...until you walk in our shoes....don't assume another's job is easy. I deal with medications every day. I could not nor would not want to take on the job of the prescriber. Its hard enough for me to get the pt to take the medication the way its supposed to be taken & safely!

As for your example of a cold or a rash...well....I get those folks every day. I try to keep them out of prescribers offices - most colds go away in 5-7 days without treatment & rashes can be dealt with otc medications. If the issue doesn't resolve within that time....or there are extenuating circumstances......I send them on to the physician.

One day....you may indeed walk into your physician's office & get a diagnosis which was not trivial. You may be grateful you actually saw a physician & not someone who knew only the first choices your symptoms reflected!

b-e-a-utiful

 

[NonTradMed]

I think P. Bear was actually trying to get at the fact that this information is heavily biased. I tend to agree. The vast majority of countries that contribute to the UN and WHO have universal healthcare and they thus base quality indicators on things that go up in a universal system. If speed or technology had ANYTHING to do with these things, the US would win hands down. I'm actually not trying to claim a superiority, just how the criteria can change the winner.

Infant mortality indicator comparisons are inherintly biased, as no two countries calculate them alike. Life expectancy is also a poor indicator with a reasonable margin of error, as outside factors influence this that have nothing to do with medicine. In the US, non-minority populations probably fare just as well as our European counterparts in life expectancy. This means that we have a social problem, not a healthcare problem.

As an example, If I decide that a major indicator for my "healthcare rank" is the number of uninsured, and I then give universal healthcare, I will improve my rank, even if my healthcare is universally poor.

Of course, some of us do not care much for the UN regardless of the fact that so many people are so enamored with it.

I think universal healthcare systems works in that most people are stuck in the middle in terms of healthcare, while a system such as the US, which is partially based on gov't and partially on private insurance, means that there is a huge disparity in terms of quality of care, which can lower the 'average' indicator quality of life or whatever people are going by---kind of like doing an exam where everyone does avg vs where people are all over the place, you may get differing means and medians depending on the distribution.

I agree that our problem with providing substandard care is that there is a subset of population not getting access to healthcare (namely, those that are the 'working poor'---too rich to get free care, too poor to buy their own care). So it is a social problem we have, but that doesn't mean that the US does well in healthcare just because 'nonpoor people have good care'. Obviously, countries like Sweden have better care in part due to a smaller country with a much more managable population and a smaller subset of 'poor people' to manage, so the US has that disadvantage as well. Larger populations typically are harder to manage by the gov't, so in that way, the US will probabaly always trail other developed nations in terms of many indicators of life....beacuse we have a wider variation of populace.

 

[Miami_med]

I think universal healthcare systems works in that most people are stuck in the middle in terms of healthcare, while a system such as the US, which is partially based on gov't and partially on private insurance, means that there is a huge disparity in terms of quality of care, which can lower the 'average' indicator quality of life or whatever people are going by---kind of like doing an exam where everyone does avg vs where people are all over the place, you may get differing means and medians depending on the distribution.

I agree that our problem with providing substandard care is that there is a subset of population not getting access to healthcare (namely, those that are the 'working poor'---too rich to get free care, too poor to buy their own care). So it is a social problem we have, but that doesn't mean that the US does well in healthcare just because 'nonpoor people have good care'. Obviously, countries like Sweden have better care in part due to a smaller country with a much more managable population and a smaller subset of 'poor people' to manage, so the US has that disadvantage as well. Larger populations typically are harder to manage by the gov't, so in that way, the US will probabaly always trail other developed nations in terms of many indicators of life....beacuse we have a wider variation of populace.

Fair enough.

I will ask one thing however:

Why is the centering of healthcare quality a desireable thing? It seems like all social policy is centered around the poor. In the US, the majority of people are NOT poor. Everybody loves to quote the 46 million uninsured number. There are all sorts of reasons for this, and I will not get into that, but it also means that there are 250 million people who ARE insured. I don't believe that there is some sort of totalitarian social justice in bringing down the quality of care for 250 million in order to improve it for 46 million. I will also point out that I am independently insuring my family on far less money than many of the uninsured make. This assuredly reflects poor choices on the part of some of these people, which makes the number who are actually unable to get insurance far less.

Universal Healthcare is a politicians dream. It will be a HUGE political beauracracy, thereby allowing the politician to put is hands in EVERYTHING. When something goes wrong, the politician can blame the greedy doctors who only want money. When something goes right, the politician can greet his constituents with all of the benefits that "he" has brought them. This already happens now, and we don't have Universal Healthcare. I BEG you to look at every institution in this country that is falling apart (from education to healthcare), and you will most assuredly find that the one common denominator is heavy government involvement.

 

[Towelie]

How many of them were junkies or alcoholics?

As to your last statement, I would ask why? Why shouldn't they happen? How do you intent to stop people from making poor life choices? Anyone (and I mean ANYONE) in the US can find a minimum wage job and buy food unless they are horrendously disabled or incredibly unwilling. The other day, I saw a bag boy at the grocery store with Down's Syndrome. Anyone who thinks that most of the people that we are supposed to feel sorry for couldn't do that job is truly insulting those people.

Also, there are SO many programs in the US to give poor people food, that anyone who doesn't have food hasn't been looking very hard. We have foodstamps, welfare, WIC for the poor with infants, and every charity in the country seems to feed the homeless. It is just so politically incorrect to point this out, that people continue to believe that there are actually people starving in the US who are looking for food instead of drugs.

Minimum wage jobs, however, do not provide healthcare (except for Starbucks).